Chest
ReviewsAcute Asthma in Adults: A Review
Section snippets
Epidemiology and Costs
AA is a common medical emergency faced by ED and intensive care specialists. In the United States, asthma represents the 11th most frequent ED diagnosis nationwide, and adolescents and young adults are the most likely age groups to visit the ED for treatment.11 Women visit the ED and are hospitalized for AA twice as often as men.1213 Previous data suggested that 40% of these hospitalizations occur during the premenstrual phase of the cycle.14 Men are less likely than women to report severe
Pathophysiology
Different triggers cause asthma exacerbations by inducing airway inflammation or provoking acute bronchospasm or both. Triggers vary from person to person and from time to time. Exposure to indoor and outdoor allergens, air pollutants, respiratory tract infections (primarily viral), exercise, weather changes, foods, additives, drugs, and extreme emotional expressions are the main triggers identified clinically. Other factors that may cause exacerbations are rhinitis, bacterial sinusitis,
Fatal Asthma
In many countries, asthma mortality increased from the 1960s to the second half of the 1980s, but reached a plateau and has subsequently declined.5455565758 This recent downward trend may reflect better management of this condition in primary care. Asthma has a low mortality rate compared with other lung diseases, but mortality does occur, typically in patients with poorly controlled disease whose condition gradually deteriorates over a period of days or even weeks before the fatal attack.596061
Assessment
AA is a medical emergency that must be diagnosed and treated urgently. The assessment of an asthma exacerbation constitutes a process with two different dimensions: (1) a static assessment to determine the severity of attack, and (2) a dynamic assessment to evaluate the response to treatment. Overall, it requires an analysis of several factors.8283
ICU Management
Many patients admitted to the ICU with AA simply require additional time for the therapies instituted in the ED to be continued and for respiratory function to improve. These patients often require a relatively brief period of time in the ICU; when improvement is clear, they can be discharged to the regular ward. Since it is not clear on ICU admission which patients will pursue such a course, the benefit of the ICU is largely one of careful observation and rapid response to those patients who
Summary
AA is a common medical emergency faced by ED and intensive care physicians. Properly managed, there should be a very low mortality rate; but death does occur, typically in patients with poorly controlled disease whose condition gradually deteriorates over a period of days or even weeks before the fatal event. This observation suggests many patients have a window of opportunity for recognition and reversal of this period of deterioration. The assessment of an asthma exacerbation constitutes a
References (244)
- et al.
Survey of asthma practice among emergency physicians
Chest
(1996) - et al.
Are doctors still failing to asses and treat asthma attacks? An audit of the management of acute attacks in a health district
Respir Med
(1999) - et al.
Asthma severity adequacy of management in accident and emergency departments in France: a prospective study
Lancet
(2001) - et al.
Influence of gender on rates of hospitalization, hospital course, and hypercapnea in high-risk patients admitted for asthma: a 10-year retrospective study at Yale-New Haven hospital
Chest
(2001) - et al.
Differences between men and women in reporting of symptoms during an asthma exacerbation
Ann Emerg Med
(2001) - et al.
Características epidemiológicas de las exacerbaciones por EPOC y asma en un hospital general
Arch Bronconeumol
(2002) - et al.
A prospective multicenter study of factors associated with hospital admission among adults with acute asthma
Am J Med
(2002) - et al.
Arterial blood gases in bronchial asthma
J Allergy
(1970) - et al.
Blood-gas tensions in bronchial asthma
Lancet
(1967) - et al.
Hypertension intracranienne au cours de l'etat asthmatique
Ann Fr Anesth Reanim
(1987)