The management of acute asthma exacerbation involves a stepwise approach aimed at rapid symptom relief and prevention of further deterioration.
Initial assessment
- The initial assessment should include measurement of peak expiratory flow (PEF) or forced expiratory volume in 1 second (FEV1), oxygen saturation, and clinical evaluation of respiratory distress
Oxygen therapy
- Oxygen therapy should be provided to maintain oxygen saturation 93-95% in adult and adolescent patients in the acute care setting
- Oxygen should not be withheld if pulse oximetry is not available. Instead, patients should be monitored for deterioration, somnolence, or fatigue due to the risk of hypercapnia and respiratory failure
Medication
- Frequent inhaled short-acting β-agonists (such as salbutamol or albuterol) should be administered in patients presenting with acute asthma
- Systemic corticosteroids should be administered in acute care settings to speed resolution of exacerbations and prevent relapses in all adult, adolescent, and pediatric (6-11 years of age) patients with asthma exacerbation, except for the mildest exacerbations
- High-dose inhaled corticosteroids should be administered within the first hour of presentation to the emergency department to reduce the need for hospitalization in patients not receiving systemic corticosteroids
- Inhaled short-acting anticholinergics and short-acting beta₂-agonists are effective therapies for adult patients with acute asthma who present to the emergency department
Monitoring and discharge
- Close monitoring during exacerbation treatment is necessary, and treatment should be titrated according to the response
- Upon discharge, patients should be prescribed regular maintenance ICS-containing treatment, as-needed reliever medication, and a short course of oral corticosteroids
Patient education
- All patients with asthma should be educated on the risks, signs, symptoms, and management of asthma exacerbations
In conclusion, the management of acute asthma exacerbation requires a comprehensive approach that includes initial assessment, oxygen therapy, medication, monitoring, and patient education.