Asthma exacerbation
| Asthma exacerbation | |
|---|---|
| Other names: Asthma flair-up, asthma episode, asthma attack, acute severe asthma[1] | |
 | |
| Change in airways during an asthma exacerbation | |
 | |
| Specialty | Emergency medicine |
| Symptoms | Worsening shortness of breath, wheezing, chest tightness, fast breathing, low oxygen[1] |
| Complications | Confusion[1] |
| Risk factors | Viral respiratory infections, exposure to allergens, insufficient inhaled steroids[1] |
| Diagnostic method | Based on symptoms, forced expiratory volume (FEV1)[1] |
| Treatment | Oxygen, short acting beta agonist, ipratropium, steroids[1] |
An asthma exacerbation is a sudden worsening of asthma symptoms.[1] This may include worsening shortness of breath, wheezing, chest tightness, fast breathing, or low oxygen.[1] Severe symptoms may include confusion or no sounds of breathing.[1]
Generally exacerbations occur in people with known asthma; though, may occasionally occur as a first presentation.[1] Common triggers include viral respiratory infections, exposure to allergens, or insufficient use of inhaled steroids.[1] Diagnosis is based on symptoms and may be supported by forced expiratory volume (FEV1).[1] A chest X-ray is not typically needed.[1]
Initial treatment is generally with oxygen and a short acting beta agonist (salbutamol).[1] For mild to moderate exacerbations giving these by metered dose inhaler, dry powder inhalers, and nebulizer are equivalent.[1] Inhaled ipratropium and steroids by mouth are often also used.[1] An inhaled steroids for at least 2 to 4 weeks is also recommended.[1]
If the above is not effective magnesium sulfate, epinephrine injected into a muscle, or non-invasive positive pressure ventilation (NIPPV) may be used.[2] If all else fails intubation maybe carried out.[2] An asthma action plan supports imitation of treatment by the person themselves.[1]
Treatment
Medications
Initial treatment is generally with oxygen and a short acting beta agonist.[1] For mild to moderate exacerbations giving medications by metered dose inhaler, dry powder inhalers, and nebulizer are equivalent.[1] In severe attacks salbutamol and ipratropium may be given continuously via nebulizer.[2]
Steroids may be given by mouth in mild to moderate attacks.[1] For severe attacks methylprednisolone via intravenous at a dose of 2 mg per kg may be used.[2]
Other options include 2 grams of magnesium sulfate and 0.5 mg of epinephrine injected into a muscle.[2] Intravenous fluids are also generally needed as those with severe asthma are dehydrated.[2]
Airway
Non-invasive positive pressure ventilation (NIPPV) may be used with intubation carried out if this is not effective.[2] NIPPV is generally started at 10 cm H20 for inspiration and 5 cm H20 for expiration with ketamine used to help if anxiety is a barrier.[2]
If intubation is required, assist-control volume cycle ventilation at a rate of 10 breaths per minute and a tidal volume if 8 mL/kg ideal body weight is recommended.[2] The plateau pressure should be kept under 30 cm H2O.[2] Long expiratory times are needed and the persons CO2 may be allowed to go high.[2]
Other
ECMO if available may be considered.[2] In those who go into cardiac arrest it is important to rule out a pneumothorax and if this is not rapidly possible bilateral finger thoracostomies may be performed.[2]
References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 Global Strategy for Asthma Management and Prevention (PDF). 2023. pp. 140-. ISBN 979-8853517370. Archived (PDF) from the original on 24 March 2024. Retrieved 1 May 2024.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 Borshoff, David (2018). The Resuscitation Crisis Manual. Leeuwin Press. ISBN 9780648270201.