Asma severo

Management of severe acute asthma in the emergency department
Brian H. Rowea,b, William Sevcika and Cristina Villa-Roela,b
a

Department of Emergency Medicine and bSchool of Public Health, University of Alberta, Edmonton, Alberta, Canada Correspondence to Brian H. Rowe, MD, MSc, CCFP(EM), FCCP, Associate Dean (Clinical Research), Faculty of Medicine & Dentistry, Canada Research Chair inEmergency Airway Diseases, Research Director, Department of Emergency Medicine, Professor, University of Alberta, 1G1.43 Walter C. Mackenzie Centre, 8440–112 Street NW, Edmonton, AB T6G 2B7, Canada Tel: +1 780 407 6707; fax: +1 780 407 3982; e-mail: brian.rowe@ualberta.ca Current Opinion in Critical Care 2011, 17:335–341

Purpose of review Asthma is one of the most common chronic diseases in mostdeveloped countries and control may be elusive. Deterioration in asthma control is common when patients are exposed to airway irritants, viruses, and/or when adherence to chronic anti-inflammatory medications is suboptimal. Acute asthma exacerbations are common, important reasons for presentations to emergency departments, and severe cases may result in hospitalization. Important knowledge gaps existin what is known and what care is delivered at the bedside. Recent findings The literature in asthma is rapidly expanding and recent advances in the care are important to summarize. Systematic reviews, especially high-quality syntheses performed using Cochrane methods, provide the best evidence for busy clinicians to remain current. Management of asthma is based on early recognition of severedisease with aggressive therapy using multimodal interventions that focus on both bronchoconstriction and inflammatory mechanisms. Summary Treatment of severe acute asthma can effectively and safely reduce hospitalizations, airway interventions, and even death. Using the approach outlined herein will enable clinicians to assist patients to rapidly regain asthma control, return to normal activities, andimprove their quality of life in the follow-up period. Keywords asthma, bronchodilators, corticosteroids, magnesium sulfate, prevention
Curr Opin Crit Care 17:335–341 ß 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins 1070-5295

Introduction
Asthma is one of the most common chronic conditions and is characterized by intermittent exacerbations followed by variable degrees of‘stability’. Asthma is an inflammatory disease of the airways, with many symptoms resulting from the secondary bronchoconstriction. This multifactorial disease is influenced by genetics, early environmental influences, demographic factors (e.g., age, sex, and ethnicity), geography (regional variation is often noted), BMI, and socioeconomic status. Not surprisingly, the prevalence of asthma varies widely withinand among countries. Control of asthma has proven to be elusive. Deterioration in asthma control is common when patients are exposed to airway irritants, viruses, and/or when adherence to chronic anti-inflammatory medications is suboptimal. The hallmark of exacerbation includes a history of asthma, increasing symptoms of dyspnea, wheeze and/ or cough, and increasing need for short-actingb-agonists. Asthma exacerbations are common presentations to the
1070-5295 ß 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

emergency department (ED) in many parts of the world [1] and the costs associated with the care of asthma are significant [2–4]. For example, in the United States approximately 14 billion dollars per year is spent on asthma [5]; nearly a quarter of all asthma expensesare related to acute exacerbations (ED visits, hospitalizations) [4]. Severe acute asthma is a potentially lifethreatening medical emergency that usually involves symptoms such as shortness of breath, cough, and wheeze and signs such as accessory muscles use, tachypnea and tachycardia, airway outflow measures [peak expiratory flow (PEF) or forced expiratory volume in one second (FEV1) less than...