Management of Acute Asthma Exacerbations in Urgent Care (Pharmacology CME)

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Delivery Method:	Online
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Publication Date: November 2023 (Volume 2, Number 11)

CME Credits: 4 AMA PRA Category 1 Credits™, and 4 AOA Category 2-B CME credits. CME expires 11/01/2026.

Specialty CME: Included as part of the 4 credits, this CME activity is eligible for 1 Pharmacology CME credit, subject to your state and institutional requirements.

Authors

Peer Reviewers

KidBits Author

Coding Author

Abstract

Asthma is a disease of the airways characterized by inflammation, hyperresponsiveness, and bronchoconstriction. The diagnosis of acute asthma exacerbation is primarily a clinical one, based on a focused history and physical examination. It is important to differentiate it from other entities such as heart failure, pneumonia, and pulmonary embolism, which can present with similar respiratory signs. Radiographs are not routinely recommended, except in atypical or refractory cases, or if there is diagnostic uncertainty. The cornerstone of acute asthma treatment includes short-acting beta agonists, anticholinergics, and systemic corticosteroids. This issue reviews the latest evidence in diagnostic and treatment strategies, including other pharmacologic treatments and newer management strategies.

Case Presentations

A 40-year-old man with a history of frequent visits for asthma, including multiple admissions and intubations, is brought into the urgent care by his spouse...

• The patient is slightly tachypneic and not using accessory muscles to breathe.
• On auscultation, air entry is significantly diminished bilaterally, and he has faint expiratory wheezing bilaterally.
• His vital signs are: blood pressure is 155/85 mm Hg; heart rate, 120 beats/min; respiratory rate, 20 breaths/min; temperature, 36.9°C; and oxygen saturation, 91% on room air.
• You recognize that this patient needs ED evaluation but wonder if interventions are needed while you await transport…

A 20-year-old woman arrives at urgent care with complaints of difficulty breathing and dry cough...

• The patient says she discontinued her asthma medications because she has not used them in the past 2 years.
• Her vital signs are: blood pressure is 120/75 mm Hg; heart rate, 80 beats/min; respiratory rate, 18 breaths/min; and room-air pulse oximeter reading, 97%.
• On auscultation she has faint diffuse wheezing with good air movement.
• You consider the treatment options for this patient…

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.