Asthma is a disease of the airways characterized by inflammation, hyperresponsiveness, and bronchoconstriction. The diagnosis is primarily a clinical one, based on a focused history and physical examination, to differentiate from other entities such as heart failure, pneumonia, and pulmonary embolism. Radiographs, laboratory studies, and blood gases 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 to avoid intubation.
How would you manage these patients? Subscribe for evidence-based best practices and to discover the outcomes.
Subscribe to access the complete flowchart to guide your clinical decision making.
Subscribe for full access to all Tables and Figures.
Following are the most informative references cited in this paper, as determined by the authors.
2. * National Asthma Education and Prevention Program, Third Expert Panel on the Diagnosis and Management of Asthma. National Asthma Education and Prevention Program, Third Expert Panel on the Diagnosis and Management of Asthma. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Bethesda, MD: National Heart, Lung, and Blood Institute; 2007. Accessed January 10, 2022. (Clinical guidelines) DOI: 10.1016/j.jaci.2007.09.029
3. * Global Initiative for Asthma. Global strategy for asthma management and prevention. Accessed January 10, 2022. (Clinical guidelines) DOI: 10.1183/09031936.00138707
17. * Padem N, Saltoun C. Classification of asthma. Allergy Asthma Proc. 2019;40(6):385-388. (Review article) DOI: 10.2500/aap.2019.40.4253
37. * Long B, Lentz S, Koyfman A, et al. Evaluation and management of the critically ill adult asthmatic in the emergency department setting. Am J Emerg Med. 2021;44:441-451. (Review article) DOI: 10.1016/j.ajem.2020.03.029
41. * Suau SJ, DeBlieux PMC. Management of acute exacerbation of asthma and chronic obstructive pulmonary disease in the emergency department. Emerg Med Clin North Am. 2016;34(1):15-37. (Review article) DOI: 10.1016/j.emc.2015.08.002
89. * Weingart SD. Managing initial mechanical ventilation in the emergency department. Ann Emerg Med. 2016;68(5):614-617. (Review article) DOI: 10.1016/j.annemergmed.2016.04.059
126. *Cloutier MM, Baptist AP, Blake KV, et al. 2020 focused updates to the asthma management guidelines: a report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol. 2020;146(6):1217-1270. (Update to clinical guidelines) DOI: 10.1016/j.jaci.2020.10.003
Subscribe to get the full list of 143 references and see how the authors distilled all of the evidence into a concise, clinically relevant, practical resource.
Keywords: asthma, exacerbation, wheezing, beta agonist, SABA, anticholinergic, magnesium, NIPPV, ventilation, ketamine, epinephrine, biologics, COPD, FeNO, metered-dose inhaler, corticosteroid, intubation
Dr. Ashoo is a practicing emergency physician, board-certified in emergency medicine and clinical informatics. Join him as he takes you through the February 2022 issue of Emergency Medicine Practice: Emergency Department Management of Acute Asthma Exacerbations
Steven M. Hochman, MD, FACEP; Anthony Catapano, DO, FACOEP; Arsalan Shawl, DO; Brandon Somwaru, DO
Drew Clare, MD; Gabriel Wardi, MD, MPH
February 1, 2022
March 1, 2025
Date of Original Release: February 1, 2022. Date of most recent review: January 10, 2022. Termination date: February 1, 2025.
Accreditation: EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. This activity has been planned and implemented in accordance with the accreditation requirements and policies of the ACCME.
Credit Designation: EB Medicine designates this enduring material for a maximum of 4 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
ACEP Accreditation: Emergency Medicine Practice is approved by the American College of Emergency Physicians for 48 hours of ACEP Category I credit per annual subscription.
AAFP Accreditation: The AAFP has reviewed Emergency Medicine Practice, and deemed it acceptable for AAFP credit. Term of approval is from 07/01/2021 to 06/30/2022. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
AOA Accreditation: Emergency Medicine Practice is eligible for 4 Category 2-A or 2-B credit hours per issue by the American Osteopathic Association.
Specialty CME: Not applicable. For more information, please call Customer Service at 678-366-7933
Needs Assessment: The need for this educational activity was determined by a survey of medical staff, including the editorial board of this publication; review of morbidity and mortality data from the CDC, AHA, NCHS, and ACEP; and evaluation of prior activities for emergency physicians.
Target Audience: This enduring material is designed for emergency medicine physicians, physician assistants, nurse practitioners, and residents.
Goals: Upon completion of this activity, you should be able to: (1) identify areas in practice that require modification to be consistent with current evidence in order to improve competence and performance; (2) develop strategies to accurately diagnose and treat both common and critical ED presentations; and (3) demonstrate informed medical decision-making based on the strongest clinical evidence.
Discussion of Investigational Information: As part of the journal, faculty may be presenting investigational information about pharmaceutical products that is outside Food and Drug Administration–approved labeling. Information presented as part of this activity is intended solely as continuing medical education and is not intended to promote off-label use of any pharmaceutical product.
Faculty Disclosures: It is the policy of EB Medicine to ensure objectivity, balance, independence, transparency, and scientific rigor in all CME activities. All faculty participating in the planning or implementation of a CME activity are expected to disclose to the participants any relevant financial relationships and to assist in mitigating the relationships. In compliance with all ACCME accreditation requirements and policies, all faculty for this CME activity were asked to complete a full financial disclosure statement. The information received is as follows: the authors, Dr. Steven M. Hochman, Dr. Anthony Catapano, Dr. Arsalan Shawl, and Dr. Brandon Somwaru; the peer reviewers, Dr. Drew Clare and Dr. Gabriel Wardi; the Editor-in-Chief, Dr. Andy Jagoda; and the research editors, Dr. Aimee Mishler and Dr. Joseph Toscano, report no relevant financial relationships with ineligible companies.
Commercial Support: This issue of Emergency Medicine Practice did not receive any commercial support.
Earning Credit: Go online to www.ebmedicine.net/CME and click on the title of the test you wish to take.When completed, a CME certificate will be emailed to you.
Hardware/Software Requirements: You will need a Macintosh or PC to access the online archived articles and CME testing.
Additional Policies: For additional policies, including our statement of conflict of interest, source of funding, statement of informed consent, and statement of human and animal rights, visit www.ebmedicine.net/policies.