Emergency Department Management of Acute Asthma Exacerbations

Points and Pearls Excerpt

• The differential diagnosis for dyspnea includes COPD, heart failure, pneumonia, pulmonary embolism, and pneumothorax. See Table 4 for a list of physical examination findings for each.
• The National Asthma Education and Prevention Program² classifies asthma exacerbations thus:
  • Mild: well-appearing, dyspnea with light activity, subtle wheezing; symptoms usually resolve with treatment at home.
  • Moderate: dyspnea inhibits activity, wheezing on exhalation, increased accessory muscle use, increased respiratory rate, tachycardia.
  • Severe: dyspnea at rest, inability to speak sentences, significant accessory muscle use, tachypnea, tachycardia, diaphoresis, agitation, and altered mental status. Wheezing may be loud. Absent wheezing indicates impending respiratory failure; intubation should not be delayed if it is deemed necessary.