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.
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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
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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
February 28, 2025
Date of Original Release: February 1, 2022. Date of most recent review: January 10, 2022. Termination date: February 1, 2025.
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