Clinical Reviews in Allergy & Immunology

, Volume 43, Issue 1, pp 14–29

The Patient with Asthma in the Emergency Department

  • Jason Y. Adams
  • Mark E. Sutter
  • Timothy E. Albertson
Article

DOI: 10.1007/s12016-011-8273-z

Cite this article as:
Adams, J.Y., Sutter, M.E. & Albertson, T.E. Clinic Rev Allerg Immunol (2012) 43: 14. doi:10.1007/s12016-011-8273-z

Abstract

Asthma is a highly prevalent disease that presents commonly to the emergency department (ED) in acute exacerbation. Recent asthma treatment guidelines have added content dedicated to the management of acute exacerbations. Effective management of an exacerbation requires rapid assessment of severity through physical examination, measurement of peak expiratory flow rate, and response to initial treatment. Most therapies are directed at alleviating bronchospasm and decreasing airway inflammation. While inhaled short-acting beta-agonists, systemic corticosteroids, and supplemental oxygen are the initial and often only therapies required for patients with mild moderate exacerbations, high-dose beta agonists and inhaled anti-cholinergics should also be given to patients with severe exacerbations. Adjunctive therapy with intravenous magnesium and Heliox-driven nebulization of bronchodilators should be considered for patients presenting with severe and very severe exacerbations. Early recognition and appropriate management of respiratory failure are required to mitigate the risk of complications including death. Disposition should be determined based on serial assessments of the response to therapy over the first 4 h in the ED. Patients stable for discharge should receive medications, asthma education including a written asthma action plan, and should have follow-up scheduled for them by ED staff. Rapid implementation of evidence-based, multi-disciplinary care is required to ensure the best possible outcomes for this potentially treatable disease.

Keywords

Emergency department Asthma Respiratory distress 

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Jason Y. Adams
    • 1
  • Mark E. Sutter
    • 2
  • Timothy E. Albertson
    • 1
  1. 1.Division of Pulmonary, Critical Care, and Sleep MedicineUniversity of California Davis Medical CenterSacramentoUSA
  2. 2.Department of Emergency MedicineUniversity of California Davis Medical CenterSacramentoUSA