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The Patient with Asthma in the Emergency Department

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Bronchial Asthma

Abstract

Patients of all ages present to the emergency department (ED) with respiratory ­distress and wheezing. Initial evaluation entails assessing the severity of the respiratory distress and determining if an acute exacerbation of asthma is the cause.

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References

  1. Moorman JE, Rudd RA, Johnson CA, King M, Minor P, Bailey C, et al. National surveillance for asthma—United States, 1980–2004. MMWR Surveill Summ. 2007;56(8):1–54.

    PubMed  Google Scholar 

  2. Aaron SD, Vandemheen KL, Boulet LP, McIvor RA, Fitzgerald JM, Hernandez P, et al. Overdiagnosis of asthma in obese and nonobese adults. CMAJ. 2008;179(11):1121–31.

    Article  Google Scholar 

  3. Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007. J Allergy Clin Immunol. 2007;120(5 Suppl):S94–138.

    Google Scholar 

  4. Turner MO, Noertjojo K, Vedal S, Bai T, Crump S, Fitzgerald JM. Risk factors for near-fatal asthma. A case-control study in hospitalized patients with asthma. Am J Respir Crit Care Med. 1998;157(6 Pt 1):1804–9.

    Article  CAS  Google Scholar 

  5. Rea HH, Garrett JE, Lanes SF, Birmann BM, Kolbe J. The association between asthma drugs and severe life-threatening attacks. Chest. 1996;110(6):1446–51.

    Article  CAS  Google Scholar 

  6. Kramer JM. Balancing the benefits and risks of inhaled long-acting beta-agonists--the influence of values. N Engl J Med. 2009;360(16):1592–5.

    Article  CAS  Google Scholar 

  7. van Belle A, Buller HR, Huisman MV, Huisman PM, Kaasjager K, Kamphuisen PW, et al. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA. 2006;295(2):172–9.

    Article  Google Scholar 

  8. Cates CJ, Crilly JA, Rowe BH. Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma. Cochrane Database Syst Rev. 2006(2):CD000052.

    Google Scholar 

  9. Page CP, Morley J. Contrasting properties of albuterol stereoisomers. J Allergy Clin Immunol. 1999;104(2 Pt 2):S31-41.

    Article  CAS  Google Scholar 

  10. Kelly HW. Levalbuterol for asthma: a better treatment? Curr Allergy Asthma Rep. 2007;7(4):310–4.

    Article  CAS  Google Scholar 

  11. Rowe BH, Edmonds ML, Spooner CH, Diner B, Camargo CA, Jr. Corticosteroid therapy for acute asthma. Respir Med. 2004;98(4):275–84.

    Article  CAS  Google Scholar 

  12. Rowe BH, Spooner C, Ducharme FM, Bretzlaff JA, Bota GW. Early emergency department treatment of acute asthma with systemic corticosteroids. Cochrane Database Syst Rev. 2001(1):CD002178.

    Google Scholar 

  13. Rowe BH, Spooner CH, Ducharme FM, Bretzlaff JA, Bota GW. Corticosteroids for preventing relapse following acute exacerbations of asthma. Cochrane Database Syst Rev. 2000(2):CD000195.

    Google Scholar 

  14. Emerman CL, Cydulka RK. A randomized comparison of 100-mg vs 500-mg dose of methylprednisolone in the treatment of acute asthma. Chest. 1995;107(6):1559–63.

    Article  CAS  Google Scholar 

  15. Manser R, Reid D, Abramson M. Corticosteroids for acute severe asthma in hospitalised patients. Cochrane Database Syst Rev. 2001(1):CD001740.

    Google Scholar 

  16. Lahn M, Bijur P, Gallagher EJ. Randomized clinical trial of intramuscular vs oral methylprednisolone in the treatment of asthma exacerbations following discharge from an emergency department. Chest. 2004;126(2):362–8.

    Article  CAS  Google Scholar 

  17. Krishnan JA, Davis SQ, Naureckas ET, Gibson P, Rowe BH. An umbrella review: corticosteroid therapy for adults with acute asthma. Am J Med. 2009;122(11):977–91.

    Article  CAS  Google Scholar 

  18. Camargo CA, Jr., Spooner CH, Rowe BH. Continuous versus intermittent beta-agonists in the treatment of acute asthma. Cochrane Database Syst Rev. 2003(4):CD001115.

    Google Scholar 

  19. Rodrigo GJ, Castro-Rodriguez JA. Anticholinergics in the treatment of children and adults with acute asthma: a systematic review with meta-analysis. Thorax. 2005;60(9):740–6.

    Article  CAS  Google Scholar 

  20. Mohammed S, Goodacre S. Intravenous and nebulised magnesium sulphate for acute asthma: systematic review and meta-analysis. Emerg Med J. 2007;24(12):823–30.

    Article  CAS  Google Scholar 

  21. Rowe BH, Camargo CA, Jr. The role of magnesium sulfate in the acute and chronic management of asthma. Curr Opin Pulm Med. 2008;14(1):70–6.

    Article  CAS  Google Scholar 

  22. Lazarus SC. Clinical practice. Emergency treatment of asthma. N Engl J Med. 2010;363(8):755–64.

    Article  CAS  Google Scholar 

  23. Rodrigo G, Pollack C, Rodrigo C, Rowe BH. Heliox for nonintubated acute asthma patients. Cochrane Database Syst Rev. 2006(4):CD002884.

    Google Scholar 

  24. Shapiro JM. Intensive care management of status asthmaticus. Chest. 2001;120(5):1439–41.

    Article  CAS  Google Scholar 

  25. Cheong B, Reynolds SR, Rajan G, Ward MJ. Intravenous beta agonist in severe acute asthma. BMJ. 1988;297(6646):448–50.

    Article  CAS  Google Scholar 

  26. Salmeron S, Brochard L, Mal H, Tenaillon A, Henry-Amar M, Renon D, et al. Nebulized versus intravenous albuterol in hypercapnic acute asthma. A multicenter, double-blind, randomized study. Am J Respir Crit Care Med. 1994;149(6):1466–70.

    Article  CAS  Google Scholar 

  27. Travers AH, Rowe BH, Barker S, Jones A, Camargo CA, Jr. The effectiveness of IV beta-agonists in treating patients with acute asthma in the emergency department: a meta-analysis. Chest. 2002;122(4):1200–7.

    Article  CAS  Google Scholar 

  28. Parameswaran K, Belda J, Rowe BH. Addition of intravenous aminophylline to beta2-agonists in adults with acute asthma. Cochrane Database Syst Rev. 2000(4):CD002742.

    Google Scholar 

  29. Camargo CA, Jr., Gurner DM, Smithline HA, Chapela R, Fabbri LM, Green SA, et al. A randomized placebo-controlled study of intravenous montelukast for the treatment of acute asthma. J Allergy Clin Immunol. 2010;125(2):374–80.

    Article  CAS  Google Scholar 

  30. Ramsay CF, Pearson D, Mildenhall S, Wilson AM. Oral montelukast in acute asthma exacerbations: a randomised, double-blind, placebo-controlled trial. Thorax. 2010.

    Google Scholar 

  31. Aroni F, Iacovidou N, Dontas I, Pourzitaki C, Xanthos T. Pharmacological aspects and potential new clinical applications of ketamine: reevaluation of an old drug. J Clin Pharmacol. 2009;49(8):957–64.

    Article  CAS  Google Scholar 

  32. Howton JC, Rose J, Duffy S, Zoltanski T, Levitt MA. Randomized, double-blind, placebo-controlled trial of intravenous ketamine in acute asthma. Ann Emerg Med. 1996;27(2):170–5.

    Article  CAS  Google Scholar 

  33. Allen JY, Macias CG. The efficacy of ketamine in pediatric emergency department patients who present with acute severe asthma. Ann Emerg Med. 2005;46(1):43–50.

    Article  Google Scholar 

  34. Denmark TK, Crane HA, Brown L. Ketamine to avoid mechanical ventilation in severe pediatric asthma. J Emerg Med. 2006;30(2):163–6.

    Article  Google Scholar 

  35. Caples SM, Gay PC. Noninvasive positive pressure ventilation in the intensive care unit: a concise review. Crit Care Med. 2005;33(11):2651–8.

    Article  Google Scholar 

  36. Meduri GU, Cook TR, Turner RE, Cohen M, Leeper KV. Noninvasive positive pressure ventilation in status asthmaticus. Chest. 1996;110(3):767–74.

    Article  CAS  Google Scholar 

  37. Fernandez MM, Villagra A, Blanch L, Fernandez R. Non-invasive mechanical ventilation in status asthmaticus. Intensive Care Med. 2001;27(3):486–92.

    Article  CAS  Google Scholar 

  38. Soroksky A, Stav D, Shpirer I. A pilot prospective, randomized, placebo-controlled trial of bilevel positive airway pressure in acute asthmatic attack. Chest. 2003;123(4):1018–25.

    Article  Google Scholar 

  39. Gupta D, Nath A, Agarwal R, Behera D. A prospective randomized controlled trial on the efficacy of noninvasive ventilation in severe acute asthma. Respir Care. 2010;55(5):536–43.

    PubMed  Google Scholar 

  40. Behbehani NA, Al-Mane F, D’Yachkova Y, Pare P, FitzGerald JM. Myopathy following mechanical ventilation for acute severe asthma: the role of muscle relaxants and corticosteroids. Chest. 1999;115(6):1627–31.

    Article  CAS  Google Scholar 

  41. Shrestha M, Bidadi K, Gourlay S, Hayes J. Continuous vs intermittent albuterol, at high and low doses, in the treatment of severe acute asthma in adults. Chest. 1996;110(1):42–7.

    Article  CAS  Google Scholar 

  42. Salpeter S, Ormiston T, Salpeter E. Cardioselective beta-blockers for reversible airway disease. Cochrane Database Syst Rev. 2002(4):CD002992.

    Google Scholar 

  43. Mallmann F, Fernandes AK, Avila EM, Nogueira FL, Steinhorst AM, Saucedo DZ, et al. Early prediction of poor outcome in patients with acute asthma in the emergency room. Braz J Med Biol Res. 2002;35(1):39–47.

    Article  CAS  Google Scholar 

  44. Gibson PG, Powell H, Coughlan J, Wilson AJ, Abramson M, Haywood P, et al. Self-management education and regular practitioner review for adults with asthma. Cochrane Database Syst Rev. 2003(1):CD001117.

    Google Scholar 

  45. http://www.nhlbi.nih.gov/health/public/lung/asthma/asthma_actplan.pdf .

  46. Leiner GC, Abramowitz S, Small MJ, Stenby VB, Lewis WA. Expiratory Peak Flow Rate. Standard Values for Normal Subjects. Use as a Clinical Test of Ventilatory Function. Am Rev Respir Dis. 1963;88:644–51.

    CAS  PubMed  Google Scholar 

  47. McElroy S.Pediatric Emergency Medicine: The Essentials. Boston, MA: Health Emergency Publishing; 2004.

    Google Scholar 

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Correspondence to Mark E. Sutter MD .

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Adams, J.Y., Sutter, M.E. (2012). The Patient with Asthma in the Emergency Department. In: Gershwin, M., Albertson, T. (eds) Bronchial Asthma. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-6836-4_7

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  • DOI: https://doi.org/10.1007/978-1-4419-6836-4_7

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