Asthma Exacerbation

Aka: Asthma Exacerbation

1. See Also
   1. Asthma Exacerbation
   2. Asthma Management
   3. Asthma Exacerbation Home Management
   4. Emergency Management of Asthma Exacerbation
   5. Asthma Inpatient Management
   6. Status Asthmaticus
2. Risk Factors: Fatal Asthma attack
   1. Precaution: One third of fatal Asthma attacks occur in children with only Mild Asthma history
   2. Underlying cardiopulmonary disease (CAD, CHF, COPD)
   3. Patient unable to sense or distinguish Severe Asthma attack
   4. Illicit Drug use
   5. Low socioeconomic status
   6. Serious mental health disorders
   7. Prior ICU admission or intubation
   8. Two hospitalizations or three emergency department visits in the last year
   9. At least two refills of short acting beta agonist (e.g. Albuterol) per month
3. Classification: Asthma Severity
   1. Mild
      1. Dyspnea on exertion (or Tachypnea in young children)
      2. Peak expiratory flow (PEF) >70% of predicted
      3. Prompt relief with inhaled Short-acting Beta Agonists
      4. Home management
   2. Moderate
      1. Dyspnea limits usual activity
      2. Peak expiratory flow (PEF) 40-69% of predicted
      3. Relief with frequent inhaled Short-acting Beta Agonists
      4. Office management
         1. Add oral Systemic Corticosteroids
         2. Anticipate 1-2 days of symptoms after treatment onset
   3. Severe
      1. Dyspnea at rest, limiting conversation
      2. Peak expiratory flow (PEF) <40 of predicted
      3. Only partial relief with inhaled Short-acting Beta Agonists
      4. Emergency department management
         1. Hospitalization is likely
         2. Add Systemic Corticosteroids and ipratroprium
         3. Anticipte >3 days of some symptoms
   4. Life Threatening
      1. Unable to speak, severe Dyspnea with associated diaphoresis
      2. Peak expiratory flow (PEF) <25 of predicted
      3. Minimal relief with inhaled Short-acting Beta Agonists
      4. Emergency department stabilization
         1. Intensive care unit admission
         2. Frequent or continuous Albuterol nebs
         3. Add Systemic Corticosteroids and ipratroprium
         4. ABC Management
4. Management
   1. See Asthma Exacerbation Home Management
   2. See Emergency Management of Asthma Exacerbation
      1. Asthma presenting to clinic with Oxygen Saturation at or below 90% may be best managed in emergency department
   3. See Asthma Inpatient Management
   4. See Status Asthmaticus
5. References
   1. (2007) Guidelines for the diagnosis and management of Asthma, NHLBI