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Curr Allergy Asthma Rep (2010) 10:5666
DOI 10.1007/s11882-009-0083-5
Managing Outpatient Asthma Exacerbations
Sitesh R. Roy & Henry Milgrom
Published online: 29 December 2009# Springer Science+Business Media, LLC 2010
Abstract Asthma is a chronic inflammatory disease that renders individuals vulnerable to acute exacerbations. A wide variety of allergic and nonallergic triggers can incite an asthma exacerbation. The goals of managing an asthma exacerbation are prompt recognition, rapid reversal of airflow obstruction, avoidance of relapses, and prevention of future episodes. A written asthma home management plan is essential to minimize the severity of exacerbations. Short-acting -agonists, oxygen, and corticosteroids remain fundamental to early intervention in acute asthma exacerbations. Anticholinergics and magnesium sulfate can help nonresponders. Combination inhalers of the long-acting -agonist formoterol and inhaled steroid budesonide have been effective in flexible dosing in treating early acute exacerbations and as a daily controller medication outside the United States. Initiation or intensification of long-term controller therapy, treatment of comorbid conditions, trigger avoidance, and prompt follow-up can help prevent relapses. Listening to patient preferences and concerns enhances adherence, and regular follow-up care can help prevent future episodes.
Keywords Asthma . Exacerbation . Status asthmaticus . Acute asthma
Introduction
Asthma is a chronic disease affecting millions of people worldwide. In the United States alone, there were about22.9 million individuals with asthma in 2007, conferring an estimated financial burden of 19.7 billion dollars in annual health care costs [1]. All asthmatics are at risk of having exacerbations characterized by worsening symptoms, airflow obstruction, and increased rescue bronchodilator need. In 2007, 12.3 million Americans (3.8 million <18 years of age) had an asthma attack. In 2005, 3884 deaths were attributed to asthma. In 2006, 444,000 discharges and 1.7 million emergency department (ED) visits were attributed to asthma. In 2003, asthma accounted for an estimated 10.1 million lost work days among adults. Regrettably, there is a high rate of patient and physician nonadherence to national guidelines for prevention and home management of asthma exacerbation [2, 3]. In this article, we discuss pharmacologic agents available to treat asthma exacerbations, home-based and ED management of asthma exacerbations, recognition and treatment of comorbid conditions, and strategies to prevent exacerbations.
Clinicopathologic Features of Acute Asthma
Asthma is a chronic inflammatory disease of the airways. The airways of...