Asthma in adults

see our comprehensive coverage of Acute asthma exacerbation

May occur in poorly controlled disease or if exposed to a major trigger (e.g., alternaria-allergic asthmatics exposed to a high level of the allergen in a grain silo).

Other patients at risk include those with a history of previous near-fatal asthma attacks and those with multiple hospitalisations. Patients on long-acting beta agonist (LABA) without a corticosteroid, and those with a psychiatric disorder and history of medication non-compliance are at high risk of severe asthma attacks and death. [79]

Patient should be placed on oxygen, a continuous nebulised short-acting beta agonist (SABA) such as salbutamol or levosalbutamol (with or without ipratropium),[B Evidence] hydration, an inhaled corticosteroid, IV magnesium,[C Evidence] and, if deemed necessary, a methylxanthine (oral or IV) and/or adrenaline (IM), with or without bilevel positive airway pressure or intubation and mechanical ventilation. [80] [A Evidence]

Severe exacerbations are associated with a more rapid decline in lung function, but this decline is reduced with inhaled corticosteroids. [81]

see our comprehensive coverage of Acute asthma exacerbation

Can occur in any asthmatic after an upper airway infection or a persistent allergen exposure.

Counsel the patient on allergen removal and treat any upper or lower airway infection as necessary.

Exacerbation can be treated in the outpatient setting with an oral corticosteroid, and use of a short-acting beta agonist on an as-needed basis.

Patients should be instructed to go to the nearest emergency department if symptoms worsen. In the interim, the inhaled corticosteroid regimen should continue.

Pathological changes affecting lung tissues as a result of persistent inflammation, causing a persistent irreversible airway obstruction. [82] This obstruction resembles that in COPD and may progressively worsen, limiting the activity of the patient. [83]

Those with more severe asthma may have a higher predilection for airway remodelling.

The ADAM 33 molecule may be used to mark these people for more aggressive therapy. [6] [84]

It is unknown what percentages have airway remodelling and of those with remodelling, how many develop COPD.

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The most common complication of inhaled corticosteroids is thrush, often prevented by the use of a spacer tube, and rinsing, gargling, and spitting after inhaler use.

see our comprehensive coverage of Assessment of hoarseness and dysphonia

Another complication of inhaled corticosteroids is dysphonia (i.e., laryngeal muscle spasm causing an abnormal voice), which can be prevented by changing the type of the inhaler.