Acute asthma exacerbation in adults

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最后审阅: 22 Sep 2025
最后更新: 15 Apr 2025
15 Apr 2025

Latest UK asthma guidance provides minimal change to exacerbation management

The latest guideline update from NICE/BTS/SIGN on the management of Asthma has been released. While there are some significant changes in the approach to chronic asthma diagnosis and management, little has been changed in relation to the management of exacerbations of Asthma. The document continues to regularly link to the 2024 guidance, SIGN 158.[49]​​​

Updates of note relating to asthma exacerbations:

  • Regular FeNO testing may lead to a reduction in exacerbations.

  • In people who present with an exacerbation of undiagnosed asthma, it is recommended to start MART (Maintenance And Reliever Therapy) alongside any treatment for the acute symptoms. This is a combination of Inhaled Corticosteroid with Formoterol). This may be stepped down to ‘as needed’ post discharge.[50]

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查看治疗:治疗路径

更新原始来源

小结

定义

病史和体格检查

关键诊断因素

  • shortness of breath
  • cough
  • wheeze
  • risk factors
  • progressive chest tightness
  • progressive decrease in lung function
  • tachypnoea
  • tachycardia
  • silent chest
  • accessory muscle use
  • sleep disturbance
完整详情

其他诊断因素

  • exercise limitation
  • collapse
  • altered consciousness
  • skin symptoms
  • cyanosis
  • arrhythmia
  • hypotension
  • exhaustion
  • stridor
完整详情

危险因素

  • viral infection
  • uncontrolled asthma symptoms
  • high use of short-acting beta-2 agonists
  • inadequate use of inhaled corticosteroids
  • incorrect inhaler technique
  • low forced expiratory volume in 1 second (FEV1)
  • high bronchodilator reversibility
  • current smoker (including e-cigarettes/vapes) or exposure to second-hand cigarette smoke
  • exposure to allergens (including history of seasonal allergic rhinitis)
  • air pollution
  • poor indoor air quality
  • obesity
  • chronic rhinosinusitis
  • gastro-oesophageal reflux disease
  • confirmed food allergy
  • history of asthma
  • history of hospitalisation for asthma exacerbations
  • one or more severe exacerbations in the last 12 months
  • use of oral corticosteroids
  • poor adherence to asthma treatment
  • pregnancy
  • psychological or socioeconomic problems
  • blood eosinophils
  • elevated fractional exhaled nitric oxide (FeNO)
  • respiratory bacterial infection
完整详情

诊断性检查

首要检查

  • arterial blood gas (in hospital)
  • peak flow (in the community and in hospital)
  • pulse oximetry (in the community and in hospital)
  • chest x-ray (in hospital)
完整详情

需考虑的检查

  • full blood count (in hospital)
  • urea and electrolytes (in hospital)
  • C-reactive protein (in hospital)
  • theophylline levels (in hospital)
  • ECG (in hospital)
完整详情

治疗流程

急症处理

life-threatening exacerbation or impending respiratory failure

acute severe exacerbation

moderate exacerbation

持续性治疗

symptomatic asthma post-stabilisation

撰稿人

专家顾问

Jonathan Bennett, MD

Honorary Professor of Respiratory Sciences

University of Leicester

Respiratory Consultant

Glenfield Hospital

Leicester

UK

简介

JB is deputy medical director of the Royal College of Physicians (RCP) Invited Service Reviews, and speaker at national society meetings including the British Thoracic Society, the Primary Care Respiratory Society, and the Society for Cardiothoracic Surgery.

利益声明

JB is deputy medical director of RCP Invited Service Reviews.

Acknowledgements

BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:

Sourav Majumdar, MD

Clinical Assistant Professor (Affiliated)

Division of Pulmonary, Allergy and Critical Care Medicine

Department of Medicine

Stanford University School of Medicine

Stanford

Lauren Eggert, MD

Fellow

Division of Pulmonary, Allergy and Critical Care Medicine

Department of Medicine

Stanford University School of Medicine

Stanford

利益声明

SM and LE declare that they have no competing interests.

同行评议者

Pujan H Patel, MD

Consultant in Respiratory Medicine

Royal Brompton Hospital

London

UK

利益声明

PP has received speaker fees for educational lecture events from GlaxoSmithKline.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

编辑

Emma Quigley

Section Editor, BMJ Best Practice

利益声明

EQ declares that she has no competing interests.

Tannaz Aliabadi-Oglesby

Lead Section Editor, BMJ Best Practice

利益声明

TAO declares that she has no competing interests.

Julie Costello

Comorbidities Editor, BMJ Best Practice

利益声明

JC declares that she has no competing interests.

Adam Mitchell

Drug Editor, BMJ Best Practice

利益声明

AM declares that he has no competing interests.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. 2024 [internet publication].全文

British Thoracic Society; Scottish Intercollegiate Guidelines Network. British guideline on the management of asthma. Nov 2024 [internet publication].全文

National Institute for Health and Care Excellence. Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN). Nov 2024 [internet publication].全文

British Thoracic Society; Scottish Intercollegiate Guidelines Network. British guideline on the management of asthma. Nov 2024 [internet publication].全文

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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