An acute asthma exacerbation in adults presents as an acute or subacute episode of progressive worsening of asthma symptoms, such as shortness of breath, wheezing, cough, and chest tightness.
Pulse rate, respiratory rate, subjective assessment of respiratory distress, accessory muscle use, and auscultation of the lung fields are key factors to assess during physical exam.
An increase in airway obstruction that can be quantified objectively by peak flow measurement or FEV₁ is typical in an acute exacerbation.
Early administration of bronchodilators and corticosteroids relieves airflow obstruction and helps to prevent future relapses. Severe exacerbations often require additional therapy including oxygen, magnesium, and, in some circumstances, mechanical ventilation.
Pneumonia, pneumothorax, pneumomediastinum, and respiratory failure are complications.
An asthma exacerbation is an acute or subacute episode of progressive worsening of symptoms of asthma, including shortness of breath, wheezing, cough, and chest tightness. Exacerbations are marked by decreases from baseline in objective measures of pulmonary function, such as peak expiratory flow rate and forced expiratory volume in 1 second (FEV₁).
This topic covers the management of adults. Children 12 years and older are generally treated the same as adults. However, consult your local pediatric guidance as there may be some differences in the treatment approach and weight-based dosing may be recommended in some adolescents.
History and exam
Key diagnostic factors
- shortness of breath
- chest tightness
- sleep disturbance
- accessory muscle use
- wheezing, poor air movement, or diminished breath sounds
- inability to speak
Other diagnostic factors
- exercise limitation
- 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 or exposure to secondhand cigarette smoke
- exposure to allergens (including history of seasonal allergic rhinitis)
- atopic eczema
- air pollution
- poor indoor air quality
- chronic rhinosinusitis
- gastroesophageal reflux disease
- confirmed food allergy
- history of asthma
- history of hospitalization for asthma exacerbations
- one or more severe exacerbations in the last 12 months
- use of oral corticosteroids
- poor adherence to asthma treatment
- blood eosinophils
- elevated fractional exhaled nitric oxide (FeNO)
- respiratory bacterial infection
1st investigations to order
- peak expiratory flow rate
- oxygen saturation
Investigations to consider
- chest x-ray
life-threatening exacerbation or impending respiratory failure
mild to moderate exacerbation
- Foreign body/obstruction
- Vocal cord dysfunction
- Cardiac dysfunction
- Global strategy for asthma management and prevention
- Australian asthma handbook
Asthma in adultsMore Patient leaflets
Peak flow measurement: animated demonstration
Tracheal intubation: animated demonstrationMore videos
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