Acute asthma exacerbation in adults

Last reviewed: March 2019

Last updated: June 2018

Summary

Presents as an acute or subacute episode of progressive worsening of 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 increased 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.

Definition

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 FEV1.

History and exam

Key diagnostic factors

cough
wheezing
shortness of breath
chest tightness
sleep disturbance
accessory muscle use
tachypnea
tachycardia
wheezing, poor air movement, or diminished breath sounds
inability to speak

Full details

Other diagnostic factors

exercise limitation
stridor
cyanosis

Full details

Risk factors

viral infection
respiratory bacterial infection
current smoker or exposure to secondhand cigarette smoke
exposure to allergens (including history of seasonal allergic rhinitis)
atopic eczema
environmental irritants
poor indoor air quality
gastroesophageal reflux disease
history of asthma
history of hospitalization for asthma exacerbations
use of oral corticosteroids
noncompliance to asthma medication

Full details

Diagnostic investigations

1st investigations to order

peak flow measurement (peak expiratory flow or FEV1)
oxygen saturation
short-acting bronchodilator trial

Full details

Investigations to consider

ABG
chest x-ray

Full details

Treatment algorithm

ACUTE

Contributors

Authors VIEW ALL 

Sourav Majumdar, MD

Staff Physician

Pulmonary, Critical Care and Sleep Medicine

VA Palo Alto Health Care System

Palo Alto

Disclosures

SM declares that he has no competing interests.

Acknowledgements

Dr Sourav Majumdar would like to gratefully acknowledge Dr Ware Kuschner, Dr Michael Ezzie and Dr Jonathan P. Parsons, the previous contributors to this monograph.

Peer reviewers VIEW ALL 

Anne Dixon, MD

Assistant Professor

Pulmonary and Critical Care Medicine

University of Vermont

Burlington

Disclosures

AD declares that she has no competing interests.

Neil C. Thomson, MBChB, MD, FRCP

Professor of Respiratory Medicine

Institute of Infection, Immunity & Inflammation

University of Glasgow

Glasgow

Scotland

Disclosures

NCT declares that he has no competing interests.

Graeme P. Currie, MBChB, MD, FRCP

Consultant Chest Physician

Chest Clinic C

Aberdeen Royal Infirmary

Aberdeen

Scotland

Disclosures

GPC declares that he has no competing interests.

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Acute asthma exacerbation in adults

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

mild exacerbation

moderate to severe exacerbation

life-threatening exacerbation

symptomatic asthma

Contributors

Authors VIEW ALL 

Sourav Majumdar, MD

Disclosures

Acknowledgements

Peer reviewers VIEW ALL 

Anne Dixon, MD

Disclosures

Neil C. Thomson, MBChB, MD, FRCP

Disclosures

Graeme P. Currie, MBChB, MD, FRCP

Disclosures

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