Acute asthma exacerbation in adults
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]
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
其他诊断因素
- exercise limitation
- collapse
- altered consciousness
- skin symptoms
- cyanosis
- arrhythmia
- hypotension
- exhaustion
- stridor
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
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)
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)
治疗流程
life-threatening exacerbation or impending respiratory failure
acute severe exacerbation
moderate exacerbation
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
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.
鉴别诊断
- Acute bronchiolitis
- Pneumonia
- Foreign body/obstruction
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