Acute asthma exacerbation in adults

Last reviewed: 3 Sep 2022
Last updated: 20 Jul 2021

Summary

Definition

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
More key diagnostic factors

Other diagnostic factors

  • exercise limitation
  • stridor
  • cyanosis
Other diagnostic factors

Risk factors

  • 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
  • obesity
  • 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
  • pregnancy
  • blood eosinophils
  • elevated fractional exhaled nitric oxide (FeNO)
  • respiratory bacterial infection
More risk factors

Diagnostic investigations

1st investigations to order

  • peak expiratory flow rate
  • oxygen saturation
More 1st investigations to order

Investigations to consider

  • ABG
  • chest x-ray
More investigations to consider

Treatment algorithm

ACUTE

life-threatening exacerbation or impending respiratory failure

severe exacerbation

mild to moderate exacerbation

ONGOING

symptomatic asthma

Contributors

Authors

Sourav Majumdar, MD

Clinical Assistant Professor (Affiliated)

Division of Pulmonary, Allergy and Critical Care Medicine

Department of Medicine

Stanford University School of Medicine

Stanford

CA

Disclosures

SM declares that he has no competing interests.

Lauren Eggert, MD

Clinical Assistant Professor

Division of Pulmonary, Allergy and Critical Care Medicine

Department of Medicine

Stanford University School of Medicine

Stanford

CA

Disclosures

LE declares that she has no competing interests.

Acknowledgements

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

Disclosures

WK and ME declare that they have no competing interests. JPP is a member of Speakers' Bureaus for GlaxoSmithKline, Inc.; Schering-Plough, Inc.; and AstraZeneca, Inc.

Peer reviewers

Anne Dixon, MD

Assistant Professor

Pulmonary and Critical Care Medicine

University of Vermont

Burlington

VT

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

UK

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

UK

Disclosures

GPC declares that he has no competing interests.

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