When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Exacerbación aguda del asma en adultos

Last reviewed: 16 Aug 2025
Last updated: 09 Jul 2025

Summary

Definition

History and exam

Key diagnostic factors

  • presencia de factores de riesgo
  • tos
  • sibilancia
  • disnea
  • opresión en el pecho
  • alteración del sueño
  • uso de músculos accesorios
  • taquipnea
  • taquicardia
  • sibilancia, flujo débil de aire o disminución de los ruidos respiratorios
  • incapacidad de hablar
Full details

Other diagnostic factors

  • limitación para realizar ejercicio
  • alteración de la consciencia
  • estridor
  • cianosis
Full details

Risk factors

  • infección viral
  • síntomas de asma no controlados
  • elevado uso de agonistas beta-2 de acción corta
  • uso incongruente de corticosteroides inhalados
  • técnica incorrecta inhalatoria
  • volumen espiratorio forzado en 1 secundo bajo (VEF₁)
  • alta capacidad de respuesta del broncodilatador
  • fumador actual (incluidos los cigarrillos electrónicos/vapeos) o exposición al humo de tabaco en no fumadores
  • exposición a alérgenos (incluidos antecedentes de rinitis alérgica estacional)
  • la contaminación atmosférica
  • aire de mala calidad en espacios cerrados
  • obesidad
  • rinosinusitis crónica
  • enfermedad por reflujo gastroesofágico
  • alergia alimentaria confirmada
  • antecedentes de asma
  • antecedentes de hospitalización por exacerbaciones asmáticas
  • una o más exacerbaciones graves en los últimos 12 meses
  • uso de corticosteroides orales
  • escaso cumplimiento del tratamiento del asma
  • embarazo
  • problemas psicológicos o socioeconómicos
  • eosinófilos elevados en sangre
  • aumento del óxido nítrico exhalado fraccionado (FeNO)
  • infección bacteriana de las vías respiratorias
Full details

Diagnostic investigations

1st investigations to order

  • saturación de oxígeno
  • flujo espiratorio máximo
Full details

Investigations to consider

  • GSA
  • radiografía de tórax
  • hemograma completo (HC)
  • perfil metabólico de electrolitos, niveles de urea, creatinina
Full details

Treatment algorithm

ACUTE

exacerbación potencialmente mortal o insuficiencia respiratoria inminente

exacerbación grave

exacerbación leve a moderada

ONGOING

asma sintomática

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 participated on advisory boards for Regeneron and AstraZeneca.

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, Schering-Plough, and AstraZeneca.

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.

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.

References

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.

Key articles

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

Cloutier MM, Baptist AP, Teach SJ, et al; Expert Panel Working Group of the National Heart, Lung, and Blood Institute (NHLBI) administered and coordinated National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC). 2020 focused updates to the asthma management guidelines: a report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol. 2020 Dec;146(6):1217-70.Full text  Abstract

British Thoracic Society; National Institute for Health and Care Excellence (NICE); Scottish Intercollegiate Guidelines Network. British guideline on the management of asthma. Nov 2024 [internet publication].Full text

Reference articles

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

    • Neumonía
    • Cuerpo extraño/obstrucción
    • Disfunción de las cuerdas vocales
    More Differentials
  • Guidelines

    • Global strategy for asthma management and prevention
    • Focused updates to the asthma management guidelines: a report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group
    More Guidelines
  • Patient information

    Asma en adultos: ¿qué es?

    ¿Cómo puedo saber si mi asma está fuera de control?

    More Patient information
  • Videos

    Demostración animada de medición del flujo máximo

    Sibilancias espiratorias

    More videos
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer