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
Other diagnostic factors
- limitación para realizar ejercicio
- alteración de la consciencia
- estridor
- cianosis
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
Diagnostic investigations
1st investigations to order
- saturación de oxígeno
- flujo espiratorio máximo
Investigations to consider
- GSA
- radiografía de tórax
- hemograma completo (HC)
- perfil metabólico de electrolitos, niveles de urea, creatinina
Treatment algorithm
exacerbación potencialmente mortal o insuficiencia respiratoria inminente
exacerbación grave
exacerbación leve a moderada
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
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
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