Summary
Definition
History and exam
Key diagnostic factors
- shortness of breath
- cough
- wheeze
- risk factors
- progressive chest tightness
- progressive decrease in lung function
- tachypnoea
- tachycardia
- silent chest
- accessory muscle use
- sleep disturbance
Other diagnostic factors
- exercise limitation
- collapse
- altered consciousness
- skin symptoms
- cyanosis
- arrhythmia
- hypotension
- exhaustion
- stridor
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 (including e-cigarettes) 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
Diagnostic investigations
1st investigations to order
- 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)
Investigations to consider
- full blood count (in hospital)
- urea and electrolytes (in hospital)
- C-reactive protein (in hospital)
- theophylline levels (in hospital)
- ECG (in hospital)
Treatment algorithm
life-threatening exacerbation or impending respiratory failure
acute severe exacerbation
moderate exacerbation
symptomatic asthma post-stabilisation
Contributors
Expert advisers
Jonathan Bennett, MD
Honorary Professor of Respiratory Sciences
University of Leicester
Respiratory Consultant
Glenfield Hospital
Leicester
UK
Biography
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.
Disclosures
JB is deputy medical director of RCP Invited Service Reviews.
Richard Russell, MBBS, PhD, MRCP
Specialty Registrar in Respiratory Medicine
Glenfield Hospital
Leicester
UK
Disclosures
RR has received support from Chiesi, covering registration fee, travel, and accommodation, to attend a conference.
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
Disclosures
SM and LE declare that they have no competing interests.
Peer reviewers
Pujan H Patel, MD
Consultant in Respiratory Medicine
Royal Brompton Hospital
London
UK
Disclosures
PP has received speaker fees for educational lecture events from GlaxoSmithKline.
Editors
Emma Quigley
Section Editor, BMJ Best Practice
Disclosures
EQ declares that she has no competing interests.
Tannaz Aliabadi-Oglesby
Lead Section Editor, BMJ Best Practice
Disclosures
TAO declares that she has no competing interests.
Julie Costello
Comorbidities Editor, BMJ Best Practice
Disclosures
JC declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
Disclosures
AM declares that he has no competing interests.
Differentials
- Acute bronchiolitis
- Pneumonia
- Foreign body/obstruction
More DifferentialsGuidelines
- Global strategy for asthma management and prevention
- British guideline on the management of asthma
More GuidelinesCalculators
Glasgow Coma Scale
More CalculatorsVideos
Peak flow measurement animated demonstration
More videosPatient information
Asthma in adults: what is it?
Asthma in adults: what treatments work?
More Patient informationLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer