Review: Assessment and management of severe asthma in adults in hospital

Review: Assessment and management of severe asthma in adults in hospital

The fifth instalment of a series of review articles on acute asthma exacerbations has been published in Thorax. This review covers the assessment and management of severe asthma in adults in hospital, under the following headings:

• History
• Clinical examination
• Assessment (lung function tests, oxygen assessment and other tests)
• Management (oxygen, NIPPV, inhaled bronchodilators, intravenous bronchodilators, systemic corticosteroids, inhaled corticosteroids)
• Response to treatment
• ICU transfer
• Ward admission
• Discharge arrangements
• Assessment sheets and treatment protocols

The authors note the following key points:

• The management of asthma in the emergency department can be improved through the use of simple assessment and treatment protocols.
• Assessment of asthma severity should be based primarily on the measurement of FEV1, expressed as the percentage of normal predicted values.
• For most patients, initial treatment with high-flow oxygen, nebulised beta-agonists and oral corticosteroids is sufficient.
• Currently available evidence does not support the routine use of intravenous theophylline or intravenous beta-agonist treatment in acute asthma; magnesium is the preferred intravenous bronchodilator in life-threatening asthma.
• Patients with any feature of a severe attack persisting after initial treatment should be admitted; patient circumstances should also be considered.
• For patients who are discharged, long-term management should be reviewed and medical follow-up arranged.

Thorax 2007; 62: 447-58 (link to abstract)