Pulmonary Disorders II
Asthma is a heterogeneous disease, usually categorized by chronic airway inflammation. It is defined
by a history of respiratory symptoms, such as wheezing, shortness of breath, chest tightness, and cough,
that vary over time and in intensity, together with variable expiratory airflow limitations.
airflow from the patientβs usual state that can be quantified by spirometry or peak expiratory flow.
Definitions and classifications of asthma exacerbations vary between experts and guidelines. Both
terms below are considered life threatening exacerbations.
Status asthmaticus is an acute severe asthma exacerbation that does not respond to initial intensive
therapy, with the potential for pulmonary compromise and death.
Near-fatal asthma is status asthmaticus that progresses to respiratory failure.
Symptoms
Initial PEF (or
FEV1)
Clinical Course
Mild/
Moderate
| β’ | Talks in phrases |
|---|---|
| β’ | Prefers sitting to laying down |
| β’ | Not agitated |
| β’ | RR increased |
| β’ | Accessory muscles not used |
| β’ | Heart rate 100β120 beats/min |
| β’ | Sao2 90%β95% |
> 50% of predicted
or personal best
| β’ | Usually cared for at home/primary care |
|---|
setting
| β’ | Relief from frequent inhaled SABA |
|---|---|
| β’ | Consider addition of ipratropium |
| β’ | Recommended course of oral CS |
| β’ | Sao2 goal 93%β95% |
Severe
| β’ | Talks in words |
|---|---|
| β’ | Sits hunched forward |
| β’ | Agitated |
| β’ | RR > 30 breaths/min |
| β’ | Accessory muscles used |
| β’ | Heart rate > 120 beats/min |
| β’ | Sao2 < 90% |
β€ 50% of predicted
or personal best
| β’ | Requires ED visit and likely |
|---|
hospitalization
| β’ | Recommended inhaled SABA + |
|---|
ipratropium bromide
| β’ | Sao2 goal 93%β95% |
|---|---|
| β’ | Oral or IV corticosteroids |
| β’ | Consider IV magnesium |
| β’ | Consider high dose ICS |
Life
threatening
| β’ | Drowsy |
|---|---|
| β’ | Confused |
| β’ | Silent chest (absent breath |
sounds)
No definition
| β’ | Requires hospitalization; possible ICU |
|---|
admission; assess patient for intubation
| β’ | Minimal or no relief from frequent |
|---|
inhaled SABA
| β’ | IV corticosteroids |
|---|---|
| β’ | Adjunctive therapies are helpful |
ED = emergency department; FEV1 = forced expiratory volume in the first second of expiration; ICS = inhaled corticosteroid; ICU = intensive care unit;
IV = intravenous; PEF = peak expiratory flow; RR = respiratory rate; SABA = short-acting Ξ²-agonist; Sao2 = oxygen saturation.
Adapted from: Global Initiative for Asthma 2024.
Viral infections
Food allergy
Air pollution