Abstract
Asthma is a chronic airway inflammatory disease that is associated with variable expiratory flow, variable respiratory symptoms, and exacerbations which sometimes require hospitalization or may be fatal. It is not only patients with severe and poorly controlled asthma that are at risk for an acute severe exacerbation, but this has also been observed in patients with otherwise mild or moderate asthma. This review discusses current aspects on the pathogenesis and pathophysiology of acute severe asthma exacerbations and provides the current perspectives on the management of acute severe asthma attacks in the emergency department and the intensive care unit.
Highlights
IntroductionAsthma is a chronic inflammatory disorder of the airways, a common and potentially serious chronic disease that is associated with variable expiratory flow, airway wall thickening, respiratory symptoms, and exacerbations (flare-ups), which sometimes require hospitalization and may be fatal [1]
Asthma is a chronic inflammatory disorder of the airways, a common and potentially serious chronic disease that is associated with variable expiratory flow, airway wall thickening, respiratory symptoms, and exacerbations, which sometimes require hospitalization and may be fatal [1]
[123] The effects of air pollution on severe asthma exacerbations may be affected by other exposures, such as stress, vitamin D insufficiency, and seasonality [4,5]. This was demonstrated in a study of children aged 0–18 years in California, where particulate matter and ozone were associated with severe asthma exacerbations in the warm season, while in the cool season exacerbations were associated with articulate matter of PM2.5, carbon monoxide, and NOx (NO1NO2) [124,125]
Summary
Asthma is a chronic inflammatory disorder of the airways, a common and potentially serious chronic disease that is associated with variable expiratory flow, airway wall thickening, respiratory symptoms, and exacerbations (flare-ups), which sometimes require hospitalization and may be fatal [1]. An exacerbation is defined as an event characterized by change from the patient’s previous status, including a progressive increase in relevant symptoms and a decrease in respiratory function. Other factors that may cause exacerbations are rhinitis [24] or sinusitis [25], polyposis [26], gastroesophageal reflux [27], menstruation [28,29], or even pregnancy [30,31] They can happen either to patients with known asthma of any level of severity, or less frequently as a first presentation. The most frequently proposed categories include elements of the clinical presentation of the asthma patient, as well as a measurement of their respiratory function at the time of the exacerbation It is of paramount importance for the clinician to distinguish the severe exacerbations, because these are the ones that correlate with worse consequences
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