Management of Asthma and COPD Exacerbations in Adults in the ICU

Abstract

Severe, life-threatening asthma and chronic obstructive pulmonary disease (COPD) exacerbations are commonly managed in the intensive care unit and associated with significant morbidity and mortality. It is important to understand the commonalities and differences in the diagnosis and management of these obstructive lung diseases to improve patient outcomes via evidence-based care. In this review, we first outline triggers of acute asthma and COPD exacerbations and an initial diagnostic evaluation and severity assessment. We then review the pathophysiology of asthma and COPD exacerbations and create a framework for the management of exacerbations in critically, ill adult patients aimed at reducing airway inflammation, reversing bronchospasm, and in severe cases supporting patients with mechanical ventilation or advanced therapies until clinical improvement is achieved.