The management of acute severe asthma in adults

Abstract

Asthma is a common condition, which can develop into a severe, life-threatening form in any sufferer. Generally, those at risk of an acute attack are women from minority ethnic groups, who have a poor compliance history. Most patients that die of asthma do so in the community. Those who attend the emergency room generally respond to conventional treatments and hospital admission. However, a small proportion of patients will require ITU admission and mechanical ventilation, and, if the admission is not secondary to cardiorespiratory arrest, generally survive. Ventilation techniques that prevent dynamic hyperinflation and the consequent complications of hypotension and barotrauma, are now generally adopted. This includes a pressure-limited mode of ventilation associated with low tidal volumes, high flows and low respiratory rate. Follow up of these patients is essential as they form a very poor prognostic group. Detailed self-management planning, PEFR monitoring and physician review should be therefore encouraged.