Asthma is an extremely common disease that the emergency physician handles on a daily basis. Accurate clinical assessment from the history and physical examination is very important to assess the severity of the disease. Some measure of airway resistance of either FEV1 or PEFR should be done in every patient initially, at repeated intervals, and at discharge, to have a parameter to follow in
therapy as well as a tool to use to warn the physician of a severe amount of
airway obstruction. The inhaled beta agonists are the first line of
therapy in acute
asthma and can be delivered by either the
nebulizer or the MDI with or without a spacer.
Aminophylline will be continued to be used acutely even though it appears there is no improvement in
bronchospasm in the first few hours of treatment when
aminophylline is added to
therapy.
Anticholinergic agents will gain a wider role in acute
asthma, especially when used in combination with a beta agonist.
Corticosteroids continue to have a role in severe attacks of
asthma, and earlier use may prevent relapse. Fatal
asthma still occurs, however, and the emergency physician must use strict criteria to recognize
status asthmaticus or the patient who is not doing well and admit them to the hospital. Using a stepwise, logical approach to the treatment of the asthmatic patient will lead to better patient satisfaction and fewer errors on part of the emergency physician.