By Jennifer E. Fergeson, DO, Shiven S. Patel, MD, and Richard F. Lockey, MD
NOTE: This is the introduction to a 10 part series.
Asthma affects about 300 million people globally and accounts for 1 in every 250 deaths in the world. Approximately 12 million people in the United States each year experience an acute exacerbation of their asthma, a quarter of which require hospitalization. Acute asthma should be differentiated from poor asthma control. Patients with acute asthma will exhibit increasing shortness of breath, chest tightness, coughing, and/or wheezing. In contrast, poor asthma control typically presents with a diurnal variability in airflow and is a characteristic that is usually not seen during an acute exacerbation. The history should include a review of comorbidities, adherence to medications, previous episodes of near-fatal asthma, and whether the patient has experienced multiple emergency department visits or hospitalizations, particularly those requiring admission to an intensive care unit involving respiratory failure, intubation, and mechanicalventilation. Patient education is important to ensure that the patient understands that asthma is mostly a chronic disease and necessitates the avoidance of allergens, prevention of infections, adherence with routine vaccinations, management of comorbid conditions, and adherence to treatment regimens. This article is a structured review of the available literature regarding the diagnosis and management of acute asthma. (J Allergy Clin Immunol 2017;139:438-47.)
Asthma exacerbations are avoidable with appropriate regular therapy and patient education. Despite this, asthma affects about 300 million people globally and accounts for 1 in every 250 deaths.(1) In the United States alone, approximately 12 million people each year experience an acute exacerbation of their asthma, a quarter of which require hospitalization.(2) In Europe approximately 30 million people have asthma, and 15,000 people die yearly from this disease.(3) This article is about acute asthma and its diagnosis, prognosis, and treatment.
Various clinical symptoms and signs can assist the clinician in determining the severity of acute asthma (Fig 1).(2,4) To prevent severe asthma exacerbations, the goals for the physician managing subjects with asthma include (1) recognition of patients who are at a greater risk for near-fatal or fatal asthma; (2) education of the patient to recognize deterioration in their disease; (3) provision of an individual action plan for the patient to manage the exacerbation and to know when to seek professional help; and (4) management of comorbidities, such as rhinitis, sinusitis, obesity, gastroesophageal reflux disease, obstructive sleep apnea, chronic obstructive pulmonary disease COPD), vocal cord dysfunction, and atopic dermatitis. (5-9)
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S, Thomson N, editors. Asthma and COPD: basic mechanisms and clinical management. 2nd ed. San Diego: Elsevier; 2009. pp. 775-91.
3. Schatz M, Rosenwasser L. The allergic asthma phenotype. J Allergy Clin Immunol Pract 2014;2:645-9.
4. Nelson R, DiNicolo R, Fernandez-Caldas E, Seleznik MJ, Lockey RF, Good R. Allergen-specific IgE levels and mite allergen exposure in children with acute asthma first seen in an emergency department and in nonasthmatic control subjects. J Allergy Clin Immunol 1996;98:258-63.
5. Lockey RF, Ledford DK, in collaboration with the World Allergy Organization, editors. Asthma, comorbidities, co-existing conditions, and differential diagnoses. New York: Oxford University Press; 2014. pp. 231-367.
6. Holguin F, Bleecker ER, Busse WW, Calhoun WJ, Castro M, Erzurum SC, et al. Obesity and asthma: an association modified by age of asthma onset. J Allergy Clin Immunol 2011;127:1486-93.e2.
7. Ledford DK, Lockey RF. Asthma and comorbidities. Curr Opin Allergy Clin Immunol 2013;13:78-86.
8. Blake K, Teague WG. Gastroesophageal reflux disease and childhood asthma. Curr Opin Pulm Med 2013;19:24-9.
9. Gibson PG, Henry RL, Coughlan JL. Gastro-oesophageal reflux treatment for asthma in adults and children. Cochrane Database Syst Rev 2003;(1):CD001496.
10. Global Initiative For Asthma (GINA) Website. Available at: http://www.ginasthma. com/. Accessed March 15, 2015.
- From the Department of Internal Medicine, Division of Allergy and Immunology, University of South Florida.
Disclosure of potential conflict of interest: R. F. Lockey is a board member for the Journal of Allergy and Clinical Immunology–In Practice and Allergy, Asthma & Immunology Research, has consultant arrangements with Merck and AstraZeneca, is employed bythe University of South Florida College of Medicine, has received payment for lectures from Merck and AstraZeneca, has received royalties from Informa Publishing, and has received travel support from national and international congresses for presentations.
The rest of the authors declare that they have no relevant conflicts of interest.
Received for publication April 5, 2016; accepted for publication June 14, 2016.
Available online August 20, 2016.
Corresponding author: Jennifer E. Fergeson, DO, 13000 Bruce B. Downs Blvd (111D), Tampa, FL 33612. E-mail: email@example.com.
The CrossMark symbol notifies online readers when updates have been made to the article such as errata or minor corrections 0091-6749/$36.00_ 2016 Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology http://dx.doi.org/10.1016/j.jaci.2016.06.054