Acute Asthma Management Guidelines: In 2005, more than 754,000 pediatric emergency department visits were related to asthma, and most of these visits were deemed a confirmation of suboptimal long-term management. Furthermore, they are highly predictive of subsequent ED visits and hospitalizations.
Acute Asthma Management Guidelines
The National Asthma Education and Prevention Program (NAEP) specifies the goal of therapy as the minimization of outcomes. Yet, even after discharge, many children still experience asthma-related symptoms. Primary care providers seldom add controller medications after the ED visit. Ultimately, the ED is the front line of preventative management, with the ability to identify and treat underlying causes and help children take better control of their condition.
Noninvasive monitoring is indispensable in the evaluation of patients in respiratory distress
The definition of acute respiratory failure is the inability to produce a significant change in arterial blood gas or oxygen saturation. However, as per acute asthma management guidelines, it is important to note that many patients with respiratory failure can function normally with these blood gas tensions, even when the changes would be alarming to a physiologically normal individual. These patients develop compensatory mechanisms that prevent them from breathing in a normal manner, making them more susceptible to respiratory insults.
One technique used to prevent life-threatening respiratory failure in acute asthma is noninvasive positive pressure ventilation. Noninvasive positive pressure ventilation (NPV) is a technique that uses a nasal or oral mask to prevent airway access and maintain a patient’s respiratory rate. Noninvasive positive pressure ventilation is also useful for treating sleep-associated hypoventilation, and it differs from invasive ventilation, which is used when the patient’s condition is life-threatening or if the patient is deteriorating rapidly.
Another noninvasive monitoring tool is pulse oximetry. Pulse oximetry is a useful tool for monitoring patients in respiratory distress. Without this monitoring, routine oxygen therapy may have masked the deterioration and did little to alleviate breathing difficulties. The use of capnography is also helpful in the evaluation of patients with respiratory distress. It provides continuous monitoring of respiratory rate and can also detect bronchospasm or airway obstruction, and can be used to quantify the effects of medications.
In addition to pulse oximetry, noninvasive monitoring is important in determining if the patient has a hypercarbic state. A patient with hypercarbic respiratory failure has a lower PCO2 than patients with normoxia. For a correct diagnosis of hypercarbic respiratory failure, arterial pH must be acidotic. Hypercarbia in the presence of a normal arterial pH is not ARF.
A combination of noninvasive and invasive monitoring is essential in the assessment of patients with respiratory distress. Noninvasive monitoring is particularly important when a patient is suffering from a severe asthma attack. Noninvasive monitoring provides the necessary information to make the correct decision. Noninvasive monitoring should be performed as soon as the patient exhibits symptoms of asthma. The results of this test will provide the necessary information to evaluate the severity of the asthma attack.
Tracheal intubation is required in patients with respiratory failure
Among other indications for endotracheal intubation, respiratory distress is a significant factor in this condition. The decision to intubate depends on the clinical situation, including respiratory failure, and whether or not a reversible condition exists. Other alternatives for acute asthma management guidelines , including high-flow nasal oxygen therapy, mask ventilation, and invasive ventilatory support, may be considered before intubation. However, these measures may not always be effective in all patients, and delays can be life-threatening.
Invasive mechanical ventilation is associated with increased risks, including mortality. Major pulmonary hyperinflation, hypovolemia, and sedation can occur after intubation. Patients should undergo a multidisciplinary discussion to determine if tracheostomy is necessary for them. Intubation is only appropriate when a patient’s condition requires it, and should be reserved for life-threatening circumstances. The indications for intubation include respiratory arrest or altered consciousness, significant hypocapnia, and pulmonary hyperinflation.
In the management of severe cases of acute asthma, a patient may need tracheal intubation. A tracheal tube must be used in the most difficult cases. The trach is placed through a hole in the right side of the patient’s mouth. Using the trach probe, the tube may be oriented anteriorly. Once the tube has passed the vocal cords, the cuff of the endotracheal tube is fixed and the patient’s airway is inflated with 3-4 mL of air.
Various complications associated with tracheal intubation can lead to a patient’s respiratory failure. These complications are serious and may require invasive mechanical ventilation. Asthma patients with respiratory failure may require a tracheostomy, which is often accompanied by a variety of complications. Intubation is the most common cause of death among patients with acute asthma, and there is a significant risk for respiratory failure after removal of the tube.
Inhalation injury can also lead to death. The mortality rate is 10% for patients with inhalation injury without skin burns. If skin burns are present, the mortality rate increases to double. Fluid resuscitation is essential in this condition, and early intubation is necessary to prevent complications. The diagnosis of inhalation injury is often difficult, and factors like the burn story in an enclosed space, carboxyhemoglobin value, and coated phlegm are critical.
Acute asthma is a common condition. Pharmacists in all settings should be knowledgeable of the evidence-based pharmacotherapies available for acute asthma management. Inhaled corticosteroids, theophylline, anti-IgE antibodies, and long-acting bronchodilators are common medicines used in the acute care setting. Asthma relief medications, such as ipratropium, are also used during an acute asthma attack. Overall, medical management of asthma is aimed at minimizing the morbidity and suffering caused by the disease.
While asthma treatment should focus on control of symptoms and patient participation, it must also be accompanied by physician supervision and monitoring. Patients are typically reluctant to use medication that they deem unnecessary. As a result, it is important to create an action plan that addresses the individual needs of every patient. Asthma guidelines emphasize the importance of developing a written action plan that is monitored closely by the healthcare provider.
Biological therapies are also available. These drugs target specific pathways that promote inflammation, including IgE and IL-4/IL-13. In addition to these drugs, a patient can also undergo bronchial thermoplasty, which involves radiofrequency ablation of airway smooth muscle. However, the effects of biologic therapies are not well understood. Therefore, physicians should carefully evaluate the side effects of each drug before recommending it.
Acute asthma is a heterogeneous disease with different phenotypes. Currently available treatments for asthma acknowledge the role of clinical phenotypes and comorbidities and aim to treat the underlying causes of inflammation. This approach is essential for the early diagnosis and treatment of asthma in patients. The guidelines also recommend the use of pharmacotherapy for the treatment of acute poorly controlled asthma.
The use of nebulized salbutamol and oral corticosteroids is largely unacceptably low in Canadian pediatric EDs. The use of early corticosteroids and ipratropium is also infrequent, while magnesium is rarely used. In addition, a meta-analysis found no evidence that adding iv-albuterol to nebulized albuterol was more effective.
Target information for this study
The GINA Guidelines are updated regularly and are designed to provide clinicians with the most recent and relevant knowledge on acute asthma management. In the 2020 Focused Updates, GINA researchers focused on six key areas of asthma care. They used GRADE methodology and systematic reviews from the Agency for Healthcare Research and Quality. The 2020 Focused Updates considered the perspective of primary care, and included representatives from the field in key leadership roles.
To understand the role of NETs and EETs in the pathophysiology of SA, physicians should understand what each of these biomarkers and eosinophil extracellular traps are. ECP stands for eosinophil cationic protein; EDN stands for eosinophil derived neurotoxin; MPO, or myeloperoxidase; NE stands for neutrophil elastase; and TSLP, a protein found in the thymus.