Management of severe acute asthma in the emergency department

Curr Opin Crit Care. 2011 Aug;17(4):335-41. doi: 10.1097/MCC.0b013e328348bf09.


Purpose of review: Asthma is one of the most common chronic diseases in most developed countries and control may be elusive. Deterioration in asthma control is common when patients are exposed to airway irritants, viruses, and/or when adherence to chronic anti-inflammatory medications is suboptimal. Acute asthma exacerbations are common, important reasons for presentations to emergency departments, and severe cases may result in hospitalization. Important knowledge gaps exist in what is known and what care is delivered at the bedside.

Recent findings: The literature in asthma is rapidly expanding and recent advances in the care are important to summarize. Systematic reviews, especially high-quality syntheses performed using Cochrane methods, provide the best evidence for busy clinicians to remain current. Management of asthma is based on early recognition of severe disease with aggressive therapy using multimodal interventions that focus on both bronchoconstriction and inflammatory mechanisms.

Summary: Treatment of severe acute asthma can effectively and safely reduce hospitalizations, airway interventions, and even death. Using the approach outlined herein will enable clinicians to assist patients to rapidly regain asthma control, return to normal activities, and improve their quality of life in the follow-up period.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Acute Disease
  • Adrenal Cortex Hormones / therapeutic use
  • Adrenergic beta-1 Receptor Agonists / therapeutic use*
  • Anti-Asthmatic Agents / therapeutic use*
  • Asthma / drug therapy*
  • Bronchoconstriction
  • Bronchodilator Agents / therapeutic use*
  • Cholinergic Antagonists / therapeutic use
  • Emergency Service, Hospital / statistics & numerical data*
  • Humans
  • Inflammation
  • Magnesium Sulfate / therapeutic use
  • Oximetry
  • Severity of Illness Index


  • Adrenal Cortex Hormones
  • Adrenergic beta-1 Receptor Agonists
  • Anti-Asthmatic Agents
  • Bronchodilator Agents
  • Cholinergic Antagonists
  • Magnesium Sulfate