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Acute Severe Asthma in Adolescent and Adult Patients: Current Perspectives on Assessment and Management

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Review

Acute Severe Asthma in Adolescent and Adult Patients: Current Perspectives on Assessment and Management

Eirini Kostakou et al. J Clin Med.

Abstract

Asthma is a chronic airway inflammatory disease that is associated with variable expiratory flow, variable respiratory symptoms, and exacerbations which sometimes require hospitalization or may be fatal. It is not only patients with severe and poorly controlled asthma that are at risk for an acute severe exacerbation, but this has also been observed in patients with otherwise mild or moderate asthma. This review discusses current aspects on the pathogenesis and pathophysiology of acute severe asthma exacerbations and provides the current perspectives on the management of acute severe asthma attacks in the emergency department and the intensive care unit.

Keywords: acute severe asthma exacerbation; near fatal asthma.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Age-standardized admission rates for asthma (all ages) in 30 European countries in two time periods: 2001–2005 and 2011–2015. Source: Eurostat updated from ec.europa.eu/Eurostat/web/health/health-care/data/database (version dated November 2017).
Figure 2
Figure 2
Age-standardized mortality rates for asthma (all ages) by country in two time periods: 2001–2005 and 2011–2015. Source: Eurostat updated from ec.europa.eu/Eurostat/web/health/health-care/data/database (version dated November 2017).
Figure 3
Figure 3
Pathogenesis of acute exacerbations in asthma.
Figure 4
Figure 4
The role of the neutrophil in modulating local inflammatory responses.
Figure 5
Figure 5
Dynamic hyperinflation during exacerbation.
Figure 6
Figure 6
Pathophysiological changes due to dynamic hyperinflation.
Figure 7
Figure 7
Global Initiative for Asthma (GINA) recommendations for the management of asthma exacerbations in acute care facility. PEF: Peak expiratory flow; FEV1: Forced expiratory volume in one second; SABA, short acting beta 2 agonists; ICU, Intensive Care Unit.
Figure 8
Figure 8
Flow time tracing of a patient with persistence of flow at the end of expiration which indicates dynamic hyperinflation and pressure time tracing with a slope increase indicative of over-distension.
Figure 9
Figure 9
Personalized management for adults and adolescents to control symptoms and minimize future risk [1].
Figure 10
Figure 10
Criteria for the choice of biologic as add on treatment in Th2 driven severe asthma.

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References

    1. Global Initiative for Asthma (GINA) Global Strategy for Asthma Management and Prevention (2019 Update) [(accessed on 6 August 2019)]; Available online: http://search.ebscohost.com/login.aspx?direct=true&db=cin20&A.N.=118972966&site=ehost-live.
    1. Teach S.J., Gill M.A., Togias A., Sorkness C.A., Arbes S.J., Jr., Calatroni A., Wildfire J.J., Gergen P.J., Cohen R.T., Pongracic J.A., et al. Preseasonal treatment with either omalizumab or an inhaled corticosteroid boost to prevent fall asthma exacerbations. J. Allergy Clin. Immunol. 2015;136:1476–1485. doi: 10.1016/j.jaci.2015.09.008. - DOI - PMC - PubMed
    1. Trasande L., Thurston G.D. The role of air pollution in asthma and other pediatric morbidities. J. Allergy Clin. Immunol. 2005;115:689–699. doi: 10.1016/j.jaci.2005.01.056. - DOI - PubMed
    1. Rosser F., Brehm J.M., Forno E., Acosta-Pérez E., Kurland K., Canino G., Celedón J.C. Proximity to a major road, vitamin D insufficiency, and severe asthma exacerbations in Puerto Rican children. Am. J. Respir. Crit. Care Med. 2014;190:1190–1193. doi: 10.1164/rccm.201408-1568LE. - DOI - PMC - PubMed
    1. Shmool J.L., Kubzansky L.D., Newman O.D., Spengler J., Shepard P., Clougherty J.E. Social stressors and air pollution across New York City communities: A spatial approach for assessing correlations among multiple exposures. Environ. Health. 2014;13:91. doi: 10.1186/1476-069X-13-91. - DOI - PMC - PubMed
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