Skip to main content
SpringerLink
Log in

The Patient With Asthma in the Emergency Department

  • Chapter
Bronchial Asthma

Part of the book series: Current Clinical Practice ((CCP))

  • 1163 Accesses

Abstract

  • Peak expiratory flow meters aid in assessing and following the progress of acute asthma

  • patients in conjunction with history, examination, and pulse oximetry.

  • Mild asthma attacks should be treated with albuterol by nebulizer or metered-dose

  • inhlaer with holding chamber.

  • Moderate to severe asthma attacks should be treated with larger doses of albuterol,

  • ipratropium bromide, and corticosteroids (CSs), usually by the oral route.

  • The CS dose does not need to be supra-high range.

  • Very severe asthma attacks should be treated with continuous high-dose albuterol, ipratropium

  • bromide, and CSs, usually by the intravenous route, plus intravenous magnesium.

  • Other options for difficult situations include heliox, ketamine, and noninvasive positive

  • pressure ventilation.

  • Determination of disposition is more feasible after the first phase of treatment than at

  • the time of initial presentation.

  • Discharge from the emergency department should involve appropriate discharge medications,

  • Teaching of action plan, and follow-up arrangements.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Turner MT, Noertjojo K, Vedal S, et al. Risk factors for near-fatal asthma: a case control study in patients hospitalized with acute asthma. Am J Respir Crit Care Med 1998; 157: 1804–1809.

    PubMed  CAS  Google Scholar 

  2. Rea H, Garrett J, Lanes S, Birmann B, Kolbe J. The association between asthma drugs and severe life-threatening attacks. Chest 1996; 110: 1446–1451.

    Article  PubMed  CAS  Google Scholar 

  3. Leiner GC, Abramowitz S, Small MJ, Stenby VB, Lewis WA. Expiratory peak flow rate. Standard values for normal subjects. Am Rev Resp Dis 1963; 88: 644–651.

    PubMed  CAS  Google Scholar 

  4. McElroy, SP. Pediatric Emergency Medicine: The Essentials. Boston, MA, Health Emergency Publishing, 2004.

    Google Scholar 

  5. Cates CC, Bara A, Crilly JA, Rowe BH. Holding chambers versus nebulisers for beta-agonist treatment of acute asthma. Cochrane Database Syst Rev 2003; (3): CD000052.

    PubMed  Google Scholar 

  6. Rodrigo G, Rodrigo C, Burschtin O. Ipratropium bromide in acute adult severe asthma: a meta-analysis of randomized controlled trials. Am J Med 1999; 107: 363–370.

    Article  PubMed  CAS  Google Scholar 

  7. Plotnick LH, Ducharme FM. Acute asthma in children and adolescents: should inhaled anticholinergics be added to beta-2 agonists? Am JRespir Med 2003; 2: 109–115.

    CAS  Google Scholar 

  8. Page CP, Morley J. Third-generation beta-agonists: changing of the guard, contrasting properties of albuterol stereoisomers. J Allergy Clin Immunol 1999; 104: S31–S41.

    Article  PubMed  CAS  Google Scholar 

  9. Nowak R. Single-isomer levalbuterol: a review of the acute data. Curr Allergy Asthma Rep 2003; 3: 172–178.

    Article  PubMed  Google Scholar 

  10. Rowe BH, Spooner C, Ducharme FM, Bretzlaff JA, Bota GW. Early emergency department treatment of acute asthma with systemic corticosteroids. Cochrane Database Syst Rev 2001; 1: CD0021178.

    Google Scholar 

  11. Rowe BH, Spooner CH, Duchrame FM, Bratzlaff JA, Bota GW. Corticosteroids for preventing relapse following acute exacerbations of asthma. Cochrane Database Syst Rev 2000; 3: CD000195.

    Google Scholar 

  12. Ratto D, Alfaro C, Sipsey J, Glovsky MM, Sharma OP. Are intravenous corticosteroids required in status asthmaticus? JAMA 1988; 260: 527.

    Article  PubMed  CAS  Google Scholar 

  13. Manser R, Reid D, Abramson H. Corticosteroids for acute severe asthma in hospitalized patients. Cochrane Database Syst Rev 2000; (2): CD001740.

    PubMed  Google Scholar 

  14. O’Driscoll BR, Kalra S, Wilson M, et al. Double-blind trial of steroid tapering in acute asthma. Lancet 1993; 341: 324–327.

    Article  PubMed  CAS  Google Scholar 

  15. Edmonds ML, Camargo CA Jr, Brenner BE, Rowe BH. Replacement of oral corticosteroids with inhaled corticosteroids in the treatment of acute asthma following emergency department discharge: a meta-analysis. Chest 2002; 121: 1798–1805.

    Article  PubMed  CAS  Google Scholar 

  16. Edmonds ML, Camargo CA Jr, Pollack CV Jr, Rowe BH. The effectiveness of inhaled corticosteroids in the emergency department treatment of acute asthma: a meta-analysis. Ann Emerg Med 2002; 40: 145–154.

    Article  PubMed  Google Scholar 

  17. Camargo CA Jr, Smithline HA, Malice MP, Green SA, Reiss TF. A randomized controlled trial of intravenous montelukast in acute asthma. Am J Respir Crit Care Med 2003; 167: 528–533.

    Article  PubMed  Google Scholar 

  18. Yaron M, Padyk P, Hutsinpiller M, Cairns CB. Utility of the expiratory capnogram in the assessment of bronchospasm. Ann Emerg Med 1996; 28: 403–407.

    Article  PubMed  CAS  Google Scholar 

  19. Rudnitsky GS, Eberlein RS, Schoffstall JM, et al. Comparison of intermittent and continuously nebulized albuterol for treatment of asthma in an urban emergency department. Ann Emerg Med 1993; 22: 1842–1846.

    Article  PubMed  CAS  Google Scholar 

  20. Cheong B, Reynolds SR, Rajan G, Ward MJ. Intravenous /gb-agonist in acute severe asthma. Br Med J 1988; 297: 448–450.

    Article  CAS  Google Scholar 

  21. Salmeron S, Brochard L, Mal H, et al. Nebulized versus intravenous albuterol in hypercapneic acute asthma. A multi-center, double blind, randomized study. Am J Respir Crit Care Med 1994; 149: 1466–1470.

    PubMed  CAS  Google Scholar 

  22. Travers AH, Rowe BH, Barker S, Jones A, Camargo CA Jr. The Effectiveness of IV beta-agonists in treating patients with acute asthma in the emergency department: a meta-analysis. Chest 2002; 122: 1116–1118.

    Article  Google Scholar 

  23. Rodrigo GJ, Rodrigo C. First-line therapy for adult patients with acute asthma receiving multiple dose protocol of ipratropium bromide plus albuterol in the emergency department. Am J Respir Crit Care Med 2000; 161: 1862–1868.

    PubMed  CAS  Google Scholar 

  24. Rowe BH, Bretzlaff JA, Bourdon C, Bota GW, Camargo CA Jr. Magnesium sulfate for treating acute asthmatic exacerbations of acute asthma in the emergency department. Cochrane Database Syst Rev 2000; 3: CD001490.

    Google Scholar 

  25. Nannini LJ, Pendino JC, Corna RA, Mannarino S, Quispe R. Magnesium sulfate as a vehicle for nebulized salbutamol in acute asthma. Am J Med 2000; 108: 193–197.

    Article  PubMed  CAS  Google Scholar 

  26. Hughes R, Goldkorn A, Masoli M, et al. Use of isotonic nebulised magnesium sulphate as an adjuvant to salbutamol in treatment of severe asthma in adults: randomised placebo-controlled trial. Lancet 2003; 361: 2114–2117.

    Article  PubMed  CAS  Google Scholar 

  27. Mahajan P, Haritos D, Rosenberg N, Thomas R. Comparison of nebulized magnesium sulfate plus albuterol to nebulized albuterol plus saline in children with acute exacerbations of mild to moderate asthma. J Emerg Med 2004; 27: 21–25.

    Article  PubMed  Google Scholar 

  28. Howton JC, Rose J, Duffy S, Zoltanski T, Levitt MA. Randomized, double-blind, placebo-controlled trial of intravenous ketamine in acute asthma. Ann Emerg Med 1996; 27: 170–175.

    Article  PubMed  CAS  Google Scholar 

  29. Rodrigo G, Pollack C, Rodrigo C, Rowe BH. Heliox for nonintubated acute asthma patients. Cochrane Database Sys Rev 2003; 4: CD002884.

    Google Scholar 

  30. Meduri CF, Cook TR, Turner RE, Cohen M, Leeper KV. Noninvasive positive pressure ventilation in status asthmaticus. Chest 1995; 110; 767–774.

    Article  Google Scholar 

  31. Soroksky A, Stav D, Shpirer I. A pilot prospective, randomized, placebo-controlled trial of bilevel positive airway pressure in acute asthmatic attack. Chest 2003;123: 1018–1025.

    Article  PubMed  Google Scholar 

  32. Behbehani NA, Al-Mane FD, Yachkova Y, Pare PD, FitzGerald JM. Myopathy following mechanical ventilation for acute severe asthma: the role of muscle relaxants and corticosteroids. Chest 1999; 115: 1627–1631.

    Article  PubMed  CAS  Google Scholar 

  33. Shrestha M, Bidadi K, Gourlay S, Hayes J. Continuous vs intermittent albuterol, at high and low doses, in the treatment of severe acute asthma in adults. Chest 1996; 110: 42–47.

    Article  PubMed  CAS  Google Scholar 

  34. Gibson PG, Coughlan J, Wilson AJ, et al. Self-management education and regular practitioner review for adults with asthma. Cochrane Database Syst Rev 2000; 3: CD001117.

    Google Scholar 

  35. Emond S, Reed C, Graff L, Clark S, Camargo C. Asthma education in the emergency department. Ann Emer Med 2000; 36: 204–211.

    Article  CAS  Google Scholar 

  36. Mallmann F, Fernandes AK, Avila EM, et al. Early prediction of poor outcome in patients with acute asthma in the emergency room. Braz J Med Biol Res 2002; 35: 39–47.

    Article  PubMed  CAS  Google Scholar 

  37. Gorelick MH, Stevens MW, Schultz TR, Scribano PV. Performance of a novel clinical score, the Pediatric Asthma Severity Score (PASS), in the evaluation of acute asthma. Acad Emerg Med 2004; 11: 10–18.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, School of Medicine, University of California at Davis, Davis, CA

    Donna Kinser MD

Authors
  1. Donna Kinser MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Division of Rheumatology/Allergy and Clinical Immunology Department of Medicine School of Medicine, University of California at Davis, Davis, CA

    M. Eric Gershwin MD

  2. Division of Pulmonary and Critical Care Medicine Department of Medicine School of Medicine, University of California at Davis, Davis, CA

    Timothy E. Albertson MD, MPH, PhD

  3. Veterans Administration Northern California Health Care System, Mather, CA

    Timothy E. Albertson MD, MPH, PhD

Rights and permissions

Reprints and permissions

Copyright information

© 2006 Humana Press Inc.

About this chapter

Cite this chapter

Kinser, D. (2006). The Patient With Asthma in the Emergency Department. In: Gershwin, M.E., Albertson, T.E. (eds) Bronchial Asthma. Current Clinical Practice. Humana Press. https://doi.org/10.1385/1-59745-014-6:143

Download citation

  • DOI: https://doi.org/10.1385/1-59745-014-6:143

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-604-7

  • Online ISBN: 978-1-59745-014-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation