The goal of treatment of acute asthma in the ED is to reverse airflow obstruction rapidly by repetitive or continuous administration of inhaled b 2 agonists, ensure adequate oxygenation, and relieve inflammation. The National Asthma Education and Prevention Program (NAEPP) Expert Panel has developed guidelines for emergency treatment of asthma (Fig..., ..64.-.1.)-17 The Canadian Association of Emergency Physicians and the British Thoracic Society have developed similar treatment guidelines.1 I9 The following categories of medications are used in the treatment of acute asthma: b-adrenergic agonists, anticholinergics, and glucocorticoids. Magnesium, heliox (helium-oxygen mixture), and ketamine may be considered when the aforementioned medications fail to relieve bronchospasm. Mast cell-stabilizing agents, methylxanthines, and leukotriene modifiers are currently reserved for maintenance therapy only.
FIG. 64-1. Management of Asthma Exacerbations: Emergency Department and Hospital-Based Care. Abbreviations: FEV1, forced expiratory volume in 1 s; PEFR, peak expiratory flow rate.17 (Adapted from National Asthma Education and Prevention Program Expert Panel, with permission.)
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If you suffer with asthma, you will no doubt be familiar with the uncomfortable sensations as your bronchial tubes begin to narrow and your muscles around them start to tighten. A sticky mucus known as phlegm begins to produce and increase within your bronchial tubes and you begin to wheeze, cough and struggle to breathe.