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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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Coping with Asthma

Coping with Asthma

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.

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