Acute asthma

Despite advances in asthma therapy and care, acute severe asthma remains a relatively common medical emergency. It can be life-threatening. Fatal and near-fatal asthma often occurs on a background of psychosocial distress. All doctors should be able to identify acute severe asthma and initiate appropriate early therapy. Initial assessment includes confirmation of the diagnosis and early physiological assessment, principal amongst which are peak expiratory flow rate and oxygen saturation. After initial therapy with bronchodilators and systemic steroids, close monitoring is needed, including personal observation of the patient to check for the onset of exhaustion. This can in itself be indication for invasive ventilation. Substantial improvement is often delayed for several hours and labile peak flows are a normal feature of the recovery period. Prior to discharge, the trigger for the exacerbation should be identified whenever possible and a self-management plan negotiated with the patient. Clear communication of the follow-up arrangements must occur and include appropriate use of both specialist and community GP services.