Acute severe asthma in adults

Approximately 300 million people suffer from asthma worldwide. Asthma exacerbations account for 75,000 hospital admissions in the UK and Republic of Ireland. Asthma still accounts for in excess of 1,300 UK deaths. Risk factors for fatal asthma include poorly controlled disease, inappropriate medical management and adverse behavioural and social factors. Asthma is a chronic inflammatory condition of the airways which causes symptoms of periodic wheeze, cough and breathlessness. A variety of triggers have been identified which can cause exacerbations; these include respiratory tract infections, mainly viral, and other environmental factors. Exacerbations are identified by an increase in asthma symptoms and fall in lung function. Such features should prompt escalation of asthma treatment to prevent severe asthma attacks. All patients presenting with poorly controlled asthma symptoms should be examined and have peak expiratory flow (PEF) or forced expiratory volume in 1 second (FEV1) recorded. Patients with a PEF of less than 50% of baseline or predicted should be regarded as having a severe exacerbation and be referred to hospital; they require treatment with systemic corticosteroids and inhaled bronchodilators. There should be a lower threshold for admission for asthmatics who have risk factors for fatal asthma attacks. Patients who have features of a life-threatening or near-fatal attack should be discussed with a senior physician and/or intensive care immediately. Prior to discharge, patients should have a medication review and personal asthma management plan agreed. There should be early follow-up arranged and immediate written information faxed to the GP.