Acute asthma, prognosis, and treatment

Asthma affects about 300 million people globally and accounts for 1 in every 250 deaths in the world. Approximately 12 million people in the United States each year experience an acute exacerbation of their asthma, a quarter of which require hospitalization. Acute asthma should be differentiated from poor asthma control. Patients with acute asthma will exhibit increasing shortness of breath, chest tightness, coughing, and/or wheezing. In contrast, poor asthma control typically presents with a diurnal variability in airflow and is a characteristic that is usually not seen during an acute exacerbation. The history should include a review of comorbidities, adherence to medications, previous episodes of near-fatal asthma, and whether the patient has experienced multiple emergency department visits or hospitalizations, particularly those requiring admission to an intensive care unit involving respiratory failure, intubation, and mechanical ventilation. Patient education is important to ensure that the patient understands that asthma is mostly a chronic disease and necessitates the avoidance of allergens, prevention of infections, adherence with routine vaccinations, management of comorbid conditions, and adherence to treatment regimens. This article is a structured review of the available literature regarding the diagnosis and management of acute asthma.