Acute severe asthma: Triage, treatment and thereafter

Summary Despite an increased understanding of the aetiology and pathogenesis of bronchial asthma, attempts to classify its severity have proved difficult. Objective changes in cardiopulmonary function do not consistently correlate with symptomatic decline during an acute exacerbation of asthma. Whilst the majority of such episodes are treatment-responsive, a number of asthmatics still succumb to the severest form of the disease every year, often despite aggressive medical therapy. Although patients with severe asthma are in the minority within the disease spectrum, they seek and receive a disproportionate share of health care resources and are responsible for considerable morbidity associated with it. In addition to identifying such patients, a major challenge is the prioritisation of medical treatment when they present to the emergency department. Patients with acute severe asthma whose initial treatment is inadequate or delayed risk admission to the intensive care unit; the in-hospital mortality of these individuals remains significant. Timely provision of emergency therapy, vigilance against failure of first-line intervention and ensuring ready availability of escalating measures are critical elements of tertiary asthma care with which hospital physicians must be familiar.