Acute Asthma Exacerbation

Acute asthma exacerbations (AAE) are episodes of progressive worsening of asthma symptoms requiring urgent evaluation and treatment. Prompt assessment and early intervention improve outcomes and reduce hospitalizations.

Assessment

Initial evaluation should include:

Vital signs: Heart rate, respiratory rate, blood pressure, oxygen saturation
Peak expiratory flow (PEF): If patient able to perform (compare to personal best or predicted)
Work of breathing: Accessory muscle use, retractions, tripod positioning
Speech: Ability to speak in full sentences vs. words only
Mental status: Alertness, agitation, altered consciousness

Severity Classification

Severity	PEF	O2 Saturation	Clinical Features
Mild	Greater than 70%	Greater than 95%	Minimal dyspnea, speaks in sentences
Moderate	40-70%	90-95%	Moderate distress, speaks in phrases
Severe	Less than 40%	Less than 90%	Severe distress, speaks in words
Life-threatening	Unable to perform	Less than 90%	Silent chest, altered consciousness

Initial Management

First-Line Therapy

Oxygen - Target O2 saturation 93-95% (94-98% in children)
Short-Acting Beta-Agonist (SABA)
- Albuterol nebulizer: 2.5-5 mg every 20 minutes for 3 doses
- MDI with spacer: 4-8 puffs every 20 minutes for 3 doses

Systemic Corticosteroids
- Start early (within first hour)
- Prednisone/Prednisolone: 1-2 mg/kg PO once daily (max 60 mg) for 5 days
- No taper needed for short courses

Key Points

Early recognition and treatment prevent progression
Systemic corticosteroids should be given within the first hour
Most patients can be managed with SABA, ipratropium, and steroids
Discharge only when sustained improvement documented
Schedule close follow-up to prevent future exacerbations

References

This is a simplified demonstration article. Full article coming soon with FrontmatterTabs component.

Assessment​

Severity Classification​

Initial Management​

First-Line Therapy​

Key Points​

References​