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Evidence-based treatments for
acute asthma.
Rowe BH, Edmonds ML, Spooner CH,
Camargo CA.
Division of Emergency Medicine, University of
Alberta, Edmonton, Alberta, Canada. brian.rowe@ualberta.ca
Asthma
is an important health care problem; over 12 million people in the
United States suffer from asthma, the majority of whom are young
patients. Presentations of acute asthma to emergency departments are
common. In the United States, acute asthma presentations account for
close to 2 million emergency department visits annually, and these
patients often exhibit acute and chronic markers of severe asthma; so
controlling asthma is important from many perspectives. We review the
evidence for various acute asthma therapies, using the highest levels of
evidence, employing systematic reviews (especially those from the
Cochrane Collaboration) and evidence from randomized controlled trials
to guide therapy decisions. beta agonists and systemic corticosteroids
are the cornerstones of initial treatment. Delivery of beta agonists via
nebulizer or metered-dose inhaler with spacer device appear to be
similarly efficacious. However, recent evidence from studies involving
children and adults indicate that addition of ipratropium bromide to
early beta agonist treatments may reduce airway obstruction and reduce
hospital admissions, especially for more severe asthma. Evidence from
systematic reviews indicates that intravenous magnesium sulfate may
provide similar benefits in severe asthma. Antibiotics, intravenous beta
agonists, and intravenous aminophylline have been shown to add little
and may increase adverse effects. Treatment for discharged patients
should include systemic corticosteroids for 5-7 days, for all but the
mildest asthma. Addition of inhaled corticosteroids should be considered
for most patients, since evidence suggests that inhaled corticosteroids
may reduce relapses and improve quality of life. Alternative treatments
such as long-acting beta agonists and leukotriene antagonists remain
unproven in this setting. Linking a discharge plan to close follow-up
and asthma education (especially an action plan) needs to be encouraged.
Acute asthma is a common problem and treatment has improved dramatically
over the past 10 years. Employing the evidence-based practice outlined
above should reduce the burden of acute asthma on patients and the
health care system.
Publication Types:
PMID: 11728298 [PubMed - indexed for
MEDLINE]
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