Guideline for the management of acute asthma in adults: 2013 update

U G Lalloo, G M Ainslie, M S Abdool-Gaffar, A A Awotedu, C Feldman, M Greenblatt, E M Irusen, R Mash, S S Naidoo, J O'Brien, W Otto, G A Richards, M L Wong,, (Official Working Group of the South African Thoracic Society)


Acute asthma attacks (asthma exacerbations) are increasing episodes of shortness of breath, cough, wheezing or chest tightness associated with a decrease in airflow that can be quantified and monitored by measurement of lung function (peak expiratory flow (PEF) or forced expiratory volume in the 1st second) and requiring emergency room treatment or admission to hospital for acute asthma and/or systemic glucocorticosteroids for management. The goals of treatment are to relieve hypoxaemia and airflow obstruction as quickly as possible, restore lung function, and provide a suitable plan to avoid relapse. Severe exacerbations are potentially life-threatening and their treatment requires baseline assessment of severity, close monitoring, and frequent reassessment using objective measures of lung function (PEF) and oxygen saturation. Patients at high risk of asthma-related death require particular attention. First-line therapy consists of oxygen supplementation, repeated administration of inhaled short-acting bronchodilators (beta-2-agonists and ipratropium bromide), and early systemic glucocorticosteroids. Intravenous magnesium sulphate and aminophylline are second- and third-line treatment strategies, respectively, for poorly responding patients. Intensive care is indicated for severe asthma that is not responsive to first-line treatment. Antibiotics are only indicated when there are definite features of bacterial infection. Factors that precipitated the acute asthma episode should be identified and preventive measures implemented. Acute asthma is preventable with optimal control of chronic asthma.

Authors' affiliations

U G Lalloo, Department of Pulmonology and Critical Care, University of KwaZulu-Natal, Durban

G M Ainslie, Respiratory Clinic, Groote Schuur Hospital and University of Cape Town

M S Abdool-Gaffar, Pulmonologist in private practice, Amanzimtoti, KwaZulu-Natal

A A Awotedu, Department of Medicine, Walter Sisulu University, Mthatha, Eastern Cape

C Feldman, Division of Pulmonology, University of the Witwatersrand, Johannesburg

M Greenblatt, Centre for Chest Diseases, Milpark Hospital, Johannesburg

E M Irusen, Division of Pulmonology, Department of Medicine, Stellenbosch University, Parow, Cape Town

R Mash, Department of Family Medicine and Primary Care, Stellenbosch University, Parow, Cape Town

S S Naidoo, Department of Family Medicine, University of KwaZulu-Natal, Durban

J O'Brien, Pulmonologist in private practice, Cape Town

W Otto, Department of Internal Medicine, University of the Free State, Bloemfontein

G A Richards, Division of Intensive Care, University of the Witwatersrand, Johannesburg

M L Wong,, Division of Pulmonology, University of the Witwatersrand, Johannesburg

(Official Working Group of the South African Thoracic Society),

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Acute Asthma

Cite this article

South African Medical Journal 2013;103(3):189-198. DOI:10.7196/SAMJ.6526

Article History

Date submitted: 2012-11-19
Date published: 2012-12-03

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