Pharmacologic approaches to life-threatening asthma
Following a peak in asthma mortality in the late 1980s and early 1990s, we have been fortunate to see a substantial decrease in asthma deaths in recent years. Although most asthma deaths occur outside the hospital, near-fatal events are commonplace, with anywhere from 2–20% of patients with acute as...
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Series: | Therapeutic Advances in Respiratory Disease |
Online Access: | https://doi.org/10.1177/1753465811398721 |
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doaj-d11fab8c19c84ab8a0978166cff9c1172020-11-25T03:43:17ZengSAGE PublishingTherapeutic Advances in Respiratory Disease1753-46581753-46662011-12-01510.1177/1753465811398721Pharmacologic approaches to life-threatening asthmaLinda RogersJoan ReibmanFollowing a peak in asthma mortality in the late 1980s and early 1990s, we have been fortunate to see a substantial decrease in asthma deaths in recent years. Although most asthma deaths occur outside the hospital, near-fatal events are commonplace, with anywhere from 2–20% of patients with acute asthma admitted to intensive care, and 2-4% intubated for respiratory failure. Standard therapies for acute severe and near-fatal asthma include administration of systemic corticosteroids, and frequent or continuous inhaled beta agonists. Controversy remains regarding the optimal therapy of those who fail to respond to these initial treatments, those who remain at risk of acute respiratory failure, and patients requiring mechanical ventilation. There remain significant gaps in our knowledge regarding relative benefits of intravenous versus oral corticosteroids, intermittent versus continuous beta agonists, and the role of various adjunctive treatments including intravenous magnesium, systemic beta agonists, aminophylline, and helium-oxygen mixtures. Using models and radiolabeled aerosols, there is a greater understanding regarding effective administration of inhaled beta-agonists in ventilated patients. There is limited available evidence for treatment of near-fatal asthma, a fact reflected by the significant variability in asthma critical care practice. Much of the data guiding treatment in this setting has been generalized from studies of acute asthma in the ED and from general populations of hospitalized patients with acute asthma. This review will focus on pharmacologic approaches to life-threatening asthma by reviewing current guideline recommendations, reviewing the scientific basis of the guidelines, and highlighting gaps in our knowledge in treatment of refractory acute or near-fatal asthma.https://doi.org/10.1177/1753465811398721 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Linda Rogers Joan Reibman |
spellingShingle |
Linda Rogers Joan Reibman Pharmacologic approaches to life-threatening asthma Therapeutic Advances in Respiratory Disease |
author_facet |
Linda Rogers Joan Reibman |
author_sort |
Linda Rogers |
title |
Pharmacologic approaches to life-threatening asthma |
title_short |
Pharmacologic approaches to life-threatening asthma |
title_full |
Pharmacologic approaches to life-threatening asthma |
title_fullStr |
Pharmacologic approaches to life-threatening asthma |
title_full_unstemmed |
Pharmacologic approaches to life-threatening asthma |
title_sort |
pharmacologic approaches to life-threatening asthma |
publisher |
SAGE Publishing |
series |
Therapeutic Advances in Respiratory Disease |
issn |
1753-4658 1753-4666 |
publishDate |
2011-12-01 |
description |
Following a peak in asthma mortality in the late 1980s and early 1990s, we have been fortunate to see a substantial decrease in asthma deaths in recent years. Although most asthma deaths occur outside the hospital, near-fatal events are commonplace, with anywhere from 2–20% of patients with acute asthma admitted to intensive care, and 2-4% intubated for respiratory failure. Standard therapies for acute severe and near-fatal asthma include administration of systemic corticosteroids, and frequent or continuous inhaled beta agonists. Controversy remains regarding the optimal therapy of those who fail to respond to these initial treatments, those who remain at risk of acute respiratory failure, and patients requiring mechanical ventilation. There remain significant gaps in our knowledge regarding relative benefits of intravenous versus oral corticosteroids, intermittent versus continuous beta agonists, and the role of various adjunctive treatments including intravenous magnesium, systemic beta agonists, aminophylline, and helium-oxygen mixtures. Using models and radiolabeled aerosols, there is a greater understanding regarding effective administration of inhaled beta-agonists in ventilated patients. There is limited available evidence for treatment of near-fatal asthma, a fact reflected by the significant variability in asthma critical care practice. Much of the data guiding treatment in this setting has been generalized from studies of acute asthma in the ED and from general populations of hospitalized patients with acute asthma. This review will focus on pharmacologic approaches to life-threatening asthma by reviewing current guideline recommendations, reviewing the scientific basis of the guidelines, and highlighting gaps in our knowledge in treatment of refractory acute or near-fatal asthma. |
url |
https://doi.org/10.1177/1753465811398721 |
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