Asthma is a multifactorial chronic inflammatory disorder of the airways affecting approximately 2 million Australians. It results in airflow obstruction characterised by recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly at night or in the early morning. A personal and family history of atopy is common. To view the 2016 definition produced by the National Asthma Council Australia click here.
ED presentations range from mild wheeze to life-threatening asthma and respiratory collapse.
Asthma remains a common ED presentation in Australia with around 40% of presentations resulting in a hospital admission. In 2018 there were 389 deaths due to asthma, most of which occurred in the elderly.
The majority of your ED exposure will be mild/moderate asthma presentations but these patients can deteriorate rapidly without timely initiation of treatment. Assessment and management must therefore occur concurrently to prevent severity progression.
Summary of steps in the emergency care of an adult with acute asthma:
Brief history and rapid primary assessment of asthma severity
If acutely distressed give oxygen and short acting bronchodilator (salbutamol) immediately
Take a more detailed history and complete secondary asthma severity assessment including spirometry
Follow the appropriate treatment pathway
Review response to treatment
Make disposition plan
If discharge criteria met ensure appropriate follow up arranged including a written asthma management plan and checking inhaler technique