Carlos Adrián Jiménez González , Luis Torre Bouscoulet
2009, Suplement 2
2009; 68 (S2)
ABSTRACT
Any asthmatic patient at risk of developing exacerbations in severity from mild to very severe and rarely ends in death. Some patients have poor perception of their symptoms and can have a very significant decrease in lung function without a significant change in its manifestations so that with the exception of children under five, it is essential to measure whether the bronchial obstruction by flujometry or spirometry. There are two stages in the progression of an exacerbation of asthma: slow-onset acute asthma or type I, when predominant airway inflammation and patients show clinical and functional deterioration in hours, days and sometimes weeks. This can be between 80 and 90% of exacerbations that occur in adults. The other scenario, less commonly, bronchospasm is caused predominantly by causing an acute exacerbation or type II changes from 3 to 6 hours. In this chapter some recommendations about the treatment of patients in crisis and emphasizes the steps to be taken in different scenarios.
The Grading of Recommendations Assessment, Development and Evaluation (short GRADE) Disponible en:www.gradeworkinggropup.org
Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Asociación Latinoamericana del Tórax (ALAT), «Guía ALERTA (América Latina y España: Recomendaciones para la Prevención y el Tratamiento de la Exacerbación Asmática)»: 2008.
Field MJ, Lohr KN. Clinical Practice Guidelines: Directions for a New Program. Institute of Medicine, Washington DC: National Academy Press: 1990.
Rodrigo GJ. Tratamiento en la urgencia. Disponible en: www.neumologia-pediatrica.cl
Rodrigo GJ, Rodriguez Verde M, Peregalli V, Rodrigo C. Effects of short-term 28% and 100% oxygen on PaCO2 and peak expiratory flow rate in acute asthma: a randomized trial. Chest 2003; 124: 1312-7.
GEMA 2009. Guía española para el manejo del asma. Disponible en: www.gemasma.com
Global Strategy for Asthma Management and Prevention. Update 2008. Available on www: ginasthma.com
Castro-Rodríguez JA, Rodrigo GJ. Beta-agonists through metered-dose inhaler with valved holding chamber versus nebulizer for acute exacerbation of wheezing or asthma in children under 5 years of age: a systematic review with meta-analysis. J Pediatr 2004; 145: 172-7.
Boulet LP, Becker A, Bérubé D, Beveridge R, Ernst P. Canadian Asthma Consensus Report, 1999. Canadian Asthma Consensus Group. CMAJ. 1999; 161(11 Suppl): S1-61.
Rodrigo GJ, Rodrigo C. Continuous vs intermittent beta agonists in the treatment of acute adult asthma: a systematic review with meta-analysis. Chest 2002; 122: 160-5.
Félez MA, Roca J, Barbera JA, Santos C, Rotger M, Chung KF, et al. Inhaled platelet-activating factor worsens gas Exchange in mild asthma. Am J Respir Crit Care Med 1994; 150: 369-73.
Rodrigo G, Rodrigo C. Inhaled flunisolide for acute severe asthma. Am J Respir Crit Care Med 1998; 157: 698-703.
Mc Fadden ER. Inhaled glucocorticoids and acute asthma: therapeutic breakthrough or non-specific effect. Am J Respir Crit Care Med 1998; 157: 677-8.
Kumar SD, Brieva JL, Danta I, Wanner A. Transient effect of inhaled fluticasone on airway mucosal blood flow in subjects with and without asthma. Am J Respir Crit Care Med 2000; 161(3): 918-21.
Edmonds ML, Camargo CA, Pollack CV, Rowe BH. The effectiveness of inhaled corticosteroids in the Emergency Department treatment of acute asthma: a meta-analysis. Ann Emerg Med 2002; 40(2): 145-54.
Jones AM, Munavvar M, Vail A, Aldridge RE , Hopkinson L, Rayner C, et al. Prospective, placebo controlled trial of 5 vs 10 days of oral prednisolone in acute adult asthma. Respir Med 2002; 96(11): 950-4.
Edmonds ML, Camargo CA, Brenner BE, Rowe BH. Replacement of oral corticosteroids with inhaled corticosteroids in the treatment of acute asthma following Emergency Department discharge: a meta-analysis. Chest 2002; 121(6): 1798-805.
British Guideline on the Management of Asthma. Thorax 2008; 63 (suppl IV): iv1-iv121.
Rodrigo G, Rodrigo C. Inhaled flunisolide for acute severe asthma. Am J Respir Crit Care Med 1998; 157 (3Pt 1): 698-703.
Parameswaran K, Belda J, Rowe BH. Additionn of intravenous aminophylline to b2-agonists in adults with acute asthma. Cochrane Database of Systematic Reviews 2000, Issue 4: CD002742.
Rowe BH. Emergency Department Treatment of Severe Acute Asthma. Ann Emerg Med 2006; 6: 564-7.
Rodrigo GJ, Rodrigo C, Pollack CV, Rowe BH. Use of helium oxygen mixtures in the treatment of acute asthma: a systematic review. Chest 2003; 123(3): 891-6.
Harris R. Emergency management of acute asthma. Aust Fam Physician 2002; 31(9): 1-4.
Practical Management of Acute Asthma in Adults and Children. 2009 Disponible en: www.rcjournal.com/contents/02.../02.02.0171.cfm