Managing exacerbations
|
SUMMARY OF PRACTICE POINTS
| LEVEL OF EVIDENCE |
|
Management of exacerbations in adults
|
|
A short (7-10 days) course of oral corticosteroids is the current standard treatment for adults with moderate-to-severe asthma exacerbations.
|
I |
| When administering a SABA via MDI during an exacerbation, use a spacer. |
[√] |
| In adults with acute exacerbations not considered severe enough for admission to hospital, high-dose ICS may be effective. |
II |
| Merely doubling the maintenance ICS dose is not effective in managing exacerbations. |
II |
|
Management of exacerbations in children
|
| A short (up to 5 days) course of oral corticosteroids (prednisolone 1 mg/kg up to 60 mg daily) is the current standard treatment for severe exacerbations. Closely monitor response to treatment. |
I |
| Children who are taking regular preventive medication should continue taking the same dose during an exacerbation. |
II |
| When administering a SABA via MDI during an exacerbation, use a spacer. |
III-1 |
| Merely doubling the maintenance ICS dose is not effective in managing exacerbations in children. |
II |
This chapter deals with the community-based management of asthma exacerbations.
For information on managing acute asthma (including asthma emergencies) in the hospital setting, see Acute asthma.
The term "exacerbation"* is usually understood to mean an acute or subacute deterioration in symptom control and lung function (compared with the individual's usual level of variation) that is sufficient to cause distress or risk to health and requires a change in treatment.1
The stage at which patients will present for additional treatment depends not only on the severity of symptoms, magnitude of reduction in lung function and the impact on daily activities, but also on access to care, costs, previous experience of health care and psychosocial factors including the patient's or carer's health-related beliefs.
- Fear of oral corticosteroids can delay presentation to medical services and therefore increase risk associated with an exacerbation.2
- Levels of anxiety and fear significantly influence patients' requests for asthma treatment. See Asthma and mental illness.
All patients and carers should be offered a current written asthma action plan to help them:
- make appropriate treatment adjustments in response to worsening asthma
- know when to use medical services (primary care or emergency facility).
See Asthma action plans.
*Notes: Guidelines for detecting and managing asthma exacerbations are currently limited by the lack of standardised criteria for exacerbations, and this is being addressed by a European Respiratory Society (ERS)/American Thoracic Society (ATS) Task Force. There is limited clinical evidence available to guide the management of early or suspected exacerbations. Few studies have compared different treatment approaches (e.g. oral corticosteroids versus high-dose ICS) in a group of clinically homogenous patients experiencing comparable exacerbations of a defined severity level or stage of onset. Most of the evidence relevant to the treatment of exacerbations in patients with stable asthma is derived from clinical trials designed to evaluate various clinical parameters as action triggers for the initiation of extra treatment. These trials have used initiation of oral corticosteroids (with or without hospitalisation) as the endpoint, and many have defined "severe exacerbation" as the requirement for oral corticosteroids, based on the treating clinician's assessment.
Content Created (Thursday, 16 November 2006)
|
