5 Other risk factors for developing an asthma exacerbation include allergen triggers (e.g., pets, seasonal allergens, smoke exposure) and improper use of medications (e.g., not using a spacer, improper use of an inhaler or other delivery device). 4 However, regular monitoring of PEF does not help predict an asthma exacerbation. 3 In adults, variables associated with relapse within eight weeks of an asthma exacerbation include three or more visits for emergent care in the preceding six months, difficulty performing daily activities because of physical health in the preceding four weeks, and patient self-discharge from care within 24 hours of hospital admission without achieving 50 percent predicted peak expiratory flow (PEF). One study of children up to 18 years of age presenting to the emergency department with acute asthma symptoms identified multiple risk factors for a subsequent emergency department visit: age younger than two years, black race or Hispanic ethnicity, persistent asthma, public health insurance, lower asthma quality-of-life scores, and increased use of the health care system during the previous 12 months. Airway inflammation can persist for days to weeks after an acute attack therefore, more intensive treatment should be continued after discharge until symptoms and peak expiratory flow return to baseline. The administration of systemic corticosteroids within one hour of emergency department presentation decreases the need for hospitalization, with the most pronounced effect in patients with severe exacerbations. ![]() Intravenous magnesium sulfate has been shown to significantly increase lung function and decrease the necessity of hospitalization in children. Multiple doses of inhaled anticholinergic medication combined with beta 2 agonists improve lung function and decrease hospitalization in school-age children with severe asthma exacerbations. In the ambulatory and emergency department settings, the goals of treatment are correction of severe hypoxemia, rapid reversal of airflow obstruction, and reduction of the risk of relapse. Administration using a hand-held metered-dose inhaler with a spacer device is at least equivalent to nebulized beta 2 agonist therapy in children and adults. In patients with a peak expiratory flow of 50 to 79 percent of their personal best, up to two treatments of two to six inhalations of short-acting beta 2 agonists 20 minutes apart followed by a reassessment of peak expiratory flow and symptoms may be safely employed at home. Criteria for exacerbation severity are based on symptoms and physical examination parameters, as well as lung function and oxygen saturation. PC20 values between 1 and 16 mg/mL are inconclusive.Asthma exacerbations can be classified as mild, moderate, severe, or life threatening. Laboratories have different definitions of airway hyperreactivity, but in general patients showing at least a 20% drop in FEV1 from baseline (PC20) when the concentration of inhaled methacholine is 16 mg/mL excludes the diagnosis. The concentration of methacholine that causes a 20% drop in FEV1 is called the PC20. ![]() In a methacholine challenge test, spirometric parameters are measured at baseline and after inhalation of increasing concentrations of methacholine. read more with methacholine, a synthetic analog of acetylcholine that is a nonspecific bronchial irritant, is indicated to detect or exclude bronchoconstriction. When suspicion of asthma remains high despite normal spirometry results, provocative testing Pulmonary function tests Asthma is a disease of diffuse airway inflammation caused by a variety of triggering stimuli resulting in partially or completely reversible bronchoconstriction. However, some patients with asthma can have normal pulmonary function and normal spirometric parameters between exacerbations. Improvement of FEV1 and/or FVC ≥ 12% and 200 mL with the administration of a bronchodilator confirms the diagnosis of asthma Asthma Asthma is a disease of diffuse airway inflammation caused by a variety of triggering stimuli resulting in partially or completely reversible bronchoconstriction.
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