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A Journal on Diseases of the Respiratory System
Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Minerva Pneumologica 2006 March;45(1):1-15
Management of patients with exacerbation of bronchial asthma
Confalonieri M., Kodric M., Della Porta R., Demsar M.
Struttura Complessa Pneumologia Ospedale di Cattinara di Alta Specializzazione e di Interesse Nazionale Azienda Ospedaliero-Universitaria Ospedali Riuniti di Trieste, Trieste
In the history of asthma, the exacerbations represent periods of worsening of symptoms characterized by dyspnea, cough, wheezing and chest tightness altogether with fast decline in lung function. The commonest triggering factors are respiratory infections and exposure to irritants, allergens and drugs and poor compliance to steady-state treatment. Airways inflammation and smooth muscle constriction cause airflow limitation, lung hyperinflation and dishomogeneity of ventilation-perfusion rate with progressive deterioration that leads to respiratory muscle fatigue and potentially fatal respiratory failure. The bases of the therapy are the evaluation of the severity of the exacerbation and its prompt treatment; however, the poor response to the initial treatment and previous severe exacerbations may predict an episode of fatal or near-fatal asthma, which often accompany a scant perception of ongoing worsening symptoms. The GINA international guidelines summarize the treatment modalities based on the severity of exacerbation in outpatient and hospital settings and define criteria for hospital admission also emphasizing the role of patient education and of a regular follow-up.