Gustavo J Rodrigo1. 1. Departamento de Emergencia, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay. gurodrig@adinet.com.uy
Abstract
PURPOSE OF REVIEW: To analyze the prediction of response of therapy into the context of acute adult asthma assessment in the emergency department (ED) setting. RECENT FINDINGS: Close monitoring of the patient's condition at presentation (static assessment) and response to treatment (dynamic assessment), including serial measurements of lung function, is an essential part of the acute asthma care in the ED. The severity of airflow obstruction cannot be accurately judged by patient's symptoms and physical examination alone. Accordingly, it is very important to use an objective measure of airway obstruction (spirometry or peak flow meter). Although spirometry can be performed in acutely ill ED asthmatics, measurement of peak expiratory flow, with values expressed as predicted normal values, represents an alternative if spirometry is not available. SUMMARY: Failure of initial therapy to improve expiratory flow predicts a more severe course and need for hospitalization. Although several score systems have been developed, different factors limit their applicability in the ED setting. Thus, peak expiratory flow rate measures at 15-60 min of treatment, joined with continuous monitoring of oxygen saturation may be the best ways to assess patients with acute asthma.
PURPOSE OF REVIEW: To analyze the prediction of response of therapy into the context of acute adult asthma assessment in the emergency department (ED) setting. RECENT FINDINGS: Close monitoring of the patient's condition at presentation (static assessment) and response to treatment (dynamic assessment), including serial measurements of lung function, is an essential part of the acute asthma care in the ED. The severity of airflow obstruction cannot be accurately judged by patient's symptoms and physical examination alone. Accordingly, it is very important to use an objective measure of airway obstruction (spirometry or peak flow meter). Although spirometry can be performed in acutely ill ED asthmatics, measurement of peak expiratory flow, with values expressed as predicted normal values, represents an alternative if spirometry is not available. SUMMARY: Failure of initial therapy to improve expiratory flow predicts a more severe course and need for hospitalization. Although several score systems have been developed, different factors limit their applicability in the ED setting. Thus, peak expiratory flow rate measures at 15-60 min of treatment, joined with continuous monitoring of oxygen saturation may be the best ways to assess patients with acute asthma.