TheAnswerPage/Hospital & Critical Care Medicine Tuesday 03/09/2010 This week: Various aspects of the management of severe asthma

Asthma is a common condition affecting 5 to 10% of the US population. It is a complex syndrome with many clinical phenotypes varying from mild to acute life threatening presentations. Many patients present with asthma during their infancy, others at adult age. There are clear genetic factors (atopy) and environmental components (virus, allergens, occupational exposure) contributing to asthma. Asthma is a (mostly IgE-mediated) inflammation of both central and peripheral airways. The prevalence and mortality of asthma are both increasing for unclear reasons. Admission to an ICU represents a failure of management. Status asthmaticus is a medical emergency where appropriate management is critical.

Assessment of the severity of asthma is critical to provide appropriate treatment and avoid complications.

1. What are the clinical features of a severe asthmatic attack?
2. Which investigations should one perform to help assess the severity of the attack?
3. What are the indications for intubation and how would one perform this?

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