TheAnswerPage/Hospital & Critical Care Medicine Thursday 03/11/2010 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.

Bronchodilator and antiinflammatory agents remain standard therapy for acute asthma, consisting mainly of B2 agonists, steroids and to a lesser extent theophyllines and anticholinergics. However there exists a large number of alternative medical therapies including noninvasive ventilation.

1. Describe some of these alternative therapies and their proposed mechanisms of action.
2. Describe the use of noninvasive ventilation in the management of the acute asthmatic.

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