TREATMENT OF SEVERE ACUTE ASTHMA - ASSESS MENT OF INTERNATIONAL GUIDELINES

Acute asthma can sometimes be severe and potentially life threatening. International guidelines have defined both characteristics of these s evere attacks and the associated therapeutic instructions. The efficac y and feasibility of these recommandations were evaluated in 15 asthma tic patients who were admitted to hospital because a severe asthma att ack. These patients fulfilled the criteria of severity defined by a Br itish experts conference in the international guidelines published in 1990 in the British Medical Journal. A first line treatment was given to all the patients and included both systemic corticosteroids and inh aled beta2-agonists. In case of failure, beta2-agonists were given int ravenously and oxygen was administered as required. Monitoring was car ried out between the admission and the 8th hour using the following cr iteria: peak expiratory flow (DP), respiratory frequency (FR), and hea rt rate (FC). Both DP and FR significantly improved from 196+/-79 to 2 92+/-104 l/min (p <0.01) and from 27.5+/-5.5 to 23.7+/-5.6 (p <0.02), respectively. FR remained unchanged (97+/-13 vs 98+/-13; ns). There wa s a favourable outcome in all cases. Beta2-agonists administered intra venously were only necessary in two patients for whom no predictive fa ctor could be determined It is concluded that international guidelines are applicable to severe acute asthma. Inhaled route for beta2-agonis t is sufficient for the majority of patients presenting with the crite ria defining severe acute asthma unless life threatening symptoms are present.