University of Virginia Health System, Charlottesville, 22908, USA.
Am Fam Physician. 2011 Jul 1;84(1):40-7.
Asthma exacerbations can be classified as mild, moderate, severe, or life threatening. Criteria for exacerbation severity are based on symptoms and physical examination parameters, as well as lung function and oxygen saturation. In patients with a peak expiratory flow of 50 to 79 percent of their personal best, up to two treatments of two to six inhalations of short-acting beta2 agonists 20 minutes apart followed by a reassessment of peak expiratory flow and symptoms may be safely employed at home. Administration using a hand-held metered-dose inhaler with a spacer device is at least equivalent to nebulized beta2 agonist therapy in children and adults. In the ambulatory and emergency department settings, the goals of treatment are correction of severe hypoxemia, rapid reversal of airflow obstruction, and reduction of the risk of relapse. Multiple doses of inhaled anticholinergic medication combined with beta2 agonists improve lung function and decrease hospitalization in school-age children with severe asthma exacerbations. Intravenous magnesium sulfate has been shown to significantly increase lung function and decrease the necessity of hospitalization in children. The administration of systemic corticosteroids within one hour of emergency department presentation decreases the need for hospitalization, with the most pronounced effect in patients with severe exacerbations. Airway inflammation can persist for days to weeks after an acute attack; therefore, more intensive treatment should be continued after discharge until symptoms and peak expiratory flow return to baseline.
哮喘加重可分为轻度、中度、重度和危及生命。加重严重程度的标准基于症状和体检参数，以及肺功能和氧饱和度。对于呼气峰流量为个人最佳值的 50%至 79%的患者，可以在家中安全地使用两种方案：每 20 分钟使用短效β2 激动剂 2 至 6 喷，共两次治疗，然后重新评估呼气峰流量和症状；或者使用带喷雾室的手持式定量吸入器进行给药。在儿童和成人中，使用这种方法的效果至少等同于雾化β2 激动剂治疗。在门诊和急诊环境中，治疗的目标是纠正严重低氧血症、迅速逆转气流阻塞以及降低复发风险。对于严重哮喘加重的学龄儿童，联合使用吸入性抗胆碱能药物和β2 激动剂可改善肺功能并降低住院率。静脉注射硫酸镁已被证明可显著改善肺功能并降低住院的必要性。在急诊科就诊后 1 小时内给予全身皮质类固醇可降低住院的必要性，在重度加重的患者中效果最为明显。气道炎症在急性发作后可持续数天至数周；因此，应在出院后继续进行更强化的治疗，直至症状和呼气峰流量恢复到基线水平。
