Department of Pulmonology and Critical Care, University of KwaZulu-Natal, Durban, South Africa.
S Afr Med J. 2012 Dec 3;103(3 Pt 2):189-98. doi: 10.7196/samj.6526.
Acute asthma attacks (asthma exacerbations) are increasing episodes of shortness of breath, cough, wheezing or chest tightness associated with a decrease in airflow that can be quantified and monitored by measurement of lung function (peak expiratory flow (PEF) or forced expiratory volume in the 1st second) and requiring emergency room treatment or admission to hospital for acute asthma and/or systemic glucocorticosteroids for management. The goals of treatment are to relieve hypoxaemia and airflow obstruction as quickly as possible, restore lung function, and provide a suitable plan to avoid relapse. Severe exacerbations are potentially life-threatening and their treatment requires baseline assessment of severity, close monitoring, and frequent reassessment using objective measures of lung function (PEF) and oxygen saturation. Patients at high risk of asthma-related death require particular attention. First-line therapy consists of oxygen supplementation, repeated administration of inhaled short-acting bronchodilators (beta-2-agonists and ipratropium bromide), and early systemic glucocorticosteroids. Intravenous magnesium sulphate and aminophylline are second- and third-line treatment strategies, respectively, for poorly responding patients. Intensive care is indicated for severe asthma that is not responsive to first-line treatment. Antibiotics are only indicated when there are definite features of bacterial infection. Factors that precipitated the acute asthma episode should be identified and preventive measures implemented. Acute asthma is preventable with optimal control of chronic asthma.
急性哮喘发作（哮喘恶化）是指与气流减少相关的呼吸急促、咳嗽、喘息或胸闷的频繁发作，这些可以通过肺功能（呼气峰流速（PEF）或第 1 秒用力呼气量）的测量来量化和监测，并需要急诊治疗或住院治疗急性哮喘和/或全身糖皮质激素来进行管理。治疗的目标是尽快缓解低氧血症和气流阻塞，恢复肺功能，并提供一个合适的计划以避免复发。严重的恶化可能危及生命，其治疗需要对严重程度进行基线评估、密切监测，并使用肺功能（PEF）和氧饱和度的客观测量指标进行频繁重新评估。有哮喘相关死亡风险的患者需要特别关注。一线治疗包括氧补充、反复吸入短效支气管扩张剂（β-2-激动剂和异丙托溴铵）和早期全身糖皮质激素。对于反应不佳的患者，静脉硫酸镁和氨茶碱分别是二线和三线治疗策略。对于严重哮喘，需要重症监护。抗生素仅在存在明确细菌感染特征时使用。应确定引发急性哮喘发作的因素，并采取预防措施。通过优化慢性哮喘的控制，可以预防急性哮喘。
