Asthma.

Asthma is an extremely common disease that the emergency physician handles on a daily basis. Accurate clinical assessment from the history and physical examination is very important to assess the severity of the disease. Some measure of airway resistance of either FEV1 or PEFR should be done in every patient initially, at repeated intervals, and at discharge, to have a parameter to follow in therapy as well as a tool to use to warn the physician of a severe amount of airway obstruction. The inhaled beta agonists are the first line of therapy in acute asthma and can be delivered by either the nebulizer or the MDI with or without a spacer. Aminophylline will be continued to be used acutely even though it appears there is no improvement in bronchospasm in the first few hours of treatment when aminophylline is added to therapy. Anticholinergic agents will gain a wider role in acute asthma, especially when used in combination with a beta agonist. Corticosteroids continue to have a role in severe attacks of asthma, and earlier use may prevent relapse. Fatal asthma still occurs, however, and the emergency physician must use strict criteria to recognize status asthmaticus or the patient who is not doing well and admit them to the hospital. Using a stepwise, logical approach to the treatment of the asthmatic patient will lead to better patient satisfaction and fewer errors on part of the emergency physician.