Mein Stephen A, Ferrera Michael C
Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
CHEST Crit Care. 2025 Mar;3(1). doi: 10.1016/j.chstcc.2024.100107. Epub 2024 Nov 8.
Severe, life-threatening asthma and COPD exacerbations are managed commonly in the ICU and are associated with significant morbidity and mortality. It is important to understand the commonalities and differences in the diagnosis and management of these obstructive lung diseases to improve patient outcomes via evidence-based care. In this review, we first outline triggers of acute asthma and COPD exacerbations and an initial diagnostic evaluation and severity assessment. We then review the pathophysiologic features of asthma and COPD exacerbations and create a framework for the management of exacerbations in critically ill adult patients aimed at reducing airway inflammation, reversing bronchospasm, and, in severe cases, supporting patients with mechanical ventilation or advanced therapies until clinical improvement is achieved.
严重的、危及生命的哮喘和慢性阻塞性肺疾病（COPD）急性加重通常在重症监护病房（ICU）进行管理，并且与显著的发病率和死亡率相关。了解这些阻塞性肺疾病在诊断和管理方面的共性与差异，对于通过循证护理改善患者预后非常重要。在本综述中，我们首先概述急性哮喘和COPD急性加重的诱发因素以及初始诊断评估和严重程度评估。然后，我们回顾哮喘和COPD急性加重的病理生理特征，并创建一个针对危重症成年患者急性加重管理的框架，旨在减轻气道炎症、逆转支气管痉挛，在严重情况下，为患者提供机械通气或高级治疗支持，直至临床症状改善。
