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Emergency Asthma

1999 Edition, February 23, 1999

Complete Document

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Active, Most Current

Additional Comments:
ISBN: 978-0-8247-1945-6
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Product Details:

  • Revision: 1999 Edition, February 23, 1999
  • Published Date: February 23, 1999
  • Status: Active, Most Current
  • Document Language: English
  • Published By: CRC Press (CRC)
  • Page Count: 618
  • ANSI Approved: No
  • DoD Adopted: No

Description / Abstract:


Acute asthma is one of the most common specific illnesses that present to an emergency department (ED). Over the last 20 years, many changes have occurred in the management of asthma in the ED. Intravenous aminophylline and subcutaneous epinephrine used to be the mainstays of acute asthma treatment in adults. In children, serial injections of subcutaneous epinephrine followed by a ‘‘chaser'' of aqueous suspension epinephrine, Susphrine®, were routine. Patients were discharged from the ED when they were asymptomatic and ‘‘wheeze-free.'' Concomitantly, emergency medicine has come of age as a specialty to care for many patients with acute asthma from a unique perspective. There are now practice guidelines, noninvasive measures of oxygenation, and monitors of airway flow rates for acute asthmatics in the ED. However, in the last 20 years there has also been a worldwide increase in asthma morbidity and mortality. Each year there are over one million visits to the ED for acute asthma, with asthma representing 10% of ED visits in certain regions. The total direct economic cost has been estimated at $6.2 billion.

This book is intended to serve as a concise but thorough, clinically useful compendium dedicated to both the clinician and patient with acute asthma in the ED. Each chapter is a short but well-referenced state-of-the-art review of the subject. Where appropriate, the chapters discuss asthma in children as well as adults. The aim of this book is to provide scholarly information applicable at the bedside or ‘‘asthma chair.'' To this end, I have sought chapter authors from a cross section of fields—including epidemiology, allergy and immunology, pulmonary, and critical care medicine—who have achieved prominence in asthma. Most of the chapter authors are academic emergency physicians and clinicians involved with both pediatric and adult emergency medicine.

The book covers a wide range of topics, including an introduction to past and future directions in asthma, i.e., the history of asthma and trends in future asthma research; pathophysiology; epidemiology of acute asthma, especially in urban centers; factors that result in the visit to the ED; clinical manifestations; evaluations such as pulse oximetry, spirometry, laboratory work, electrocardiograms, and X-rays; management of acute asthma involving the National Institutes of Health (NIH) protocol, among others, and specific treatments; management of the airway and endotracheal intubation; special situations, such as the pregnant asthmatic or intractable severe asthma; disposition from the ED and the role of the observation unit; and how to prevent relapse.

Emergency Asthma reviews the current thinking about asthma, especially as it presents to the ED. The definition and diagnosis of acute asthma are covered in several chapters in this book (see Chapters 5, 13, and 14 on epidemiology, differential diagnosis, and spirometry, respectively). Of particular note is that there is no overall diagnostic or treatment plan covering the entire subject of acute asthma. For this purpose, I suggest the reader refer to Chapter 18 for guidelines for the management of adult asthma, which lists the 1997 National Asthma Education and Prevention Program (NAEPP) guidelines. The impact of algorithmic treatment guidelines for acute asthma in the ED remains an area of investigation.

It is my hope that this book will be a starting point to stimulate new interventions; develop effective management protocols; and forge partnerships between emergency physicians, private practitioners, and researchers. It is also my goal that this collaboration will work to reverse the tide of increasing ED visits, admissions, and mortality due to asthma. This effort is dedicated to the patients, the best justification for the academic excellence of the clinician.