The acute severe asthma attack [Der akute schwere Asthmaanfall]

Acute dypnoea due to an acute asthma attack is a frequent cause of emergency treatment. Alternative diagnosis can be acute left heart failure with pulmonary edema, lung emboli, acute exacerbations of COPD and foreign body aspiration. Fatal asthma attacks are rare compared to the number of asthma attacks treated and due to underestimation of the severity of the attack. Cornerstones of acute treatment are oxygen, β2-adrenergic agonists, systemic corticosteroids and parasymaptholytics. The addition of theophylline has not been shown to add any bronchodilatory but more side effects. Additional pharmacological options are magnesium, volatile anesthetics, lidocaine, ketamine, and propofol. Depending on the clinical development mechanical ventilation might be necessary. However, endotracheal intubation per se might cause an increase in bronchoconstriction with side effects like overdistension, compression atelectasis, pneumothoraces, and hemodynamic depression. Overall, with intensive pharmacological treatment severe asthma attacks can be significantly improved within 24 hours. Thus, fatal asthma attacks seem to be avoidable with early and intensive treatment. © Springer Medizin Verlag 2004.