Summary and References

Asthma exacerbations represent a significant healthcare challenge that requires a multifaceted approach to management. This comprehensive course has detailed the:

• Pathophysiology: Understanding the underlying mechanisms, including inflammation and bronchoconstriction.
• Risk Factors and Triggers: Identification and avoidance of common triggers.
• Clinical Manifestations and Diagnosis: Recognizing signs, symptoms, and utilizing diagnostic tools.
• Non-Pharmacological Management: Including breathing techniques and allergen avoidance.
• Pharmacological Management: Extensive review of medications, including dosing, rationale, and adverse effects.
• Complications and Emergency Management: Recognition and intervention in severe cases.
• Monitoring and Follow-up: Continuous assessment and long-term care planning.
• Discharge Planning and Patient Education: Ensuring a successful transition to home care.

The emphasis on evidence-based practice, individualized care, and the crucial role of healthcare providers, particularly clinical pharmacists, has been highlighted throughout.

References

The information presented in this course is grounded in current clinical guidelines, expert consensus, and evidence-based literature. Key references include:

1. Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention, 2021.
2. National Heart, Lung, and Blood Institute. Guidelines for the Diagnosis and Management of Asthma, 2020.
3. UpToDate. Acute exacerbations of asthma in adults: Emergency department and inpatient management.
4. UpToDate. Acute exacerbations of asthma in adults: Home and office management.
5. British Thoracic Society. BTS/SIGN British Guideline on the Management of Asthma, 2021.
6. Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma, 2007.
7. Camargo CA Jr, Rachelefsky G, Schatz M. Managing asthma exacerbations in the emergency department: Summary of the National Asthma Education and Prevention Program Expert Panel Report 3 guidelines for the management of asthma exacerbations. Proc Am Thorac Soc. 2009;6(4):357-66.
8. Rodrigo GJ, Rodriquez Verde M, Peregalli V, Rodrigo C. Effects of short-term 28% and 100% oxygen on PaCO2 and peak expiratory flow rate in acute asthma: A randomized trial. Chest. 2003;124(4):1312-7.
9. Griffiths B, Ducharme FM. Combined inhaled anticholinergics and short-acting beta2-agonists for initial treatment of acute asthma in children. Cochrane Database Syst Rev. 2013;(8):CD000060.
10. Rowe BH, Spooner C, Ducharme FM, Bretzlaff JA, Bota GW. Early emergency department treatment of acute asthma with systemic corticosteroids. Cochrane Database Syst Rev. 2001;(1):CD002178.
11. Stoodley RG, Aaron SD, Dales RE. The role of ipratropium bromide in the emergency management of acute asthma exacerbation: A metaanalysis of randomized clinical trials. Ann Emerg Med. 1999;34(1):8-18.
12. Cates CC, Welsh EJ, Rowe BH. Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma. Cochrane Database Syst Rev. 2013;(9):CD000052.
13. Kew KM, Kirtchuk L, Michell CI. Intravenous magnesium sulfate for treating adults with acute asthma in the emergency department. Cochrane Database Syst Rev. 2014;(5):CD010909.
14. Rowe BH, Bretzlaff JA, Bourdon C, Bota GW, Camargo CA Jr. Intravenous magnesium sulfate treatment for acute asthma in the emergency department: A systematic review of the literature. Ann Emerg Med. 2000;36(3):181-90.
15. Kerem E, Canny G, Tibshirani R, Reisman J, Bentur L, Schuh S, et al. Clinical-physiologic correlations in acute asthma of childhood. Pediatr Pulmonol. 1991;10(2):57-63.