The longer the attack, the more likely it is that recovery will be prolonged and that more intense therapy is required. Medications used previously should be identified, particularly, the use of inhalational or systemic glucocorticosteroids. The patient may be at risk for severe asthma requiring prolonged and intensive treatment if there is a history of previous hospitalizations, frequent emergency room visits, chronic inhalational or systemic corticosteroid use or recent withdrawal from systemic steroids, and a history of intensive care unit management, with or without mechanical ventilation. Psychosocial problems, particularly in teenagers, are a risk factor for sudden death.
Outpatient Assessment and Management of Acute Asthma
Acute exacerbations of asthma in children and emergency department management. Most acutely severe exacerbations of asthma require an extensive course of therapy in a well-equipped physician's office or the emergency department. PEF % baseline refers to the norm for the individual, established by the clinician. This may be percentage predicted based on standardized norms or the patient's personal best.
Many clinical scoring systems using salient clinical findings are available for children with acute asthma. These scoring systems are useful since they can be accessed instantaneously and can be recorded onto flow-sheets used for serial evaluation of the patient's asthma, severity, and response to therapy.for example,a scoring system at the Siriraj Hospital in Bangkok to evaluate children with asthma exacerbations. This scoring system was validated and was also found useful for monitoring efficacy of treatment, thus improving communication among physicians and other healthcare professionals caring for these acutely ill patients.
The score includes 6 items (RR, wheezing, chest retraction, dyspnea and oxygen saturation). Each item is scored at the time of assessment (0-2). All scores are summed to give total score (maximum 10).
