Evaluation and management of the critically ill adult asthmatic in the emergency department setting

Long, Brit; Lentz, Skyler; Koyfman, Alex; Gottlieb, Michael

doi:10.1016/j.ajem.2020.03.029

Cited by 13 publications

(10 citation statements)

References 177 publications

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“…35 Scientists have noted that even with severe exacerbations, glucocorticosteroids prescribed in the early stages of the disease can be effective without the need to hospitalize the patient. 36 Therefore, when a patient's condition is assessed as very serious, systemic glucocorticosteroids are the first medications prescribed. 37 Usage of these drugs leads to rapid improvement of bronchial obstruction and reduces the likelihood of complications that may arise after the patient is discharged from the hospital.…”

Section: Methodsmentioning

confidence: 99%

Effect of combined glucocorticoid therapy on bronchial asthma dynamics

Batrakova

Kartashova

Babaskina

et al. 2022

aei

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This work is aimed to compare the effectiveness of parenteral and inhalation bronchial asthma treatment in combination with glucocorticosteroids and bronchodilators. The study was conducted in 2020 in Botkin City Clinical Hospital (Moscow, the Russian Federation). Case histories of 106 patients diagnosed with bronchial asthma exacerbation of moderate severity were analyzed. Patients were divided into two equal groups based on the therapy method: (1) Group 1 received systemic glucocorticosteroids parenterally in combination with inhalation glucocorticosteroids; (2) Group 2 received systemic glucocorticosteroids parenterally, but inhalation therapy was performed with a nebulizer. Clinical manifestations of bronchial asthma have been recorded. During hospital admission, the breath rate was 22.0 for Group 1 and 21.5 for Group 2, P ≥ 0.05, and heart rates were 93.0 and 92.5, respectively (P ≥ 0.05). All indices (blood saturation, breath rate, peak output rate) in Group 1 remained unchanged 4 h after the start of the therapy, while in Group 2, peak flow rate changed to 53.5% with a median increase of 72.0 ml over 4 h, P ≤ 0.05. On Day 3, patients of Group 1 demonstrated a peak flow rate of 59.5%, P ≤ 0.05, and on Day 10, patients of Group 2 had a peak output rate of 53.0 and 59.5%, respectively (P ≤ 0.05). Systemic glucocorticoids were eliminated in 47 patients of Group 1 and in all patients of Group 2. The treatment tactics applied in Group 2 resulted in faster and more significant improvement in patients diagnosed with bronchial asthma exacerbation. Both treatment regimens showed high results.

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Section: Methodsmentioning

confidence: 99%

Effect of combined glucocorticoid therapy on bronchial asthma dynamics

Batrakova

Kartashova

Babaskina

et al. 2022

aei

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“…Epinephrine is a non-selective alpha and beta-adrenergic agonist, which causes bronchodilation through stimulation of β 2 adrenergic receptors leading to relaxation of bronchial smooth muscle. Alpha-agonist effects of epinephrine may also reduce airway oedema 3 4. Historically, parenteral epinephrine by the subcutaneous or intramuscular route was the mainstay of acute asthma treatment,1 but inhaled selective β 2 -agonists are now the primary bronchodilators of choice and international asthma guidelines do not recommend the use of epinephrine for acute asthma except in the context of concomitant anaphylaxis or angio-oedema 5–8.…”

Section: Introductionmentioning

confidence: 99%

“…Historically, parenteral epinephrine by the subcutaneous or intramuscular route was the mainstay of acute asthma treatment,1 but inhaled selective β 2 -agonists are now the primary bronchodilators of choice and international asthma guidelines do not recommend the use of epinephrine for acute asthma except in the context of concomitant anaphylaxis or angio-oedema 5–8. However, the administration of intramuscular epinephrine in addition to nebulised selective β 2 -agonist for acute severe or life-threatening asthma remains part of many prehospital ambulance guidelines, including in the UK, New Zealand and the USA9–12 and continues to be used and advocated for in hospital by some clinicians 4 13–17…”

Section: Introductionmentioning

confidence: 99%

Epinephrine (adrenaline) compared to selective beta-2-agonist in adults or children with acute asthma: a systematic review and meta-analysis

Baggott

Hardy

Sparks

et al. 2021

Thorax

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BackgroundInternational asthma guidelines recommend against epinephrine (adrenaline) administration in acute asthma unless associated with anaphylaxis or angio-oedema. However, administration of intramuscular epinephrine in addition to nebulised selective β2-agonist is recommended for acute severe or life-threatening asthma in many prehospital guidelines. We conducted a systematic review to determine the efficacy of epinephrine in comparison to selective β2-agonist in acute asthma.MethodsWe included peer-reviewed publications of randomised controlled trials (RCTs) that enrolled children or adults in any healthcare setting and compared epinephrine by any route to selective β2-agonist by any route for an acute asthma exacerbation. The primary outcome was treatment failure, including hospitalisation, need for intubation or death.ResultsThirty-eight of 1140 studies were included. Overall quality of evidence was low. Seventeen studies contributed data on 1299 participants to the meta-analysis. There was significant statistical heterogeneity, I2=56%. The pooled Peto’s OR for treatment failure with epinephrine versus selective β2-agonist was 0.99 (0.75 to 1.32), p=0.95. There was strong evidence that recruitment age group was associated with different estimates of the odds of treatment failure; with studies recruiting adults-only having lower odds of treatment failure with epinephrine. It was not possible to determine whether epinephrine in addition to selective β2-agonist improved outcomes.ConclusionThe low-quality evidence available suggests that epinephrine and selective β2-agonists have similar efficacy in acute asthma. There is a need for high-quality double-blind RCTs to determine whether addition of intramuscular epinephrine to inhaled or nebulised selective β2-agonist improves outcome.PROSPERO registration numberCRD42017079472.

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“…Alpha-agonist effects of adrenaline may also reduce airway oedema. [3,4] Historically, parenteral adrenaline by the subcutaneous or intra-muscular route was the mainstay of acute asthma treatment, [1] but inhaled selective beta2-agonists are now the primary bronchodilators of choice and international asthma guidelines do not recommend the use of adrenaline except in the context of concomitant acute asthma and anaphylaxis or angioedema. [5–8] However, the administration of intra-muscular adrenaline in addition to nebulised selective β 2 -agonist for acute severe or life-threatening asthma remains part of many pre-hospital ambulance guidelines, including in the UK, New Zealand and the USA[9–12] and continues to be used and advocated for in hospital by some clinicians.…”

Section: Introductionmentioning

confidence: 99%

“…[5–8] However, the administration of intra-muscular adrenaline in addition to nebulised selective β 2 -agonist for acute severe or life-threatening asthma remains part of many pre-hospital ambulance guidelines, including in the UK, New Zealand and the USA[9–12] and continues to be used and advocated for in hospital by some clinicians. [4,13–17]…”

Section: Introductionmentioning

confidence: 99%

Adrenaline (epinephrine) compared to selective beta-2-agonist in adults or children with acute asthma: a systematic review and meta-analysis

Baggott

Hardy

Sparks

et al. 2021

Preprint

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Background International asthma guidelines recommend against adrenaline administration in acute asthma unless associated with anaphylaxis or angioedema. However, administration of intra-muscular adrenaline in addition to nebulised selective β2-agonist is recommended for acute severe or life-threatening asthma in many pre-hospital guidelines. We conducted a systematic review to determine the efficacy of adrenaline in comparison to selective β2-agonist in acute asthma. Methods We included peer-reviewed publications of randomised controlled trials (RCTs) that enrolled children or adults in any healthcare setting and compared adrenaline by any route to selective β2-agonist by any route for an acute asthma exacerbation. The primary outcome was treatment failure, as indicated by hospitalisation, stay >24hrs in emergency department, need for intubation, or death. Results Thirty-eight of 1,140 studies were included, involving 2,275 participants. Overall quality of evidence was low. There was significant statistical heterogeneity, I2=56%. The pooled odds ratio for treatment failure with adrenaline versus selective β2-agonist was 0.99 (0.74 to 1.34), p=0.96. There was strong evidence that recruitment age-group was associated with different estimates of the risk of treatment failure; with studies recruiting adults-only having a lower risk of treatment failure with adrenaline. It was not possible to determine whether adrenaline in addition to selective β2-agonist improved outcomes. Conclusion The limited evidence available suggests that adrenaline and selective β2-agonists have similar efficacy in acute asthma and does not support the use of adrenaline in addition to selective β2-agonists in acute asthma. There is a need for high-quality double-blind RCTs to address this issue. PROSPERO registration number CRD42017079472

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Evaluation and management of the critically ill adult asthmatic in the emergency department setting

Cited by 13 publications

References 177 publications

Effect of combined glucocorticoid therapy on bronchial asthma dynamics

Effect of combined glucocorticoid therapy on bronchial asthma dynamics

Epinephrine (adrenaline) compared to selective beta-2-agonist in adults or children with acute asthma: a systematic review and meta-analysis

Adrenaline (epinephrine) compared to selective beta-2-agonist in adults or children with acute asthma: a systematic review and meta-analysis

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