Management of severe asthma exacerbation: guidelines from the Société Française de Médecine d’Urgence, the Société de Réanimation de Langue Française and the French Group for Pediatric Intensive Care and Emergencies

Abstract

BackgroundThe French Emergency Medicine Society, the French Intensive Care Society and the Pediatric Intensive Care and Emergency Medicine French-Speaking Group edited guidelines on severe asthma exacerbation (SAE) in adult and pediatric patients.ResultsThe guidelines were related to 5 areas: diagnosis, pharmacological treatment, oxygen therapy and ventilation, patients triage, specific considerations regarding pregnant women. The literature analysis and formulation of the guidelines were conducted according to the Grade of Recommendation Assessment, Development and Evaluation methodology. An extensive literature research was conducted based on publications indexed in PubMed™ and Cochrane™ databases. Of the 21 formalized guidelines, 4 had a high level of evidence (GRADE 1+/−) and 7 a low level of evidence (GRADE 2+/−). The GRADE method was inapplicable to 10 guidelines, which resulted in expert opinions. A strong agreement was reached for all guidelines.ConclusionThe conjunct work of 36 experts from 3 scientific societies resulted in 21 formalized recommendations to help improving the emergency and intensive care management of adult and pediatric patients with SAE.

Acute severe asthma requiring invasive mechanical ventilation in the era of modern resuscitation techniques: A 10-year bicentric retrospective study

“…While the one patient who was treated with halogenated gas in our study had a good outcome, the evidence for the efficacy of this technique is based only on small case reports [26]. Indications for this treatment, which is not included in recent recommendation [10], have yet to be clearly defined. The same applies to immunotherapy targeting hypereosinophilic asthma.…”

“…Third, data collection was spread over a period of 10 years, raising the possibility that changes occurred in the global management of asthma. Yet, no major advances have been made in the treatment of asthma during the study period, and all patients in our study received treatments based on recent recommendations [10]. Fourth, our results concerning the SMR relative to SAPS II have to be interpreted carefully.…”

“…In view of these good results, venovenous ECMO should be considered as an effective tool for highly-selected ASA patients refractory to usual care [21]. However, precise clinical indications for ECMO have yet to be specified [10].…”

“…The rate of tracheostomy was 7%. Hospital and ICU length of stay was 13 [8][9][10][11][12][13][14][15][16][17] and 7 [4][5][6][7][8][9][10][11][12] days, respectively, with IMV being administered for a period of 4 [2][3][4][5][6][7][8][9] days. These data are summarized in S3 Table. In-ICU mortality was 14% (n = 11) and in-hospital mortality was 15% (n = 12).…”

Associations among chronic obstructive pulmonary disease with asthma, pneumonia, and corticosteroid use in the general population

“…In the LE et al study suggest that patients treated for severe asthma exacerbation (SAE), the discharge prescription for patients treated for SAE in the emergency room (ER) should at least include a SABA, OSs therapy for a short period, and ICSs therapy if it has not been prescribed before [60]. In 30% of severe adult asthma patients, OSs are required in addition to ICSs to maintain of asthma control [61].…”