Asthma is a chronic inflamatory disorder of the airways mediated through many cells and cellular elements, particularly , mast cells, eosinophils, T lymphocytes, macrophages, neutrophils, and epithelial cells; along with increase in tracheal and bronchial hyper responsiveness to a variety of stimuli; all this is manifested as recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly at night or in the early morning asociated with widespread but variable airway obstruction that is often reversible either spontaneously or with treatment.
Acute Exacerbation Of Asthma: These are acute episodes of progressively worsening shortness of breath, cough, wheezing, chest tightness or a combination of symptoms.
It is any such severe exacerbation of asthma which does not respond to initial conventional therapy with bronchodilators.
Initial Management Of Acute Exacerbation Of Asthma at Home:
Management of an asthma exacerbation at home is very crucialas beginning treatment at home avoids treatment delays, prevents exacerbations from becoming severe, and also adds to patient’s and parents’ confidence due to a sense of control over their asthma.The degree of care provided in the home depends on the patients'(or parents’) abilities and experience.
All patients/parents must be taught how to monitor symptoms to recognize early signs of deterioration and how to adjust their medications accordingly.
In case of moderate to severe persistent asthma or with history of severe exacerbation, they must be taught how to monitor their peak flow to asses the severiity of an exacerbation and the response to therapy.
All patients, especially those with moderate to severe persistent asthma or with a history of severe exacerbations, must be given a written asthma action plan to be followed in the event of an exacerbation.
Such patients with moderate to severe asthma or a history of severe exacerbations must be advised to have the medications and equipments for treating exacerbations at home.
An acute exacerbation must be identified early in its course by increase in symptoms like cough, wheeze and breathlessness and decrease in PEFR, usually from 15% from the baseline.