Do we recognize the seriousness of an acute asthma-attack?

An acute asthma-attack is an acute increase of shortness of breath, coughing and wheezing. It is accompanied by a temporary reduction of the lung function.

Diagnosing the seriousness of the attack can be done by determining the lung function (PEF or ESW). Clinical investigation however is even more important because measuring the lung function in these cases is often not reliable.

Criteria that are suspicious for a very serious attack (hospitalization necessary) are:

• Shortness of breath at rest that doesn’t allow the patient to say one sentence smoothly.

• Heart frequency > 110/minute in adults and > 120 in children older that 5, >130/minute in children between 2 and 5.

• Be careful: in life threatening asthma there can be bradycardia.

• The use of accessory respiration muscles.

• PEF: 50% of the best personal value.

• Oxygen saturation < 92%.

The following red flags demand urgent hospitali¬zation:

• Confusion.

• Diminishing of pulls frequency.

• Diminishing respiration frequency.

• Diminishing or absence of inspirational noise.

• Cyanosis.

• No more wheezle.

Patients with a history of hospitalization because of asthma must be sent to the hospital sooner. This also counts for patients that use oral corticosteroids, patients that don’t take their medication regularly and patients with psychiatric history and psychosocial problems.