Diagnosis and treatment of acute bronchial asthma in adults

The article is expertly consulted by Master, Doctor Nguyen Le Duc Hoang - Emergency Medicine Doctor - Emergency Department - Vinmec Danang International Hospital.

Acute bronchial asthma in adults often occurs in the early morning or at night, can cause airway obstruction, difficulty breathing, wheezing, coughing. Acute bronchial asthma in adults is often recurrent but can be treated with medication.

It is necessary to distinguish acute bronchial asthma in adults with respiratory symptoms caused by other diseases such as:
The patient has a foreign body in the respiratory tract causing difficulty breathing, cyanosis, coughing. Patients with chronic obstructive pulmonary disease have persistent shortness of breath, common in men and smokers. Patients with pneumothorax usually do not have difficulty breathing, there is no hissing sound on the lungs. Patients with acute bronchiolitis often have other symptoms such as fever, cough with sputum, while the cough of acute bronchiolitis is a dry cough. Patients with cardiac asthma often have a history of heart disease and find it difficult to breathe during heavy or strenuous work, high blood pressure, and a hissing sound in the lungs.

Diagnosis of acute bronchial asthma in adults is based on the following factors:
History: Patient or family members have had allergic diseases such as allergic rhinitis, eczema, asthma, bronchial asthma. Time of asthma attack: Night or early morning, when the weather changes, exposure to allergens. Symptoms: Acute bronchial asthma with symptoms of shortness of breath, dry cough, wheezing cough, heaviness in the chest. With bronchodilators, symptoms may improve or go away. Clinical examination: Listen to the lungs when the patient has difficulty breathing with hissing sound. Measurement of peak flow (PEF) showed an increase greater than or equal to 20% in the morning, afternoon or before drug administration (beta 2, inhaled corticosteroid).

Acute bronchial asthma in adults is classified and evaluated according to the following levels:
Mild: The patient has mild shortness of breath, slow breathing, can lie down, chest pulls less, listen to the lungs when exhaling There is stridor but little, normal speech, measured heart rate <100. Moderate: The patient has moderate dyspnea, slow breathing, shortness of breath increases when lying down, the chest pulls less, the lungs have many hissing sounds, can only speak in sentences, heart rate is measured 100-200. Severe: The patient has a lot of shortness of breath, very slow breathing > 30 times/minute, can't lie down, the chest is pulled a lot, there are many hissing sounds in the lungs, can only speak each word, the measured heart rate is > 120.

Depending on the severity of the asthma attack, the patient is initially managed specifically as follows:
Mild: Use inhaled beta 2 drug at a dose of 3 hours/time. Moderate: Use inhaled beta-2, consider corticosteroids. Severe: Use inhaled beta 2 drugs and corticosteroids. Group of beta 2 drugs to treat acute bronchial asthma in adults include the following types:
Salbutamol spray: Spray into the throat when the patient inhales 2 consecutive sprays. After 20 minutes, if symptoms do not improve, 2 - 4 sprays can be used. In the first hour, you can use Salbutamol spray 2-3 times (2-4 sprays each time). Ventolin 5mg: Used as an alternative to aerosol sprays in medical facilities with nebulizers. Oral Salbutamol: The average dose of oral Salbutamol is 4 tablets/day. Take 1 tablet of Salbutamol 4mg, after 2 hours, if symptoms have not improved, you can take the 2nd pill. The group of corticosteroids for acute asthma treatment includes the following types: Mazipredone (Depersolon) 30mg: Intravenous 1 tube. Methylprednisolone (Solu-Medrol) 40 mg: Intravenous 1 - 2 ampoules.

After initial management, depending on the level of response in patients with acute bronchial asthma, the doctor will recommend the next course of treatment as follows:
Good response: If symptoms improve or go away After taking beta 2 drug and the drug effect lasts for 4 hours, the patient is assigned to continue taking beta 2 drug for 1-2 days with a dose of 3-4 hours / time, and is monitored by the doctor. specialist. Moderate response: If acute asthma symptoms subside and recur after taking beta medication (less than 3 hours after taking the drug), the patient is indicated to continue taking beta drug and take additional oral corticosteroids. Poor response: If after taking beta 2 drugs, the symptoms do not improve or worsen, the patient is prescribed additional oral corticosteroids or injections, intravenous infusion. Acute bronchial asthma in adults is diagnosed based on personal and family medical history and clinical examination symptoms. The initial treatment is beta 2 drug, depending on the severity of the asthma attack, the patient is prescribed a corticosteroid drug.

Patients with acute bronchial asthma need to see a respiratory specialist as soon as possible for treatment advice.
Vinmec International General Hospital is the address for examination, treatment and prevention of diseases. When performing the examination process at Vinmec, customers will be welcomed and used modern facilities and equipment along with perfect medical services under the guidance and advice of experts. Good doctors, well-trained both at home and abroad.
Especially now, to improve service quality, Vinmec also deploys many medical services, including the Asthma Screening Package to help screen and detect the disease early to promptly control and treat the disease. performing clinical examination, taking medical history, measuring respiratory function, otolaryngology examination, screening for bronchial asthma.