Episode 66 – Acute Asthma Exacerbations – An Interview with Dr. Steven Hochman and Dr. Brandon Somwaru

EMplify – February 2022

Emergency Department Management of Acute Asthma Exacerbations

Interview with the authors: Steven M. Hochman, MD, and Brandon Somwaru, DO

Episode Outline:

• Epidemiology
• Risk factors for death from asthma (Table 1)
• Triggers for asthma attacks
• Variants of asthma (Table 2)
• Differential diagnosis (Table 3)
• Can PE be a trigger for an acute asthma attack? 
• Prehospital care
• ED care: history (what should we ask?)
• ED care: physical exam (what are we looking for?)
• Classifying mild/moderate/severe asthma 
• Lab studies
• POCUS (Table 5 and Figure 3)
• Peak expiratory flow
• ETCO2 capnography and capnometry
• Chest x-ray
• Treatment (Table 6)
• Medications
• Oxygen
• SABA vs LABA
• What about MDIs?
• Continuous nebs?
• Anticholinergics
• Steroids (IV, oral, inhaled; prednisone vs dexamethasone)
• Magnesium sulfate
• Epinephrine
• Terbutaline
• Ketamine
• NIPPV
• Intubation pearls and pitfalls (Table 8)
• Special populations
• Pediatrics 
• Pregnancy
• COVID-19 
• Controversies and cutting edge
• Biologics
• Fractional exhaled nitric oxide
• Heliox 
• High flow nasal cannula
• Delayed sequence intubation
• ECMO
• Disposition