Guidelines for the management of asthma in adults in South Africa: Part II. Acute asthma

Statement by a working group of the South African Pulmonology SocietyThe morbidity and mortality caused by asthma can be attributed to three factors: underassessment of severity, failure on the part of both patients and their medical attendants to initiate treatment promptly, and undertreatment of exacerbations; Moreover, most exacerbations can be prevented by use of appropriate long-termtreatment (S Afr Med J 1992; 81: 319-322). The present guidelines are for the care of acute asthma ('asthma attacks') and are intended to encourage a uniform approach to the m.anagement of exacerbations, whether of rapid or gradual onset, mild or severe. They have been developed on the basis of the best available evidence on the efficacy and safety of asthma drugs, and efforts have been made to ensure that recom.m.endations are costeffective and affordable, and may with little modification be applied in all locations: the home (as initial self-management), the clinic with modest facilities, doctors' surgeries, emergency departments and hospitals. The guidelines stress (i) assessment of severity; (ii) recognition of risk; and (iii) stepwise treatm.ent based upon these assessments. Primary therapies are the repeated use of high doses of [β2-agonists and early introduction of corticosteroids.Specific goals of treatment are to: (i) relieve airway obstruction; (ii) relieve hypoxaemia; (iii) restore lung function to normal as rapidly as possible by reducing airway irritability; (iv) provide a suitable plan to avoid future relapse; and (v) provide a written plan of action to be followed early in future attacks.Simplified management schemes for different locations are provided as addenda for ease of reference