Pharmacotherapeutic strategies for critical asthma syndrome: a look at the state of the art

ABSTRACT

Introduction

‘Critical Asthma Syndrome’ (CAS) is an umbrella term proposed to include several forms of asthma, responsible for acute and life-threatening exacerbations. CAS requires urgent and adequate supportive and pharmacological treatments to prevent serious outcomes.

Areas covered

The purpose of this review is to discuss current knowledge on the pharmacotherapeutic strategies for treatment of CAS.

Expert opinion

Airflow limitation, airway wall edema, and mucus plugs are the pathophysiological targets of pharmacological therapies. Strategies to achieve these goals are based on the use of various classes of drugs. Inhaled beta2-agonists are the mainstay of the initial therapy of CAS. Inhaled anticholinergic agents may be considered in the treatment of CAS in addition to beta 2 agonists. Systemic corticosteroids should be administered as soon as possible in order to counteract airway inflammation and restore normal airway sensitivity. The effectiveness of pharmacological therapies in CAS is linked not only to the timely use of drugsbut also to the dosage and route of administration. Early recognition and aggressive treatment are essential for the management of CAS; however, prevention is the best cure. Although significant progress has been made, further efforts are needed to implement an optimal exacerbation prevention strategy.

KEYWORDS:

• Acute asthma
• anticholinergics
• asthma exacerbation
• asthma therapy
• beta 2 agonists
• corticosteroids
• CAS
• critical asthma syndrome
• severe asthma

Article highlights

• Critical Asthma Syndrome (CAS) is an umbrella term proposed to describe all that forms of asthma responsible for acute and life-threatening exacerbations.

• Timely recognition and aggressive treatment are essential for the management of CAS.

• Close monitoring of clinical parameters and blood gases is extremely important in order to evaluate the response to treatment and make the appropriate changes for therapeutic success.

• SABAs are the mainstay of the initial therapy of acute severe asthma exacerbations.

• Inhaled antimuscarinic agents may be considered in the emergency treatment of CAS in addition to β2-agonists.

• Systemic corticosteroids should be administered as soon as possible in order to counteract airway inflammation and restore normal airway sensitivity.

• In addition to drugs mentioned above, administration of magnesium sulfate intravenously and high ICS dose can be considered.

• Administration of methylxanthines is not recommended.

This box summarizes the key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.