Editorial: Management of acute asthma.

Management of acute asthmaAcute asthma is a medical emergency and an indication for admission to hospital.The first sign of the development of an acute attack is that the patient fails to obtain relief from his or her usual treatment.All asthmatic patients should understand that if their condition is deteriorating then a change of treatment is needed, and they should therefore have ready access to their doctor or to a unit with a special interest in this disease.Unfortunately the gravity of a worsening attack of asthma is not sufficiently recognised by patients, their relatives, and even their doctors.In the epidemic of asthma deaths in the late 'sixties the event was sudden and unexpected in almost 80% of patients, most of them young, who died at home or were dead on arrival at hospital.'What, then, indicates that an attack of asthma is entering a severe and dangerous stage ?The ability to continue a conversa- tion is a good clinical guide: mild-frequent pauses between speech; moderate-monosyllabic speech; and severe-too dyspnoeic to speak.2Thoracic overinflation, tachycardia, pulsus paradoxus, and electrocardiographic abnormalities of right ventricular hypertrophy and strain are common, and the patients are usually unresponsive to aerosol adrenergic- stimulant drugs.3While spirometry is helpful in assessment, arterial puncture and measurement of the arterial oxygen