Oxygen treatment for acute severe asthma

Deaths from asthma in England and Wales dropped by about 6% a year in people aged 5-64 from 1983 to 1995,1 but about 20 children and 1600 adults still die in the United Kingdom every year from acute asthma. Profound hypoxaemia may be a readily preventable cause of some of these deaths. The British Thoracic Society's asthma guidelines advise oxygen as first line treatment in hospital for all patients in cases of acute severe asthma.2 However, the guidelines do not advise treatment with oxygen in primary care in children and do not insist on its use in adults. The recent death of a child in a primary care setting after administration of salbutamol nebulised with air prompted us to question whether treatment with oxygen should be recommended in all cases of acute severe asthma, including those presenting in primary care. #### Summary points Asthma causes 1600 deaths in the United Kingdom every year Progressive hypoxaemia is probably an important cause of death Oxygen should be the first treatment given to any patient with acute severe asthma Nebulisation of β2 agonists with air during severe attacks may worsen hypoxaemia Patients with acute severe asthma should receive β2 agonists nebulised with oxygen A systematic review was not possible as there have never been any randomised controlled trials of oxygen in acute severe asthma. We therefore present a traditional literature review and our opinion based on it. We selected 24 publications from our personal collections and from Medline searches. Using the search terms “asthma” and “hypoxaemia or hypoxemia or hypoxia or oxygen” and “salbutamol or albuterol” yielded 204 papers, of which 11 were included in this review. The other 13 papers that we evaluated were from our personal collections. In acute severe asthma, narrowing of the airway occurs as a result of …