Anti-inflammatory Treatment after Discharge Home from the Emergency Department in Adults with Acute Asthma

摘要

Airway inflammation from respiratory infections or exposure to allergens, irritants, or both leads to increased airflow obstruction and respiratory symptoms in patients with acute asthma. Anti-inflammatory therapy with systemic corticosteroids (CSs) is therefore a cornerstone of the management of patients with acute asthma, particularly those presenting to the emergency department (ED) (1, 2). After initial management in the ED, most patients improve sufficiently to be discharged home with instructions to complete a short course of daily oral corticosteroids (OCSs) and short-acting inhaled bronchodilators as needed for symptom relief. Unfortunately, up to one third of patients who initially respond to therapy relapse within the first 3 to 4 weeks after ED discharge (e.g., require treatment escalation, urgent care or ED visits, or hospitalizations for asthma) (3, 4). The propensity of many patients to relapse after ED discharge has led to a number of randomized clinical trials evaluating alternative outpatient anti-inflammatory treatment strategies in this population, including the use of inhaled corticosteroids (ICSs), intramuscular corticosteroids (IMCSs), and noncorticosteroid anti-inflammatory regimens.