[Asthma attack out of control--what to do? Therapy of acute asthma exacerbation depends on severity]

Treatment of acute asthma exacerbation is determined by the severity of the attack, making it necessary to grade the latter using objective parameters such as clinical symptoms, respiratory rate, heart rate, oxygen saturation and FEV1 or PEF. Severity grading is also essential for the further management--need for early hospitalization--in particular in the case of risk patients. Apart from the treatment of hypoxia, first-line treatment comprises bronchodilation with beta-2-agonists. Anti-inflammatory measures applying corticosteroids are indicated, in particular in moderate to severe exacerbation, while inhalative anticholinergics and theophyline are available in addition when primary treatment fails, and in the case of severe exacerbations.