Chronic asthma is characterized by inflammatory changes of the airways, chronic bronchospasm, and mucus hypersecretion. These changes result in a variety of physiological abnormalities including wheezing, coughing, chest tightness, and difficulty breathing. During an acute exacerbation of asthma (also known as an “asthma attack”), these symptoms become more severe due to a further increase in airway inflammation/inflammation-induced narrowing and increased mucus production.
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The arterial blood gas patterns during an exacerbation typically reveal hypoxemia (low arterial oxygen levels), hypercapnia (high arterial carbon dioxide levels), respiratory alkalosis (low pH) and hypocarbia (low level of carbon dioxide). This may also be accompanied by an increase in the partial pressure of oxygen (PaO2) and a decrease in the alveolar-arterial oxygen difference (AaDO2). These changes indicate that during an exacerbation, ventilation is inadequate to meet oxygen demands and alveolar hypoventilation occurs. This leads to further airway narrowing, more mucus production and increased airflow obstruction. The end result is increased shortness of breath and worsening of symptoms.
Treatment for acute asthma exacerbation typically includes inhaled bronchodilators such as beta agonists or anticholinergics which help to quickly open up narrowed airways, and systemic steroids which reduce inflammation.