Management of severe asthma exacerbation: guidelines from the Société Française de Médecine d'Urgence, the Société de Réanimation de Langue Française and the French Group for Pediatric Intensive Care and Emergencies

doi:10.1186/s13613-019-0584-x

Review

. 2019 Oct 10;9(1):115.

doi: 10.1186/s13613-019-0584-x.

Management of severe asthma exacerbation: guidelines from the Société Française de Médecine d'Urgence, the Société de Réanimation de Langue Française and the French Group for Pediatric Intensive Care and Emergencies

Philippe Le Conte^{1

2}, Nicolas Terzi^{3

4}, Guillaume Mortamet⁵, Fekri Abroug⁶, Guillaume Carteaux⁷, Céline Charasse⁸, Anthony Chauvin⁹, Xavier Combes¹⁰, Stéphane Dauger¹¹, Alexandre Demoule¹², Thibaut Desmettre¹³, Stephan Ehrmann¹⁴, Bénédicte Gaillard-Le Roux¹⁵, Valérie Hamel¹⁶, Boris Jung¹⁷, Sabrina Kepka¹⁸, Erwan L'Her¹⁹, Mikaël Martinez^{20

21}, Christophe Milési²², Élise Morawiec²³, Mathieu Oberlin²⁴, Patrick Plaisance²⁵, Robin Pouyau²⁶, Chantal Raherison²⁷, Patrick Ray²⁸, Mathieu Schmidt²⁹, Arnaud W Thille³⁰, Jennifer Truchot⁹, Guillaume Valdenaire³¹, Julien Vaux³², Damien Viglino^{33

34}, Guillaume Voiriot³⁵, Bénédicte Vrignaud³⁶, Sandrine Jean³⁷, Eric Mariotte³⁸, Pierre-Géraud Claret³⁹

Affiliations

¹ Service d'Accueil des Urgences, CHU de Nantes, 5 allée de l'île gloriette, 44093, Nantes Cedex 1, France.
² PHU3, Faculté de Médecine 1, rue Gaston Veil, 44035, Nantes, France.
³ Service de Médecine Intensive Réanimation, CHU de Grenoble Alpes, 38000, Grenoble, France. nterzi@chu-grenoble.fr.
⁴ INSERM, U1042, University of Grenoble-Alpes, HP2, 38000, Grenoble, France. nterzi@chu-grenoble.fr.
⁵ Service de Réanimation Pédiatrique, CHU de Grenoble Alpes, 38000, Grenoble, France.
⁶ Service de réanimation, CHU de Monastir, Monastir, Tunisia.
⁷ Service de MIR, Hôpital Henri Mondor, APHP, Créteil, France.
⁸ Pediatric Emergency Department, CHU Pellegrin Enfants, Bordeaux, France.
⁹ Service des Urgences, Hôpital Lariboisière, APHP, Paris, France.
¹⁰ Service des Urgences, CHU de la Réunion, Saint-Denis, France.
¹¹ Pediatric Intensive Care Unit, Robert Debré Hospital, APHP, Paris, France.
¹² Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), AP-HP, INSERM, UMRS1158 neurophysiologie respiratoire expérimentale et clinique, Sorbonne Université, Paris, France.
¹³ Service des Urgences, CHU de Besançon, Besançon, France.
¹⁴ Médecine Intensive Réanimation, INSERM CIC 1415, réseau CRICS-TriggerSEP, CHRU de Tours and Centre d'Etude des Pathologies Respiratoires, INSERM U1100, faculté de médecine, Université de Tours, Tours, France.
¹⁵ Pediatric Intensive Care Unit, Women and Children's University Hospital, Nantes, France.
¹⁶ Service des Urgences, CHU de Toulouse, Toulouse, France.
¹⁷ Service de MIR, CHU de Montpelliers, Montpellier, France.
¹⁸ Service des Urgences, CHU de Strasbourg, Strasbourg, France.
¹⁹ Service de MIR, CHRU de Brest, Brest, France.
²⁰ Pôle Urgences, centre hospitalier du Forez, 42605, Montbrison, France.
²¹ Réseau d'urgence Ligérien Ardèche Nord (REULIAN), centre hospitalier Le Corbusier, 42700, Firminy, France.
²² Département de Pédiatrie Néonatale et Réanimations, CHU de Montpellier, Montpellier, France.
²³ Service de Pneumologie et Réanimation, GH Pitié-Salpêtrière, APHP, Paris, France.
²⁴ Service des Urgences, centre hospitalier de Cahors, Cahors, France.
²⁵ Service des Urgences, AP-HP, hôpital la Riboisière, Paris, France.
²⁶ Pediatric Intensive Care Unit, Women-Mothers and Children's University Hospital, Lyon, France.
²⁷ service de Pneumologie, CHU de Bordeaux, Pessac, France.
²⁸ Service des Urgences, CHU de Dijon, faculté de médecine de Dijon, Dijon, France.
²⁹ INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, Sorbonne Universités, 75651, Paris Cedex 13, France.
³⁰ CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France.
³¹ Service des Urgences, CHU de Bordeaux, Pessac, France.
³² SAMU 94, CHU Henri Mondor, AP-HP, Créteil, France.
³³ INSERM, U1042, University of Grenoble-Alpes, HP2, 38000, Grenoble, France.
³⁴ Service des Urgences Adultes, CHU de Grenoble Alpes, 38000, Grenoble, France.
³⁵ Service de réanimation polyvalente, Hôpital Tenon, APHP, Paris, France.
³⁶ Pediatric Emergency Department, Women and Children', s University Hospital, Nantes, France.
³⁷ Service de Réanimation Pédiatrique, APHP Hôpital Trousseau, 75012, Paris, France.
³⁸ Service de Médecine Intensive Réanimation, APHP Hôpital Saint Louis, 75010, Paris, France.
³⁹ Service d'Accueil des Urgences, CHU de Nîmes, 30029, Nîmes, France.

PMID: 31602529
PMCID: PMC6787133
DOI: 10.1186/s13613-019-0584-x

Review

Management of severe asthma exacerbation: guidelines from the Société Française de Médecine d'Urgence, the Société de Réanimation de Langue Française and the French Group for Pediatric Intensive Care and Emergencies

Philippe Le Conte et al. Ann Intensive Care. 2019.

. 2019 Oct 10;9(1):115.

doi: 10.1186/s13613-019-0584-x.

Authors

Affiliations

¹ Service d'Accueil des Urgences, CHU de Nantes, 5 allée de l'île gloriette, 44093, Nantes Cedex 1, France.
² PHU3, Faculté de Médecine 1, rue Gaston Veil, 44035, Nantes, France.
³ Service de Médecine Intensive Réanimation, CHU de Grenoble Alpes, 38000, Grenoble, France. nterzi@chu-grenoble.fr.
⁴ INSERM, U1042, University of Grenoble-Alpes, HP2, 38000, Grenoble, France. nterzi@chu-grenoble.fr.
⁵ Service de Réanimation Pédiatrique, CHU de Grenoble Alpes, 38000, Grenoble, France.
⁶ Service de réanimation, CHU de Monastir, Monastir, Tunisia.
⁷ Service de MIR, Hôpital Henri Mondor, APHP, Créteil, France.
⁸ Pediatric Emergency Department, CHU Pellegrin Enfants, Bordeaux, France.
⁹ Service des Urgences, Hôpital Lariboisière, APHP, Paris, France.
¹⁰ Service des Urgences, CHU de la Réunion, Saint-Denis, France.
¹¹ Pediatric Intensive Care Unit, Robert Debré Hospital, APHP, Paris, France.
¹² Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), AP-HP, INSERM, UMRS1158 neurophysiologie respiratoire expérimentale et clinique, Sorbonne Université, Paris, France.
¹³ Service des Urgences, CHU de Besançon, Besançon, France.
¹⁴ Médecine Intensive Réanimation, INSERM CIC 1415, réseau CRICS-TriggerSEP, CHRU de Tours and Centre d'Etude des Pathologies Respiratoires, INSERM U1100, faculté de médecine, Université de Tours, Tours, France.
¹⁵ Pediatric Intensive Care Unit, Women and Children's University Hospital, Nantes, France.
¹⁶ Service des Urgences, CHU de Toulouse, Toulouse, France.
¹⁷ Service de MIR, CHU de Montpelliers, Montpellier, France.
¹⁸ Service des Urgences, CHU de Strasbourg, Strasbourg, France.
¹⁹ Service de MIR, CHRU de Brest, Brest, France.
²⁰ Pôle Urgences, centre hospitalier du Forez, 42605, Montbrison, France.
²¹ Réseau d'urgence Ligérien Ardèche Nord (REULIAN), centre hospitalier Le Corbusier, 42700, Firminy, France.
²² Département de Pédiatrie Néonatale et Réanimations, CHU de Montpellier, Montpellier, France.
²³ Service de Pneumologie et Réanimation, GH Pitié-Salpêtrière, APHP, Paris, France.
²⁴ Service des Urgences, centre hospitalier de Cahors, Cahors, France.
²⁵ Service des Urgences, AP-HP, hôpital la Riboisière, Paris, France.
²⁶ Pediatric Intensive Care Unit, Women-Mothers and Children's University Hospital, Lyon, France.
²⁷ service de Pneumologie, CHU de Bordeaux, Pessac, France.
²⁸ Service des Urgences, CHU de Dijon, faculté de médecine de Dijon, Dijon, France.
²⁹ INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, Sorbonne Universités, 75651, Paris Cedex 13, France.
³⁰ CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France.
³¹ Service des Urgences, CHU de Bordeaux, Pessac, France.
³² SAMU 94, CHU Henri Mondor, AP-HP, Créteil, France.
³³ INSERM, U1042, University of Grenoble-Alpes, HP2, 38000, Grenoble, France.
³⁴ Service des Urgences Adultes, CHU de Grenoble Alpes, 38000, Grenoble, France.
³⁵ Service de réanimation polyvalente, Hôpital Tenon, APHP, Paris, France.
³⁶ Pediatric Emergency Department, Women and Children', s University Hospital, Nantes, France.
³⁷ Service de Réanimation Pédiatrique, APHP Hôpital Trousseau, 75012, Paris, France.
³⁸ Service de Médecine Intensive Réanimation, APHP Hôpital Saint Louis, 75010, Paris, France.
³⁹ Service d'Accueil des Urgences, CHU de Nîmes, 30029, Nîmes, France.

PMID: 31602529
PMCID: PMC6787133
DOI: 10.1186/s13613-019-0584-x

Abstract

Background: The French Emergency Medicine Society, the French Intensive Care Society and the Pediatric Intensive Care and Emergency Medicine French-Speaking Group edited guidelines on severe asthma exacerbation (SAE) in adult and pediatric patients.

Results: The guidelines were related to 5 areas: diagnosis, pharmacological treatment, oxygen therapy and ventilation, patients triage, specific considerations regarding pregnant women. The literature analysis and formulation of the guidelines were conducted according to the Grade of Recommendation Assessment, Development and Evaluation methodology. An extensive literature research was conducted based on publications indexed in PubMed™ and Cochrane™ databases. Of the 21 formalized guidelines, 4 had a high level of evidence (GRADE 1+/-) and 7 a low level of evidence (GRADE 2+/-). The GRADE method was inapplicable to 10 guidelines, which resulted in expert opinions. A strong agreement was reached for all guidelines.

Conclusion: The conjunct work of 36 experts from 3 scientific societies resulted in 21 formalized recommendations to help improving the emergency and intensive care management of adult and pediatric patients with SAE.

Keywords: Asthma; Emergency; Guidelines; Intensive Care; Pediatric; Severe exacerbation.

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Conflict of interest statement

Philippe Le Conte reports personal fees from Novartis, outside the submitted work; Nicolas Terzi reports personal fees from Boehringer Inghelheim, personal fees from Pfizer, outside the submitted work; Guillaume Carteaux reports congress registration expanses from Orkyn, personal fees from Air Liquide Medical System, outside the submitted work; Alexandre Demoule reports personal fees from Medtronic, grants, personal fees and non-financial support from Philips, personal fees from Baxter, personal fees from Hamilton, personal fees and non-financial support from Fisher & Paykel, grants from French Ministry of Health, personal fees from Getinge, grants and personal fees from Respinor, grants and non-financial support from Lungpacer; Stéphan Ehrmann reports consultancies fees from Aerogen, Baxter healthcare, Bayer medical and La DiffusionTechnique Française, research support from Aerogen, Fisher & Paykel and Hamilton, travel expenses reimbursement from Aerogen and Fisher & Paykel; Bénédicte Gaillard-Le Roux reports non-financial support from BAXTER NUTRITION, non-financial support from FRESENIUS, outside the submitted work; Boris Jung reports travel expenses reimbursement from Sedana Medical; Erwan L’Her reports grants and personal fees from Smiths Medical, General Electrics, Sedana Medical and Oxynov Inc., all outside the submitted work; Mikaël Martinez reports personnal fees from Astra Zeneca and Actélion, outside the submitted work; Chantal Raherison eports personal fees from Mundipharma, grants and personal fees from Astra Zeneca, personal fees from ALK, grants and personal fees from Boehringer Ingelheim, grants from Chiesi, grants and personal fees from Glaxo Smith Kline, grants and personal fees from Novartis, personal fees from Zambon, outside the submitted work; Mathieu Schmidt reports personal fees from Drager, personal fees from Getinge, personal fees from Xenios, outside the submitted work; Arnaud Thille reports personal fees from Fisher&Paykel, personal fees from Covidien, personal fees from Maquet-Getinge, personal fees from GE healthcare, outside the submitted work; Damien Viglino reports grants from Mundipharma, from Astra Zeneca, outside the submitted work; Guillaume Voiriot reports grants, personal fees and non-financial support from Biomérieux, grants from Janssen, grants from SOS Oxygène, outside the submitted work; Eric Mariotte reports personal fees from Sanofi, outside the submitted work; Guillaume Mortamet, Fekri Abroug, Céline Charasse, Anthony Chauvin, Xavier Combes, Stéphane Dauger, Thibaut Desmettre, Valérie Hamel, Sabrina Kepka, Christophe Milési, Élise Morawiec, Mathieu Oberlin, Patrick Plaisance, Robin Pouyau, Patrick Ray, Jennifer Truchot, Guillaume Valdenaire, Julien Vaux, Bénédicte Vrignaud, Sandrine Jean, Pierre-Géraud Claret has nothing to disclose.

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References

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1. Raherison C, Bourdin A, Bonniaud P, Deslée G, Garcia G, Leroyer C, Taillé C, De Blic J, Dubus J-C, Tillié-Leblond I, Chanez P. Updated guidelines (2015) for management and monitoring of adult and adolescent asthmatic patients (from 12 years and older) of the Société de Pneumologie de Langue Française (SPLF) (Full length text) Rev Mal Respir. 2016;33:279–325. doi: 10.1016/j.rmr.2016.03.002. - DOI - PubMed
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[1] Global Initiative for Asthma. Global strategy for asthma management and prevention; 2018. https://ginasthma.org/wp-content/uploads/2019/01/2018-GINA.pdf.

[2] Global Initiative for Asthma. Global strategy for asthma management and prevention; 2018. https://ginasthma.org/wp-content/uploads/2019/01/2018-GINA.pdf.

[3] Raherison C, Bourdin A, Bonniaud P, Deslée G, Garcia G, Leroyer C, Taillé C, De Blic J, Dubus J-C, Tillié-Leblond I, Chanez P. Updated guidelines (2015) for management and monitoring of adult and adolescent asthmatic patients (from 12 years and older) of the Société de Pneumologie de Langue Française (SPLF) (Full length text) Rev Mal Respir. 2016;33:279–325. doi: 10.1016/j.rmr.2016.03.002. - DOI - PubMed

[4] Raherison C, Bourdin A, Bonniaud P, Deslée G, Garcia G, Leroyer C, Taillé C, De Blic J, Dubus J-C, Tillié-Leblond I, Chanez P. Updated guidelines (2015) for management and monitoring of adult and adolescent asthmatic patients (from 12 years and older) of the Société de Pneumologie de Langue Française (SPLF) (Full length text) Rev Mal Respir. 2016;33:279–325. doi: 10.1016/j.rmr.2016.03.002. - DOI - PubMed

[5] Fuhlbrigge A, Peden D, Apter AJ, Boushey HA, Camargo CA, Gern J, Heymann PW, Martinez FD, Mauger D, Teague WG, Blaisdell C. Asthma outcomes: Exacerbations. J Allergy Clin Immunol. 2012;129:S34–S48. doi: 10.1016/j.jaci.2011.12.983. - DOI - PMC - PubMed

[6] Fuhlbrigge A, Peden D, Apter AJ, Boushey HA, Camargo CA, Gern J, Heymann PW, Martinez FD, Mauger D, Teague WG, Blaisdell C. Asthma outcomes: Exacerbations. J Allergy Clin Immunol. 2012;129:S34–S48. doi: 10.1016/j.jaci.2011.12.983. - DOI - PMC - PubMed

[7] Chan-Yeung M, Chang JH, Manfreda J, Ferguson A, Becker A. Changes in peak flow, symptom score, and the use of medications during acute exacerbations of asthma. Am J Respir Crit Care Med. 1996;154:889–893. doi: 10.1164/ajrccm.154.4.8887581. - DOI - PubMed

[8] Chan-Yeung M, Chang JH, Manfreda J, Ferguson A, Becker A. Changes in peak flow, symptom score, and the use of medications during acute exacerbations of asthma. Am J Respir Crit Care Med. 1996;154:889–893. doi: 10.1164/ajrccm.154.4.8887581. - DOI - PubMed

[9] British guideline on the management of asthma SIGN 153; 2016. https://www.sign.ac.uk/assets/qrg153.pdf. - PubMed

[10] British guideline on the management of asthma SIGN 153; 2016. https://www.sign.ac.uk/assets/qrg153.pdf. - PubMed

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Management of severe asthma exacerbation: guidelines from the Société Française de Médecine d'Urgence, the Société de Réanimation de Langue Française and the French Group for Pediatric Intensive Care and Emergencies

Affiliations

Management of severe asthma exacerbation: guidelines from the Société Française de Médecine d'Urgence, the Société de Réanimation de Langue Française and the French Group for Pediatric Intensive Care and Emergencies

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