Asthma exacerbation represents an acute worsening of chronic airway inflammation and bronchial hyperresponsiveness. During an exacerbation, airway narrowing increases due to bronchospasm, mucosal swelling, and mucus production, resulting in airflow limitation. Severe asthma attacks can progress rapidly and require urgent emergency intervention to prevent respiratory failure.

Patients commonly present with wheezing, chest tightness, coughing, and shortness of breath. Symptoms may worsen at night or after exposure to triggers such as viral infections, allergens, air pollution, exercise, stress, or medication non-adherence. In severe cases, patients may struggle to speak full sentences, use accessory respiratory muscles, and show signs of fatigue or declining oxygen levels.

Emergency evaluation begins with assessment of airway stability and breathing adequacy. Oxygen saturation is monitored immediately. Respiratory rate, heart rate, and blood pressure are recorded. Auscultation may reveal wheezing or reduced air entry in severe obstruction. Peak expiratory flow measurement may be used when feasible to assess severity compared to baseline.

Initial management focuses on rapid bronchodilation. Short-acting inhaled bronchodilators are administered to relax airway smooth muscle and restore airflow. Supplemental oxygen is provided to maintain adequate oxygen saturation. Systemic anti-inflammatory therapy is initiated to reduce airway swelling and prevent relapse. Hydration and careful monitoring are also important components of care.

Response to treatment is reassessed frequently. Improvement in breathing effort, oxygen levels, and symptom severity indicates positive response. Lack of improvement may require escalation of therapy and consideration of advanced respiratory support. Severe cases with exhaustion or declining mental status require immediate intervention to secure the airway.

Risk stratification determines whether the patient can be discharged with optimized outpatient therapy or requires hospital admission. Education regarding inhaler technique, trigger avoidance, and adherence to maintenance medication is reinforced before discharge.

Asthma exacerbations require structured emergency management because delayed treatment increases risk of respiratory arrest. Protocol-driven care restores airflow, reduces inflammation, prevents complications, and minimizes hospitalization risk. Early intervention and close monitoring significantly improve outcomes and long-term asthma control.