Status asthmaticus

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Status asthmaticus is an medical emergency caused by an acute exacerbation of asthma that does not respond to standard bronchodilator and corticosteroid therapy. Symptoms include chest tightness, rapidly progressive dyspnea, non-productive cough and wheezing. Status asthmaticus if left untreated may result in severe bronchospasm, mucus plugging and rapidly develops acidosis and respiratory failure as a consequent of carbon dioxide retention and hypoxemia.

Approximately 10% of the US population is affected by asthma and an increased prevalence of 60% is observed in all age groups, with status asthmaticus requiring the highest rates of hospitalization.^[1]

The presence of supraventricular tachycardia on ECG should raise a suspicion of theophylline toxicity.

High-resolution CT may reveal several structural changes related to small-airway disease including cylindrical bronchiectasis, bronchial wall thickening, and air trapping.^[2]

FEV1 lower than 60% predicted is strongly suggestive of severe airway obstruction. Peak flow rate measurement is a simple bedside method to assess the severity of airway obstruction. A red zone indicates less than 50% of the usual or normal peak flow reading signifying a severe airway obstruction.

Initial severity assessment is evaluated using arterial blood gas and pulmonary function test and aggressive therapy is initiated to prevent progression to respiratory failure.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Approximately 10% of the US population is affected by asthma and an increased prevalence of 60% is observed in all age groups, with status asthmaticus requiring the highest rates of hospitalization.^[1]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

• Increased use of bronchodilator despite resistance,
• Frequent exacerbations despite the use of corticosteroids,
• Despite adhering to therapy, a peak flow rate of less than 10% from baseline,
• Frequent hospitalization for acute attacks,
• History of syncope or seizure during an acute asthmatic attack,
• Oxygen saturation lower than 92% despite supplemental oxygen,
• Airway obstruction is significantly reduced, resulting in severe impairment of air motion that leads to a silent chest with the absence of wheeze suggestive of an imminent respiratory arrest.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

• Pneumothorax as a complication of mechanical ventilation
• Intubation increases the risk of super-imposed infection

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