Status asthmaticus overview

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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