Status Asthmaticus: When Asthma Gets Serious

Types, Diagnosis and Treatment of Sudden and Severe Asthma Attacks

Patient laying in hospital bed in oxygen mask. Credit: Blend Images/ERproductions Ltd / Getty Images

Status Asthmaticus, or SA for short, is a severe asthma attack usually of long duration or abruptly sudden in onset. In SA, asthma symptoms continue on and respiratory function declines, despite standard treatments.

SA can lead to respiratory failure, prolonged hospitalization and even death, and it signifies a medical emergency that requires immediate and aggressive treatments. As many as 10% of people who experience SA will die.

Of the total population, asthma affects approximately 8% of adults and 10% of children. Of these, 5% to 10% have a severe form of asthma and are at greater risk for status asthmaticus.

What Happens During a Severe Asthma Attack?

During a severe asthma attack, the way the body normally processes gases is impaired. This leads to lower oxygen levels and higher carbon dioxide levels in the blood, which, in extreme cases, can cause coma and death.

Asthma also creates air trapping in the lungs, a condition that causes increased pressure in the chest. This can cause lung collapse and even cardiac arrest.

Two Types of Status Asthmaticus

There are two types of SA. The first and more common type is a slow-onset attack. This may take a long time to unfold and usually results because of inadequate treatment. The person with this type of SA will experience days or weeks of worsening symptoms, punctuated by moments of relief, and ending in symptoms that cannot be reversed with medications in the home.

The second type of severe attack is a sudden-onset attack. The person experiencing this type of SA has not experienced any worsening symptoms in the preceding weeks, but is struck with sudden and severe bronchospasm, breathlessness, wheezing and cough. This type of asthma attack is often brought on by a large exposure to trigger substances, such as pollen, dust or food allergens.

How Doctors Diagnosis Status Asthmaticus

The following are signs and symptoms that doctors use to diagnose SA:

  • Breathlessness at rest
  • Inability to speak in sentences or not being able to speak at all
  • High respiratory rate (greater than 30 breaths per minute)
  • Elevated pulse (greater than 120 beats per minute)
  • Agitation (although as the attack progresses, sleepiness is more worrisome)
  • Low levels of oxygen in the blood
  • Diminished breathing capacity, as measured by peak expiratory flow (PEF)

How Doctors Treat Status Asthmaticus

Standard treatment of status asthmaticus in the emergency room includes:

  • Oxygen by mask
  • Measurement of PEF
  • Inhaled medications that relax and open the airways (beta-agonists)
  • Steroids (such as prednisone) given either by mouth or intravenously
  • Inhaled anticholinergic medications (such as atrovent)

Other medications that may be used during an acute episode include:

  • Beta-agonists injected under the skin (such as Terbutaline)
  • Magnesium sulfate intravenously
  • Leukotriene modifiers (such as Zafirlukast or Zileuton) by mouth

    Mechanical ventilation is a treatment of last resort because of the risk of trauma to the lungs and other serious complications that can occur. About 4% of emergency room visits for asthma will result in the patient needing mechanical ventilation.

    People With Asthma Should Know Their PEF Measurement

    There are more than 5,000 deaths from asthma in the United States each year. Often the severity of symptoms for a person with asthma are not closely related to the severity of his or her lung dysfunction. Therefore, it is important for all asthmatics to measure their PEF regularly. This is done by using a peak flow meter, which is a small plastic device that is exhaled into forcefully, which measures the PEF.

    The PEF measurement gives information about respiratory status, any decline from the person's own normal (baseline) condition, and the need to increase medications or seek medical treatment. Any person with asthma who has a decline of 30% or more in PEF, particularly if rescue inhalers are not being effective, should seek medical attention without hesitation.


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