The incidence and prevalence of severe asthma are increasing in both adults and children in October 2020. All patients with asthma, a chronic inflammation of the airways in the lungs, are at risk of developing status asthmaticus (acute severe asthma). This is an acute episode of progressive symptoms and poor response to standard treatments. It is very important that a doctor correctly recognizes and addresses status asthmaticus, otherwise a patient will experience acute respiratory failure and possibly die. Numerous medications treat status asthmaticus. However, mechanical ventilation may be required to treat this life-threatening asthma attack.

• Epidemiology
• Causes of status asthmaticus
• Risk factors of acute severe asthma
• Symptoms: Severe, progressive shortness of breath

• Breathing
• Other symptoms

• Diagnosis and examinations
• Diagnosis and examinations
• Treatment of severe asthma attack

• Medicines
• Other treatments

• Prognosis
• Complications of lung disease

Epidemiology

Status asthmaticus is slightly more common in men and is more common in people of African and Hispanic descent. Exact prevalence and incidence figures were not found in the sources consulted (October 2020).Exposure to allergens, for example from pets, may lead to acutely severe asthma / Source: Kim Bols

Causes of status asthmaticus

About 50% of severe asthma attacks are due to upper respiratory tract infections such as viral cold infections. Other causes include:

• allergic reactions to foods (food allergy)
• exposure to allergens (triggers of an allergic reaction) and especially allergens from pets in severely atopic patients
• a chlamydial pneumonia
• herpes simplex virus infections.
• non-compliance with medication use for asthma
• the inadequate use of inhaled (breathed in) or oral (taken by mouth) corticosteroids.
• irritant inhalation (smoke, paint, etc.)
• exercise
• nonsteroidal anti-inflammatory exposure in patients allergic to aspirin

This causes a life-threatening episode of airway obstruction, leading to the breathing-related symptoms of acute severe asthma.The doctor is not always able to identify the cause of the serious lung disease.

Risk factors of acute severe asthma

Patients with status asthmaticus often have a history of endotracheal intubation (breathing tube placed in the trachea) and mechanical ventilation, frequent emergency room visits, and previous use of systemic corticosteroids (powerful anti-inflammatory drugs that suppress the immune system).

Symptoms: Severe, progressive shortness of breath

Chest pain is one of the possible complaints / Source: Pexels, Pixabay

Breathing

Patients with status asthmaticus have rapidly progressive, severe shortness of breath (dyspnea) that has developed over hours to days. In most cases there is a lead time of several days. Other breathing-related symptoms include:

• a tightness in the chest
• a blue tint to the lips and fingernails (cyanosis)
• a dry cough (which is often worse at night)
• extreme wheezing
• rapid and/or labored breathing
• sitting down or standing up to breathe easier
• the use of additional respiratory muscles
• feeling breathless (even when the patient lies down)

Due to the shortness of breath, a patient may not be able to say more than a few words in a row.

Other symptoms

Some other signs include:

• agitation (restlessness)
• fear
• concentration problems
• reduced alertness/reduced consciousness
• hunched shoulders and muscle tension in the abdomen and neck
• fatigue / impending exhaustion
• confusion
• to sweat

Diagnosis and examinations

Interview When going through the interview, the doctor asks questions about:

• other major medical conditions
• the symptoms present
• exposure to allergens
• the training intolerance
• the number of hospital admissions / emergency department visits / intensive care unit admissions and intubations
• current medication use and frequency of use

Diagnosis and examinations

Physical and diagnostic examination The doctor listens to the patient’s breathing sounds through his stethoscope (auscultation) and then hears weakened breath sounds. He also measures oxygen saturation via pulse oximery; oxygen saturation levels are usually reduced.Differential diagnosisThe symptoms of acute severe asthma sometimes mimic the symptoms of other conditions such as:

• bronchiolitis (respiratory tract infection with breathing problems)
• an anaphylactic allergic reaction (severe allergic reaction)
• an Aspergillus infection (fungal infection with lung problems)
• a swallowed foreign object that blocks the airways
• a pneumonia
• cystic fibrosis (cystic fibrosis with blockage of organs)

Treatment of severe asthma attack

Status asthmaticus is considered a medical emergency requiring immediate treatment. The doctor wants to treat the narrowing of the tracheal branches and the inflammation as quickly as possible, otherwise complications will arise and the patient may die.

Medicines

The doctor uses the following possible (combinations of) medications:

• antibiotics
• beta agonists
• bronchodilators (drugs that widen the airways)
• corticosteroids
• heliox and oxygen
• ketamine
• magnesium sulfate (intravenous = administered through a vein)
• methylxanthines
• paralytic drugs
• propofol
• theophylline

Other treatments

Hydration (giving fluids), with intravenous normal saline at a reasonable rate, is essential. Special attention to preventing electrolyte disturbances in the patient is important. Furthermore, mechanical ventilation and sedation are sometimes required.

Prognosis

Status asthmaticus is a serious medical condition that can lead to death if left untreated. Often combinations of treatments are required to improve breathing and reduce the risk of complications. In general, results are good when the patient is taken to the emergency room and treated promptly. However, when the patient requires mechanical ventilation, results range from moderate to severe. Sometimes these patients die. The reason for the high morbidity and mortality is due to pneumonia acquired in the hospital (hospital infection) while a patient is on a ventilator.

Complications of lung disease

There are a few complications associated with status asthmaticus:

• respiratory alkalosis: Too early hyperventilation leads to low carbon dioxide levels in the blood.
• respiratory failure or stopped breathing: The airways dilate and fill with mucus so that a patient cannot breathe.
• cardiac arrest: A lack of oxygen causes the heart to stop.
• Hypercarbia: As the disease progresses, the lungs are no longer able to remove carbon dioxide, so an excess of this substance occurs. This mainly occurs in patients who are mechanically ventilated.
• Hypoxemia: Prolonged insufficient oxygen in the blood leads to brain damage or death.
• pneumomediastinum: Air leaks from the lungs and into the chest cavity.
• pneumothorax (collapsed lung): The lung collapses and air leaks into the space between the lung and chest wall.
• drug toxicity: Bronchodilators are potentially toxic (poisonous) to multiple organs.

 

read more

• Asthma: Chronic inflammation of the airways in the lungs
• Bronchodilators: Bronchodilators for lung disorders
• Allergic asthma: Inflamed airways due to allergens
• Brittle asthma: Severe and persistent symptoms of attack
• Eosinophilic asthma: Obstructed airflow with shortness of breath