What is Status Asthmaticus ? or Acute Severe Asthma ?
DefinitionAcute severe asthma (status asthmaticus) is a severe form of asthmatic attack not responding to the classic therapy in 24 hours, it may persists for days or even weeks making the patient at risk of ventilatory failure.
How to diagnose Status Asthmaticus ?
Signs of severe asthmatic attacks, or acute severe asthma.
1- Tachycardia >110/m.
2- Exhaustion, patient can't speak in sentences.
3- Pulsus paradoxius.
4- Silent chest (No rhonchi)
5- Cyanosis.
6- Dehydration due to hyperventilation
7- Severe hypoxia - Normal or CO2 retension.
8- Peak expiratory flow rate (PEFR) < 50% of the expected value by peak flow meter (patient asked to take a full inspiration and then blowout forcefully).
Treatment of Status Asthmaticus
(1) Hospitalization with full assessment including:
• Signs of severity of asthmatic attack, see later.
• Peak expiratory flow rate PEFR.
• Arterial blood gases.
(2) Initial treatment :
• O2 with high concentration (60%), thereafter the O2 concentration can be adjusted according to the arterial blood gases.
• Hydrocortisone 200 mg IV/4-6 hours for 24 hours then prednisolone 60 mg/day orally for 2 weeks then gradual tapering.
• Salbutamol by nebulizer (2.5-5 mg/4 hours) it can be repeated every 30 minutes as necessary, then 2.5 mg/4 hours once there is clinical response.
Then reassess clinically, PEFR, blood gases.
