Status asthmaticus
Status asthmaticus is a severe asthma exacerbation refractory to standard acute-care bronchodilator and glucocorticoid therapy, with impending or actual respiratory failure. ICU-level escalation adds IV magnesium sulfate, continuous nebulized SABA, and parenteral terbutaline, reserving intubation and a permissive-hypercapnia ventilator strategy for patients who fail this bundle.
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What this article covers
- Overview
A severe asthma exacerbation refractory to standard acute-care therapy, with impending or actual respiratory failure: status asthmaticus is the escalated, ICU-level continuation of an exacerbation…
- Epidemiology
A minority but the most dangerous subset of acute exacerbations: most exacerbations resolve with standard acute-care treatment; status asthmaticus is the fraction that progresses despite it and…
- Risk factors
History of a near-fatal asthma attack or prior intubation, the single strongest predictor of a future life-threatening exacerbation.
- Pathophysiology
Severe bronchospasm, mucosal edema, and mucous plugging produce very high airway resistance, far beyond a routine exacerbation, so air cannot exit the lung before the next breath begins.
- Clinical features
Severe-exacerbation vital signs define the syndrome: inability to speak in full sentences, accessory-muscle use, respiratory rate above 30/min, heart rate above 120/min, and SpO2 below 90% on ambient…
- Differential diagnosis
Anaphylaxis: acute bronchospasm after an exposure, but with urticaria, angioedema, or hypotension, multisystem findings that uncomplicated status asthmaticus lacks; see anaphylaxis.
- Diagnosis
Status asthmaticus is a clinical diagnosis established by known or presumed asthma with severe-exacerbation vital signs (respiratory rate 30/min, heart rate 120/min, SpO2 <90% on room air, inability…
- Management
First, give oxygen to maintain SpO2 above 93% by nasal cannula or face mask, titrated up as needed; never withhold oxygen while other therapies are arranged.
- Complications
Respiratory arrest, the most immediately life-threatening outcome of untreated or inadequately escalated status asthmaticus.
- Prognosis
Prior near-fatal attack or intubation is the strongest predictor of a future fatal or near-fatal episode, and should trigger the most aggressive follow-up and lowest threshold for acute-care presentation.
- Prevention
Identify high-risk patients using the mortality risk-factor profile (near-fatal attack or intubation history, ED/hospital visit in the past 12 months, poor adherence or oral glucocorticoid use…
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