Medical News Today: What to know about status asthmaticus

Status asthmaticus is a severe and life-threatening asthma state. Doctors also call it acute severe asthma. This condition is a medical emergency that can cause death without treatment.

Unfortunately, some people with status asthmaticus may not recognize the severity of their symptoms, and their breathing abilities may rapidly decline.

This article will explain how status asthmaticus differs from traditional asthma symptoms, when to seek help, and how doctors treat it.

Versus regular asthma

When a person has asthma, their doctor typically prescribes an inhaler that contains long-acting medications to keep the airways open.

They may also prescribe a short-acting inhaler that a person can use if they have significant difficulty breathing.

Most of the time, when a person has an asthma attack or experiences difficulty breathing, using this inhaler will help improve their symptoms.

However, when a person is in status asthmaticus, their breathing problems do not respond to traditional treatments.

According to an article in the journal Respiratory Care, about 20% of asthma-related hospitalizations are due to status asthmaticus. If a person’s breathing does not improve after using an inhaler, they should seek medical care immediately.

Causes and triggers

An upper respiratory infection is one of the most common causes of a status asthmaticus attack. The infection increases the amount of mucus in a person’s lungs, making it harder for them to breathe.

Other potential causes include:

  • allergic reactions to foods
  • chlamydial pneumonia
  • cold viruses
  • herpes simplex virus infections

Sometimes, a doctor may not be able to identify the cause of status asthmaticus.

Symptoms

When a person is in status asthmaticus, they may experience some of the following symptoms:

  • anxiety
  • blue tinge to lips and fingernails
  • diminished breath sounds
  • decreased alertness
  • fatigue
  • shortness of breath
  • sweating
  • trouble taking deep breaths
  • wheezing

In addition to noting these symptoms, a doctor may assess a person’s vital signs. A person with status asthmaticus will usually have a fast respiratory rate, rapid heart rate, and a low pulse oximetry reading.

Status asthmaticus symptoms can mimic those of other medical conditions.

These include:

  • anaphylactic allergic reaction
  • Aspergillus infection
  • bronchiolitis
  • cystic fibrosis
  • pneumonia
  • a swallowed foreign object that is blocking the airway

If a person presents with status asthmaticus symptoms, a doctor will evaluate whether the symptoms are due to status asthmaticus or another underlying condition.

When to see a doctor

A person should seek emergency medical attention if they are having difficulty breathing, and their inhalers are not helping them breathe more easily. The longer a person waits to seek medical attention, the more at risk they are for respiratory failure.

People should also seek medical attention if they experience any of the symptoms associated with status asthmaticus. This includes anxiety, confusion, and a blue tinge to the lips and fingernails.

Without treatment, status asthmaticus can cause death. A person can experience a bronchospasm, where the airways become small. Mucus can plug the airways, making it impossible for air to exchange. This can cause hypoxia, or low oxygen levels, which can lead to cardiac arrest.

Although status asthmaticus can be life-threatening, it is treatable, so it is essential that a person seeks emergency care.

Primary care

Status asthmaticus is an emergency that requires immediate care in the hospital. A doctor will prescribe treatments to improve a person’s breathing as quickly as possible.

In the first instance, doctors typically treat status asthmaticus with albuterol. This is a short-acting beta-agonist, which helps to make the airways wider.

The person will need to wear a mask or nasal cannula that will deliver extra oxygen.

The albuterol usually enters the body via aerosol, which is a vapor-like substance. Doctors or respiratory therapists usually call this a breathing treatment.

If albuterol does not help improve a person’s breathing, a doctor can prescribe other beta-agonists that are in aerosol form, such as terbutaline.

They may also prescribe anticholinergic agents that can work effectively with beta-agonists. An example is ipratropium bromide or Atrovent. This medicine works on different receptors in the airways to enlarge them and make breathing easier.

If a person’s condition does not respond to these treatments, a doctor will prescribe other treatments.

These include:

Helium therapy

The same gas used to inflate balloons can help treat status asthmaticus. Inhaled helium with oxygen (heliox) can help to reduce turbulent airflow in the lungs.

A person can breathe heliox via a mask. They can also receive heliox therapy at the same time as receiving albuterol.

Oxygen

Because a person’s lungs are not exchanging oxygen effectively, a doctor will often prescribe additional oxygen via a facemask or nasal cannula. Ideally, this can help prevent hypoxia in a person with status asthmaticus.

Ketamine

Doctors may use this medication in anesthesia. It has the beneficial effect of bronchodilation, or opening of the airways. Because ketamine has sedating properties, a doctor will usually only prescribe it if a person does not respond to other therapies.

Inhaled anesthetics

Also known as anesthesia gases, inhaled anesthetics can relax the smooth muscle of the airways. Delivering inhaled anesthetics requires specialized equipment, including an anesthesia machine.

A person will usually require intubation, which involves using a tube to support breathing.

Magnesium

Magnesium is an electrolyte that causes smooth muscle relaxation when delivered in high enough amounts.

Because it can cause side effects that include low blood pressure, a person will require careful monitoring when receiving intravenous magnesium.

Steroids

Steroids are inflammation-reducing medications that usually start to work a few hours after a doctor administers them. They will not immediately relieve asthma symptoms, but they will begin to help in the 24 hours after a person starts treatment.

Whenever possible, a doctor will try to avoid intubation. While it may be necessary for some people, there is a possibility that it could make the airways even tighter.

Longer-term treatment

If a person has a status asthmaticus exacerbation of their asthma, they are at risk for future events.

As a result, a doctor may recommend additional medications or other interventions to reduce the likelihood that status asthmaticus will recur.

Some of these measures include:

  • Educating a person about asthma and the warning signs and symptoms of status asthmaticus.
  • Teaching a person how to identify triggers and how to avoid them.
  • Training a person how to measure their peak air flow using a flowmeter and when to call a doctor.
  • Prescribing medications, such as maintenance inhalers, or immunotherapy to reduce the body’s immune response to asthma triggers.

A doctor may also prescribe an EpiPen to deliver epinephrine under the skin to treat anaphylactic reactions.

Ideally, these methods will prevent a person from entering status asthmaticus.

Takeaway

Status asthmaticus is a serious medical condition that can cause death without treatment. It differs from a traditional asthma attack in that it does not resolve with at-home inhaler use.

Instead, a person will need continuous treatments to improve their breathing and reduce the risks of complications. The earlier a person can seek treatment, the more likely their symptoms will resolve.

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