This is the term used when a patient’s asthma attack is severe, prolonged and not responding to his or her usual medications.This is a medical emergency and, unless treated promptly, it is potentially life-threatening. Inhalation treatments, including the nebulizers have only fleeting effect in this state.This is so because the inhaled medications are blocked by a combination of swelling of the airways lining membranes and by the dried up mucus, as well as the intense spasm of the muscles lining the airways.Injected and oral medications are then necessary to treat this condition, often in an intensive care setting.Among the medications, large doses of steroids, usually by intravenous route are the most important.Occasionally, patients may need artificial ventilation and appropriate doses of oxygen administered. As the condition deteriorates, due to inadequate treatment early on, carbon dioxide is retained and arterial oxygen concentration diminishes.In the emergency department, the essential ingredients of evaluation of status asthmaticus include a careful clinical assessment, supplemented by chest x-ray, arterial blood oxygen and carbon dioxide levels at room air. In the very late stages, when the carbon dioxide level rises, the use of oxygen is done more carefully so as not to knock out the ‘respiratory center’ of the brainstem’s ability to control breathing and therefore gas exchange.


Of utmost importance in knowing about this condition is so that one can take steps to prevent asthma from deteriorating to this state. And, the most important measure in this regard is the identification of causes of the patient’s asthma, such as specific allergies, the environmental problems such as indoor furred pet animals, mold accumulation due to leaks etc and then the institution of specific measures to change the situation. Another important aspect of treatment of asthma, which has become widely known and used, is the administration of effective, preventive drugs to address the airway inflammation that is at the root of the pathophysiology of asthma. Inhaled steroids and cromolyn and a special class of agents called “Leukotriene antagonists” are drugs that have vastly improved the care of asthma. When allergy immunotherapy to inhaled allergens is given and such allergy is neutralized, the asthma literally disappears. Also, when a definite aggravant such as chest cold or flu is the initiating event, early use of oral steroids in large doses (so-called ‘burst steroid’ doses) can mean termination of the slow deterioration to the status.


This article was submitted by P.K. Raghuprasad M.D.If the reader wants more information or has questions, please direct it to Dr. Raghu’s email address: pkrp12@gmail.com


Disclaimer: The facts presented in this article and the views expressed are solely those of the author(s) and do not necessarily reflect the views of the Board of Directors or other members of West Texas Physicians Alliance.