ACUTE SEVERE ASTHMA

Life-threatening exacerbation of asthma

Clinical features:
Increasing chest tightness, wheezing, and
dyspnea that are often not or poorly relieved by
inhaler.
Severe exacerbations: so breathless, unable to
complete sentences, may become cyanotic.
Examination:
ventilation, hyperinflation, and tachycardia.
Harrisons Principles of Internal Medicine. 18th ed.

 Pulsus paradoxus may be present.

Marked fall in spirometric values and PEF.
Arterial blood gases:
Hypoxemia
PCO2 is usually low due to hyperventilation.
A normal or rising PCO2 impending respiratory
failure and requires immediate monitoring and
therapy.

A chest roentgenogram is not usually

informative, but may show pneumonia or
pneumothorax.
Harrisons Principles of Internal Medicine. 18th ed.

Treatment:
High concentration O2 by face mask SaO2
>90%.
High doses of SABAs given either by nebulizer or
via a metered-dose inhaler with a spacer.
Severely ill patients with impending respiratory
failure: IV 2-agonists. An inhaled anticholinergic
may be added if there is not a satisfactory
response to 2-agonists alone.
Refractory to inhaled therapies: slow infusion of
aminophylline. Monitor blood levels.
Harrisons Principles of Internal Medicine. 18th ed.

 Magnesium sulfate IV or nebulizer can be added

to inhaled 2-agonists.
Prophylactic intubation for impending
respiratory failure, when the PCO2 is normal or
rises.
Respiratory failure: intubate & institute
ventilation. Anesthetic (halothane) if not
responded to conventional bronchodilators.
Never give sedatives may depress
ventilation.
Antibiotics if there are signs of pneumonia.
Harrisons Principles of Internal Medicine. 18th ed.