Status Asthmaticus Treatment Notes

Status Asthmaticus Treatment

Status asthmaticus is a continuous state of breadthlessness without any period of relief. A prolong attack of continuous asthma with flctuations also comes under status asthmaticus.

Clinical Features Asthmaticus.

1. Presence of repeated dry cough which causes aggravation of dyspnea and respiratory distress.
2. Patient sweats heavily and there is also presence of tachycardia.
3. Presence of an increased pulse rate till 120/min.
4. Respiratory rate is 30/min
5. Presence of pulsus paradoxsus
6. As breathlessness is present, patient is unable to speak.
7. Peak expiratory flw is falls to less than 50%.
8. When patient develops carbon dioxide retention,hypoxemia and acidosis, there can be occurrence of lifethreatening situation.
9. CNS effect s such as confusion, drowsiness,semiconciousness and cyanosis develops.
10. In critically ill patients, chest becomes silent due to decrease in the air entry.

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Management Asthmaticus.

Status Asthmaticus Treatment

Treatment of severe acute asthma at Home

1. Administer oxygen (40–60%) through mask, if available.
2. Bronchodilator: IV Aminophylline i.e. 250–375 mg in 20 mL of saline slowly after checking blood pressure Or IV, Salbutamol 250 µg in 20 mL of saline over 10 min Or IV.
3. Terbutaline 250 µg in 20 mL of saline over 10 min.
4. Alternatively
5. Salbutamol (5 mg) or terbutaline (10 mg) by nebulizer.
6. Give hydrocortisone sodium succinate 200 mg IV stat.
7. Arrange for emergency admission to a hospital in ambulance equipped with oxygen therapy.
8. Give prednisolone 60 mg orally

In Hospital Treatment Asthmaticus.

1. High conc. of oxygen, i.e. 40–60% at high flow rate should be given. It is recommended in all cases even in the presence of CO2 retention.
   Oxygen supply should be started immediately through mask, and concentration adjusted according to blood gas measurement.
   PaO2 of greater than 8.5 to 9.0 kPa should be maintained ifpossible.
2. High doses of salbutamol, i.e. 2.5–5 mg or terbutaline 5–l0 mg by nebulizer should be given initially and repeated after 30 minutes, necessary.
   If no improvement occurs with nebulised therapy then 250 µg of salbutamol or terbutaline may be given by IV infusion over 10 minutes.
3. In all severe cases of acute asthma systemic corticosteroids i.e. hydrocortisone 200 mg IV stat and then 4 to 6 hourly or oral prednisolone 40–60 mg/day to tide over the crisis.
4. Systemic bronchodilators such as aminophylline 250 mg IV over a period of 30 minutes may be given immediately followed by either 8 hours doses or continuous infusion not exceeding total dose of 1.5 g/day.
5. Ipratropium bromide can be used in acute severe asthma in doses of 0.5 mg added to a nebulised beta­agonist.
6. Reassess the patient by PEFR and arterial blood gas analysis. If recovery is good, continue oxygen therapy and oral prednisolone, i.e. 40 mg/day in decreasing doses is given. Nebulized β-adrenoreceptor agonist may be continued every 4–6 hours and then replaced by metered dose inhalation. IV hydrocortisone 200 mg 6 hourly may be continued for 24–48 hours in severe cases followed by oral steroids.
   lf response is not good, then shift the patient in respiratory intensive care for assisted ventilation.
7. Assisted ventilation: Mechanical ventilation can be life saving in few patients, who are critically ill.

Patient Education and Monitoring of Therapy

1. Educate the patients about the nature of disease as well as its treatment.
   Patients are trained to recognize the severity of their disease and monitor the response to therapy with the use of peak flwmeter.
2. Demonstrate the proper use of inhalation devices such as metered­dose inhalers (pressurized aerosol system),rotahaler (dry powder system) and nebulizers.
3. Encourage the usage of inhaler therapy because it is effctive in lower dosage together with a rapid onset of action and has less side effcts.