Status Asthmaticus
What is it?
Status asthmaticus is a severe asthma attack that does
not respond to the usual therapies. Although reversible,
it is life threatening because it can lead to respiratory
failure and cardiac arrest. Status asthmaticus requires
immediate treatment.
Who gets it?
Any child with asthma can experience status asthmaticus,
but the risk increases in children with asthma that is not
properly treated. Children who have had previous status
asthmaticus attacks are also at higher risk for repeated
attacks. Status asthmaticus is also more likely to occur
in children with an unsupportive family, in lower-income
families, and in non-white children, most likely because
of poor medical care.
What causes it?
Status asthmaticus is caused by severe bronchospasm, in
which the smooth muscles of the bronchi suddenly contract
and narrow the airways. Asthma attacks can be triggered by
allergens, such as pollen, smoke, and animal dander, as
well as by physical exertion and cold air.
What are the symptoms?
The symptoms of status asthmaticus are extreme
difficulty with breathing, which causes restlessness and
anxiety. Although coughing and wheezing are common
symptoms of asthma, a child with status asthmaticus may
not cough or wheeze because there is not enough airflow.
Advanced symptoms include little or no breath sounds,
inability to speak, bluish tinge to the skin (cyanosis),
and heavy sweating. Status asthmaticus can lead to
unconsciousness and cardiopulmonary arrest, which can be
fatal.
How is it diagnosed?
Status asthmaticus is diagnosed according to the
child’s symptoms and a physical examination. The most
important diagnostic test is the arterial blood gas, which
measures the concentration of oxygen and carbon dioxide in
the blood. This test can be performed by taking a blood
sample, or by monitoring blood oxygen through an electrode
on the fingertip or earlobe (called oximetry). Low blood
oxygen is called hypoxemia.
What is the treatment?
To treat status asthmaticus, the child is given
supplemental oxygen to increase blood oxygen levels. He or
she will also be treated with an inhaled or intravenous
bronchodilator to open the airways. Other common
treatements include corticosteroids, to reduce
inflammation, and anticholinergics, to block smooth muscle
contraction and the production of excess mucus. The
child’s heart rate, blood pressure, fluid levels, and
blood oxygen, pH, and carbon dioxide levels are monitored
carefully. Intravenous fluids are given if the child is
dehydrated. A child with severe respiratory distress,
extreme lethargy, altered consciousness, elevated carbon
dioxide levels, or high blood acidity (acidosis) needs to
be hospitalized in a pediatric intensive care unit (PICU).
Self-care tips
If your child has asthma, seek treatment immediately if
he or she has a severe attack that does not respond to
usual treatment. Following your doctor’s recommendations
for regular asthma treatment can help prevent status
asthmaticus.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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