How Status Asthmaticus Differs From an Asthma Attack

Status asthmaticus is a severe and potentially life-threatening asthma attack. More commonly known as acute severe asthma, status asthmaticus occurs when bronchodilator drugs fail to control an attack. Some cases have been known to cause a collapsed lung, coma, and cardiac arrest.

Status asthmatica is a medical emergency that can affect anyone with mild to severe asthma. It is associated with poor asthma control and is commonly seen in poor people who lack access to consistent asthma care. Hospitalization in an intensive care unit is often required.

This article explains what status asthmatic is, including the causes, symptoms, and treatments. It also describes the signs of a medical emergency.

Status Asthmaticus Symptoms

Symptoms of status asthmaticus are not unlike those of asthma but are considerably worse.

During an attack, the constriction (narrowing) of the airways leads to a drop in oxygen levels and an increase in carbon dioxide levels in the blood. The imbalance triggers acute respiratory distress syndrome (ARDS).

With ARDs, fluids accumulate inside the tiny air sacs of the lungs (called alveoli) and surfactants that enable smooth respiration start to break down.

This can lead to potentially devastating symptoms such as:

• Severe shortness of breath
• Rapid, shallow breathing
• Rapid heartbeat
• Anxiety and panic
• Coughing with phlegm
• Extreme tiredness
• Fever
• Crepitus (crackling sound in the lungs)
• Cyanosis (blue-tinted lips or skin)
• Confusion
  
• Loss of consciousness

In emergencies, these symptoms—commonly referred to as critical asthma syndrome—suggest that the person is at an increased risk of death.

How Is Status Asthmaticus Different From an Asthma Attack?

Despite advances in emergency treatment, status asthmaticus (SA) remains a serious health concern. Each year, around 3,500 deaths are attributed to asthma in the United States.

Status asthmatics is more than just a "bad" asthma attack. It is one in which prescription inhalers and asthma medications fail to provide control.

There are two reasons for this, characterized by the speed at which symptoms develop:

Slow-Onset Status Asthmaticus

This is the most common type of SA linked to inadequate asthma control. Symptoms develop over days or weeks, punctuated by moments of relief but eventually ending with symptoms that cannot be controlled with your regular home medications.

Slow-onset SA disproportionately affects poor people who lack adequate access to healthcare. Without consistent access to bronchodilators and other asthma medications, their ability to maintain long-term control is all but compromised.

According to the Centers for Disease Control and Prevention (CDC), the highest rates of asthma complications and hospitalizations are in Black and American Indian/Native American communities. These are the communities with the highest rates of poverty in the United States.

Struggling with asthma control for more than 17 years independently places you at high risk of status asthmaticus.

Sudden-Onset Status Asthmaticus

This type of SA develops swiftly due to a sudden massive exposure to pollen, dust, foods, sulfites, or other allergy-causing substances (allergens). Sudden-onset SA affects highly allergic people who tend to react adversely to even small amounts of an allergen.

The deterioration occurs within hours, sometimes accompanied by symptoms of anaphylaxis (a potentially life-threatening, whole-body allergy).

Any person with asthma who has a decline of 30% or more in their PEF (particularly if rescue inhalers are not effective) should seek emergency medical care without exception.

What Are the Diagnostic Criteria for Status Asthmaticus?

Status asthmaticus is typically diagnosed by symptoms and supported by various tests that measure respiration rate and blood oxygen levels. The common diagnostic signs of status asthmaticus include:

• Breathlessness at rest
• Inability to speak in sentences or not being able to speak at all
• Increased respiratory rate at rest (greater than 30 breaths per minute)
• Elevated pulse rate at rest (greater than 120 beats per minute)
• Agitation and irritability
• Low blood oxygen levels (hypoxemia)
• Reduced breathing capacity (as measured by peak flow meter)

What Treatment of Choice for Status Asthmaticus?

Status asthmaticus is treated as a medical emergency. Standard treatment protocols in the emergency room include:

• Emergency oxygen therapy delivered by mask
• Short-acting beta-agonists (such as albuterol) via inhaler or nebulizer
• Corticosteroids (such as prednisone) given by mouth or intravenously (into a vein)
• Inhaled anticholinergic medications (such as Atrovent)
• Beta-agonists (such as terbutaline) injected under the skin
• Magnesium sulfate delivered intravenously
• Leukotriene modifiers (such as zafirlukast or zileuton) taken by mouth

Mechanical ventilation is generally considered a treatment of last resort due to the risk of lung trauma and an increased risk of death. Less than 1% of emergency room visits for asthma require mechanical ventilation.

Extracorporeal membrane oxygenation (ECMO) may be used if mechanical ventilation fails. This involves a machine similar to a heart-lung machine which removes blood continuously from the body and returns it after oxygen has been added and carbon dioxide has been removed.

Summary

Acute severe asthma, formerly known as status asthmaticus, is a severe asthma attack that does not respond to self-administered prescription asthma drugs. This can lead to severe respiratory distress and possibly death if not treated as a medical emergency.

Status asthmaticus often occurs when asthma is improperly controlled or when a highly allergic person is exposed to massive amounts of pollen, dust, or other allergens.