Acute Severe Asthma - Causes, Symptoms, Diagnosis, and Treatment

Introduction

Acute severe asthma, also known as status asthmaticus, is a sudden asthma attack mainly caused by the ineffectiveness of traditional medication used to treat asthma. The effects of this asthma attack usually last up to a few minutes or hours, causing severe symptoms that cannot be managed at home. A person may also need hospitalization in acute severe asthma attacks if they cannot get relief from their regular inhalers and nebulizers. Therefore, a person with asthma must follow the doctor's action plan and take preventive measures.

What Are the Causes of Severe Acute Asthma?

Acute severe asthma is caused by the same triggers that lead to traditional asthma attacks. These include:

• Cold weather.

• Respiratory infections.

• Smoking.

• Air pollution.

• Severe allergic reactions.

• Severe stress.

• Chemical irritants and dust particles.

What Are the Types of Acute Severe Asthma?

Acute severe asthma is mainly of two types:

• Sudden-Onset Attack- This type of status asthmaticus is usually not experienced by a person, and the worsening symptoms occur suddenly, causing severe cough, wheezing, and bronchospasm. A sudden attack is caused by exposure to significant triggers such as pollen, dust, or allergens.

• Slow-Onset Attack- This type of asthma attack takes a long time and mainly results from poor treatment. The person experiences symptoms after days, weeks, or months with some relief moments, but these symptoms cannot be treated at home by a person.

What Are the Symptoms Caused By Acute Severe Asthma?

The symptoms caused by severe acute asthma are as follows:

• Wheezing and coughing.

• Shortness of breath.

• Chest tightness.

• Weakness and fatigue.

• Blue-tinted skin and lips.

• Breathlessness.

• Loss of consciousness.

• Sweating.

• Confused and agitated.

• Difficulty in speaking.

• Neck, abdomen, and back muscle spasms.

• Shallow breaths.

What Are the Risk Factors Associated With Acute Severe Asthma?

• Increased need for inhalers.

• Sudden nighttime awakening due to an asthma attack.

• Breathlessness even after consistent use of asthma medicines and inhalers.

• Reduction in peak expiratory flow (PEF).

How Is Acute Severe Asthma Diagnosed?

Acute severe asthma is diagnosed by the doctor by doing an initial assessment of a person’s breathing and can also inquire about the symptoms and treatments taken in the past. These include:

• Checking the breathlessness of a person at rest.

• The inability of a person to speak correctly or who cannot speak at all.

• Increased pulse rate at rest.

• Irritability and agitation.

• Reduced blood oxygen levels.

• Reduced breathing capacity.

• The elevated respiratory rate at rest.

How Is Acute Severe Asthma Treated?

Acute severe asthma usually does not respond to traditional asthma medication, making it difficult and challenging for doctors. The treatment options include:

Severe cases need hospitalization and ICU (intensive care unit) admission due to a gross decline in PEFR (peak expiratory flow rate). A person with severe symptoms of respiratory failure, respiratory or cardiac arrest, arrhythmia, poor mental status, and other complications need ICU admission with resuscitation measures.

Pharmacological Management/ Treatment:

• Beta Agonists - This is the first-line treatment for severe acute asthma in the form of short-acting inhalers. During the initial phase of the treatment, Albuterol (2.5 mg) is given by nebulization therapy. Then, the dose is given thrice, each after 20 minutes.

• Corticosteroids (150 to 225 mg) are given to a person every day to achieve maximum benefit. In addition, Methylprednisone (60 to 125 mg) is a recommended dose to treat status asthmaticus. Therefore, it is given to a person every six hours for initial treatment. Oral steroids are also given to a person for 10 to 14 days during recovery.

• Anticholinergics - These drugs are not very effective in treating acute severe asthma symptoms but can be beneficial for treating bronchospasm caused by some associated obstructive disorder or beta-blockade. Ipratroprium bromide with Albuterol (5mg) is given to aperson with a nebulizer.

• Oxygen Therapy - This therapy is given to a person with an oxygen mask by the doctor to treat emergency oxygen needs to manage respiratory failure and airway obstruction.

• Magnesium Sulfate - It helps in the smooth constriction of muscles and is given intravenously (2 grams) to a person with acute severe asthma.

• Sedation and Mechanical Ventilation - In severe cases of acute severe asthma, intubation and mechanical ventilation support are also needed to treat a person. The indications for mechanical support include cardiopulmonary arrest, coma, difficulty in speaking, and respiratory fatigue.

How Can We Prevent Acute Severe Asthma?

• The following ways can prevent acute severe asthma: A person with asthma may not be able to prevent asthma attacks but can take preventive measures to make them less painful.

• A person should always take asthma medications regularly or as prescribed by the doctor without failing to minimize the risk factors.

• Peak flow meters should be kept at home for regular monitoring of lung function multiple times a day.

• A person should always carry an extra inhaler during traveling and for other purposes to cope with emergencies.

• A person should constantly monitor asthma triggers to avoid them in the future.

• The person should regularly do appointments and follow-ups with the doctor to know the status of their condition and the effectiveness of the medication they are taking for asthma.

What Are the Complications Related to Acute Severe Asthma?

• Respiratory Arrest or Failure - In this condition, the airway tract gets filled with mucus and makes it difficult for a person to breathe.

• Cardiac Arrest - This condition is caused due to the lack of oxygen to the heart, which results in decreased cardiac rhythm.

• Respiratory Alkalosis - This is caused by deep or rapid breathing (hyperventilation), which can reduce carbon dioxide levels in the blood.

• Hypoxemia - The condition is caused by the lack of oxygen in the blood and leads to brain damage or death of a person.

• Hypercarbia - This condition occurs when a person’s lungs cannot remove the carbon dioxide from the body, leading to excess carbon dioxide in the body. The person usually ends up on the ventilation support.

• Medication Toxicity - Certain medications (Theophylline) used to treat airway blockage can have adverse or side effects on a person, thus causing toxicity.

• Pneumothorax - This condition occurs due to the lungs' collapse and air leakage between the chest wall and the lungs.

• Pneumomediastinum - In this condition, the air is the least in the lung and the chest cavity.

Conclusion

Status asthmaticus or acute severe asthma is a serious respiratory complication that can be life-threatening and fatal for a person. These chronic asthma episodes occur suddenly, causing a respiratory decline along with other medical conditions. A person requires aggressive medical intervention in such a condition and, therefore, should always take proper follow-ups with the doctor to reduce the risk of such events. Also, a person must follow the treatment plan and the asthma action plan as directed by the healthcare provider to avoid fatal consequences.