Status asthma is a serious complication of bronchial asthma that threatens health. It several times increases the risk of death of a patient with an attack. 

The complication is accompanied by constantly developing respiratory failure, while there is no result from therapeutic measures.

It is extremely difficult to stop the attack in this case. It is important to know the rules of first aid for this condition.

Asthmatic status

Status asthmaticus is a prolonged attack of bronchial asthma, with the progression of which severe respiratory failure develops. Mortality in this case reaches 17%. 

This condition is associated with swelling of the bronchial mucosa and spasms of their muscles. Under such conditions, a large amount of thick sputum accumulates in the alveoli, which does not leave at all or leaves in insignificant quantities.

The pathology is very dangerous, since the attack cannot be stopped with an increased dose of bronchodilators, which the patient usually uses for asthmatic attacks.

Classification of status asthmaticus

Status asthmaticus is characterized by impaired breathing during inhalation and prolonged exhalation. With a short breath, more air enters the lungs than it exits during exhalation, which is due to blockage and a decrease in the lumen of the airways. Such conditions lead to distension of the lungs.

Due to an increase in the level of pressure in the chest cavity and inside the alveoli, pulmonary hypertension develops, and the pressure in the cavity of the right ventricle of the heart also increases. In this case, there is a violation of the return of venous blood to the heart.

With forced expiration, the small bronchi undergo an even more pronounced spasm. Under such conditions, air stagnates in the lungs, and the amount of oxygen in the blood decreases.

A similar phenomenon requires immediate hospitalization of the patient.

According to the criterion of occurrence, such types of asthmatic status are distinguished:

• gradually developing, in which there is a slow increase in mechanical obstruction of the bronchi. The patient has a blockade of beta-adrenergic receptors, receptors are activated, which cause narrowing of the bronchi;
• anaphylactic. This type of pathology is expressed in an anaphylactic reaction of an immediate type. In this case, the release of mediators of the allergic reaction occurs, which is accompanied by total bronchospasm and asphyxia at the time of contact with the allergen;
• anaphylactoid. Reflex bronchospasm occurs as a response to the effect on the receptors of the respiratory tract of various stimuli – physical, mechanical, chemical.

The following stages of status asthmaticus are distinguished:

• relative decompensation;
• decompensation, in which there is a violation of lung function;
• coma associated with oxygen deficiency.

Any form of status asthmaticus requires urgent qualified help.

Causes and risk factors

Status asthma most often occurs due to the lack or improper therapy of bronchial asthma. A similar complication may be encountered by a patient who has refused to constantly take drugs that form the basis of basic therapy.

To a greater extent, this applies to inhaled glucocorticosteroids.

Other reasons that can provoke a prolonged spasm of the bronchi in bronchial asthma, which is characteristic of status asthmaticus, include the following:

• uncontrolled intake of medications to relieve an asthma attack. The maximum number of inhaler use is 6-8 per day, since its too frequent use reduces the body’s sensitivity to the action of the drug and leads to a prolonged asthma attack and status asthmaticus;
• constant exposure to allergens on the patient’s body, in the role of which are some food products, pollen of flowering plants, animal hair, vaccines and serums, household and library dust, molds;
• emotional stress;
• the development of infectious and inflammatory diseases of the respiratory system;
• uncontrolled use of certain drugs.

Risk factors in this case are:

• unfavorable social conditions. Status asthma is most often observed in people with low income and less access to qualified medical care; 
• age. Most often, this complication occurs in the elderly;
• the presence of concomitant pathologies (lung disease, chest deformity, congestive heart failure);
• smoking;
• chronic inflammation of the small bronchi with constant exacerbations.

A sharp change in climate is also one of the factors that can trigger a prolonged asthma attack. That is why asthmatics are recommended to undergo a course of therapy in the usual climatic conditions.

Another risk factor in this case is episodes of seizures or fainting during exacerbations of asthma. 

Symptoms

Each stage of status asthmaticus has characteristic symptoms.

At the first stage, the following symptoms appear:

• prolonged attacks of suffocation during the day, which, which is characteristic of status asthmaticus, cannot be stopped using conventional inhalers. In the periods between attacks, it is not possible to fully restore breathing;
• severe tachycardia;
• wheezing rales in the patient’s chest, which can be clearly heard even from a distance;
• painful cough of a paroxysmal nature. He’s dry, harsh. A small amount of viscous transparent phlegm may be released;
• acceleration of heart rate up to 120 beats per minute;
• hypertension;
• increased unmotivated irritability;
• pain in the region of the heart, aching or stabbing;
• rapid breathing. In status asthmaticus, the patient makes [M12] up to 40 respiratory movements per minute; 
• bluish tint of the skin and mucous membranes.

The second stage (stage of decompensation) is an extremely serious condition, which is characterized by the following manifestations:

• severe shortness of breath;
• inhibition of reactions;
• shallow breathing;
• swelling of the veins in the neck;
• the acquisition of a pale gray skin. In addition, the skin becomes moist and clammy.

Blood pressure drops, the number of heartbeats does not exceed 140. Heart sounds are muffled.

Also, at the second stage of this complication, the patient’s sleep is disturbed, he cannot eat or drink.

At this stage, the use of bronchodilators is completely ineffective.

In the third stage of status asthmaticus, which is also called hypercapnic acidotic coma, the following symptoms occur:

• threadlike pulse;
• loss of consciousness;
• muffled heart sounds;
• rare shallow breathing;
• redness of the skin;
• protrusion of cold clammy sweat.

At the third stage, when listening to the lungs, there are no breathing sounds.

With status asthma, as the most severe complication of asthma, all patients experience dehydration, and the electrolyte balance in the body is disturbed.

At different stages of status asthmaticus, disturbances of consciousness are not excluded, which can be of a different nature: from an excited emotional state to a coma.

First aid for status asthmaticus

With a prolonged asthma attack, you need to know how to properly help the patient.

The algorithm for emergency care for status asthmaticus is as follows:

• call an ambulance brigade. Without medical qualified intervention, it will not be possible to cope with a prolonged attack;
• organization of the flow of fresh air. It is necessary to open all the vents in the room;
• ensuring the correct position of the patient’s body. You need to help him to take the correct posture: he should sit with support on his hands – this will somewhat facilitate breathing. When the correct position is taken, you need to help the victim use the inhaler. Clothing and other items that compress the chest must be removed.

A patient with status asthmaticus is subject to immediate hospitalization.

After providing first aid, a symptom of relief of the patient’s condition is a productive cough. In this case, the respiratory tract is freed from phlegm, and breathing is gradually restored.

Treatment of status asthmaticus

To improve the condition of the patient with status asthmaticus and save his life, specific treatment is carried out.

Doctors after arrival help the patient:

• make up for oxygen deficiency. For this, oxygen therapy is carried out – the patient receives humidified oxygen from an oxygen cylinder through a mask;
• inject drugs-adrenergic agonists;
• in severe cases, corticosteroids are administered.

The goals of therapy for status asthmaticus, regardless of the stage, are:

• relief of inflammation and removal of edema of the mucous membrane of small bronchi;
• restoration of patency of the bronchial tract;
• stimulation of beta-adrenergic receptors.

Medication for status asthmaticus consists in the use of the following drugs:

• corticosteroids. Medicines of this pharmacological group increase the sensitivity of beta-adrenergic receptors. Also, hormones have anti-edema, antihistamine and anti-inflammatory effects;
• non-selective beta2 agonists. It’s mostly about adrenaline. With the use of this remedy, the treatment of a patient who is admitted to a medical institution with symptoms of a prolonged asthmatic attack begins. Adrenaline relaxes the muscles of the bronchi, as a result of which they expand. The dosage depends on the patient’s weight and is calculated individually;
• antibiotics. Such funds are needed only in cases where the patient had an infiltration in the lungs, as well as with exacerbation of chronic bronchitis with the release of purulent sputum;
• sedatives. Such drugs are indicated for use in small doses, with careful monitoring of the patient’s consciousness by the attending physician.

Artificial ventilation of the lungs is carried out in the second and third stages of status asthmaticus.

Status asthmaticus can be removed not so much by the number of drugs administered, but by long-term and multi-stage treatment.

Treatment of pathology in children is similar to therapy that is carried out for adults.

Signs of an improvement in the condition of a patient with status asthmaticus are a decrease in tachycardia, an improvement in respiratory functions, and an increase in the peak expiratory flow rate.

If there is a positive trend, then the patient disappears fear, irritability, and improves sleep.

If treatment is ineffective, oxygen starvation and airway obstruction progress.

Forecast

If a patient with status asthmaticus received qualified assistance in a timely manner, then the prognosis for life is favorable. It worsens significantly if the necessary treatment measures have not been taken. In this case, the risk of death increases.

Hospital mortality with such a diagnosis is about 5-6%. In outpatient settings, this figure reaches 70%.

The probable consequences of status asthmaticus include:

• heart rhythm disturbances incompatible with life;
• pneumothorax;
• damage to the central nervous system, provoked by hypoxia;
• pulmonary edema;
• the addition of a secondary infection and the development of an inflammatory process (for example, pneumonia);
• metabolic acidosis;
• adrenal insufficiency.

Prevention

It is important for asthmatics to adhere to preventive measures in order to avoid exacerbation of asthma and the development of status asthma. This requires:

• regularly use medications to control asthma;
• always carry with you a drug that relieves seizures;
• avoid exposure to food allergens. Chocolate, honey, citrus fruits, nuts, milk, as well as all products with artificial additives – dyes, flavors should be excluded from the daily menu;
• control the intake of sedatives, antihistamines, hypnotics;
• limit contact with animals;
• quit smoking, do not go to places with a high concentration of tobacco smoke.

Status asthma is the most dangerous complication of asthma, requiring hospitalization of the patient. Timely treatment can save his life. In the absence of therapy, the patient dies. In no case should you treat the pathology yourself.