Status asthmaticus overview: Difference between revisions
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==Overview== | ==Overview== | ||
'''Status asthmaticus''' is an medical emergency caused by an [[Acute (medical)|acute]] exacerbation of [[asthma]] that does not respond to standard [[Bronchodilator|bronchodilator]] and [[corticosteroid]] therapy. Symptoms include [[chest tightness]], [[dyspnea|rapidly progressive dyspnea]], [[cough|non-productive cough]] and [[Wheeze|wheezing]]. Status asthmaticus if left untreated may result in severe [[bronchospasm]], mucus plugging and rapidly develops [[acidosis]] and [[respiratory failure]] as a consequent of [[carbon | '''Status asthmaticus''' is an medical emergency caused by an [[Acute (medical)|acute]] exacerbation of [[asthma]] that does not respond to standard [[Bronchodilator|bronchodilator]] and [[corticosteroid]] therapy. Symptoms include [[chest tightness]], [[dyspnea|rapidly progressive dyspnea]], [[cough|non-productive cough]] and [[Wheeze|wheezing]]. Status asthmaticus if left untreated may result in severe [[bronchospasm]], mucus plugging and rapidly develops [[acidosis]] and [[respiratory failure]] as a consequent of [[carbon dioxide]] retention and [[hypoxemia]]. | ||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
Approximately 10% of the US population is affected by asthma and an increased prevalence of 60% is observed in all age groups, with status asthmaticus requiring the highest rates of hospitalization.<ref name="pmid18955910">Gorelick M, Scribano PV, Stevens MW, Schultz T, Shults J (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18955910 Predicting need for hospitalization in acute pediatric asthma.] ''Pediatr Emerg Care'' 24 (11):735-44. [http://dx.doi.org/10.1097/PEC.0b013e31818c268f DOI:10.1097/PEC.0b013e31818c268f] PMID: [http://pubmed.gov/18955910 18955910]</ref> | Approximately 10% of the US population is affected by asthma and an increased prevalence of 60% is observed in all age groups, with status asthmaticus requiring the highest rates of hospitalization.<ref name="pmid18955910">Gorelick M, Scribano PV, Stevens MW, Schultz T, Shults J (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18955910 Predicting need for hospitalization in acute pediatric asthma.] ''Pediatr Emerg Care'' 24 (11):735-44. [http://dx.doi.org/10.1097/PEC.0b013e31818c268f DOI:10.1097/PEC.0b013e31818c268f] PMID: [http://pubmed.gov/18955910 18955910]</ref> | ||
==Diagnosis== | |||
===Electrocardiogram=== | |||
The presence of [[supraventricular tachycardia]] on ECG should raise a suspicion of [[Bronchodilator#Theophylline|theophylline toxicity]]. | |||
===CT=== | |||
[[Asthma CT|High-resolution CT]] may reveal several structural changes related to small-airway disease including [[Bronchiectasis|cylindrical bronchiectasis]], bronchial wall thickening, and [[air trapping]].<ref name="pmid1094668">Robards VL, Lubin EN, Medlock TR (1975) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1094668 Renal transplantation and placement of ileal stoma.] ''Urology'' 5 (6):787-9. PMID: [http://pubmed.gov/1094668 1094668]</ref> | |||
===Other Diagnostic Studies=== | |||
[[Spirometry#Explanation of common test values in FVC tests|FEV1]] lower than 60% predicted is strongly suggestive of severe airway obstruction. [[Asthma pulmonary function test#Peak Expiratory Flow Rate|Peak flow rate]] measurement is a simple bedside method to assess the severity of airway obstruction. A red zone indicates less than 50% of the usual or normal peak flow reading signifying a severe airway obstruction. | |||
==Treatment== | |||
===Medical Therapy=== | |||
Initial severity assessment is evaluated using [[Asthma laboratory tests#Arterial Blood Gas|arterial blood gas]] and [[Asthma pulmonary function test|pulmonary function test]] and aggressive therapy is initiated to prevent progression to [[respiratory failure]]. | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Asthma]] | [[Category:Asthma]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
Latest revision as of 21:33, 12 February 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Status asthmaticus is an medical emergency caused by an acute exacerbation of asthma that does not respond to standard bronchodilator and corticosteroid therapy. Symptoms include chest tightness, rapidly progressive dyspnea, non-productive cough and wheezing. Status asthmaticus if left untreated may result in severe bronchospasm, mucus plugging and rapidly develops acidosis and respiratory failure as a consequent of carbon dioxide retention and hypoxemia.
Epidemiology and Demographics
Approximately 10% of the US population is affected by asthma and an increased prevalence of 60% is observed in all age groups, with status asthmaticus requiring the highest rates of hospitalization.[1]
Diagnosis
Electrocardiogram
The presence of supraventricular tachycardia on ECG should raise a suspicion of theophylline toxicity.
CT
High-resolution CT may reveal several structural changes related to small-airway disease including cylindrical bronchiectasis, bronchial wall thickening, and air trapping.[2]
Other Diagnostic Studies
FEV1 lower than 60% predicted is strongly suggestive of severe airway obstruction. Peak flow rate measurement is a simple bedside method to assess the severity of airway obstruction. A red zone indicates less than 50% of the usual or normal peak flow reading signifying a severe airway obstruction.
Treatment
Medical Therapy
Initial severity assessment is evaluated using arterial blood gas and pulmonary function test and aggressive therapy is initiated to prevent progression to respiratory failure.
References
- ↑ Gorelick M, Scribano PV, Stevens MW, Schultz T, Shults J (2008) Predicting need for hospitalization in acute pediatric asthma. Pediatr Emerg Care 24 (11):735-44. DOI:10.1097/PEC.0b013e31818c268f PMID: 18955910
- ↑ Robards VL, Lubin EN, Medlock TR (1975) Renal transplantation and placement of ileal stoma. Urology 5 (6):787-9. PMID: 1094668