Status asthmaticus: Difference between revisions
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==Overview== | ==Overview== | ||
'''Status asthmaticus''' is 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 rapidly | '''Status asthmaticus''' is 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 di oxide]] retention and [[hypoxemia]]. | ||
==Epidemiology== | |||
Approximately 10% of the US population is affected by asthma with status asthmaticus requiring 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> | |||
==Predisposing factors== | |||
*Increase use of [[bronchodilator]] despite resistance, | |||
*Frequent exacerbations despite the use of [[corticosteroids]], | |||
*Despite adhering to therapy, a peak flow rate of less than 10% from baseline, | |||
*Frequent hospitalization for acute attacks, | |||
*History of [[syncope]] or [[seizure]] during an acute asthmatic attack, | |||
*Oxygen saturation lower than 92% despite supplemental oxygen, | |||
*Airway obstruction is significantly reduced, resulting in severe impairment of air motion that leads to a '''silent chest''' with the absence of [[wheeze]] suggestive of an [[respiratory failure|imminent respiratory arrest]]. | |||
==Diagnosis== | |||
===History and Symptoms=== | |||
*[[dyspnea|Rapidly progressive dyspnea]] | |||
*[[cough|Non-productive cough]] | |||
*[[sweating|Profuse sweating]] | |||
*[[Cyanosis]] | |||
*[[Loss of consciousness]] and/or [[seizure]] secondary to [[hypoxia|severe hypoxia]] may be observed | |||
*Inability to speak more than one or two words may be observed with severe airway obstruction | |||
===Physical Examination=== | |||
====Vital Signs==== | |||
*Early stages: | |||
:*[[Tachypnea|Increased respiratory rate]] greater than 30 cycles per minute | |||
:*[[Tachycardia|Increased heart rate]] | |||
:*[[Pulsus paradoxus]] (a fall of SBP greater than 20-40 mmHg during inspiration) | |||
*With progressive untreated airway obstruction, increased work of breathing may result in [[bradycardia]], [[hypoventilation]] and [[cardiorespiratory arrest]] | |||
====General Physical Examination==== | |||
*Sit upright with arms extended to support the upper chest ('''tripod position''') that assist the use of accessory muscles of respiration | |||
*Use of accessory muscles of respiration | |||
==References== | ==References== | ||
Revision as of 02:59, 27 September 2011
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Status asthmaticus On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]
Overview
Status asthmaticus is 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 di oxide retention and hypoxemia.
Epidemiology
Approximately 10% of the US population is affected by asthma with status asthmaticus requiring highest rates of hospitalization.[1]
Predisposing factors
- Increase use of bronchodilator despite resistance,
- Frequent exacerbations despite the use of corticosteroids,
- Despite adhering to therapy, a peak flow rate of less than 10% from baseline,
- Frequent hospitalization for acute attacks,
- History of syncope or seizure during an acute asthmatic attack,
- Oxygen saturation lower than 92% despite supplemental oxygen,
- Airway obstruction is significantly reduced, resulting in severe impairment of air motion that leads to a silent chest with the absence of wheeze suggestive of an imminent respiratory arrest.
Diagnosis
History and Symptoms
- Rapidly progressive dyspnea
- Non-productive cough
- Profuse sweating
- Cyanosis
- Loss of consciousness and/or seizure secondary to severe hypoxia may be observed
- Inability to speak more than one or two words may be observed with severe airway obstruction
Physical Examination
Vital Signs
- Early stages:
- Increased respiratory rate greater than 30 cycles per minute
- Increased heart rate
- Pulsus paradoxus (a fall of SBP greater than 20-40 mmHg during inspiration)
- With progressive untreated airway obstruction, increased work of breathing may result in bradycardia, hypoventilation and cardiorespiratory arrest
General Physical Examination
- Sit upright with arms extended to support the upper chest (tripod position) that assist the use of accessory muscles of respiration
- Use of accessory muscles of respiration
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