Status asthmaticus medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
- Initial severity assessment is evaluated using arterial blood gas and pulmonary function test and aggressive therapy is initiated to prevent progression to respiratory failure
Medical Therapy
Therapy based on the severity of the disease assessed by Arterial Blood Gas Analysis
Stage 1
- Hyperventilation with normal PO2
- No hypoxemia
- Patients may benefit from nebulized ipratropium used adjunctive to β2-agonist therapy
Stage 2
- Hyperventilation with hypoxemia (low PO2 and PCO2)
- Patients may require corticosteroids in addition to bronchodilator therapy
Stage 3
- CO2 retention due to respiratory muscle fatigue
- Markedly elevated PCO2 levels are an indicator for mechanical ventilation
- Aggressive β2-agonist therapy along with parenteral steroids and/or theophylline is indicated
Stage 4
- Severe hypoxia with markedly elevated PCO2
- FEV1 lower than 20% predicted is suggestive of an impending respiratory arrest that may require intubation and mechanical ventilation
- Metered-dose inhalation of β2-agonist and anticholinergics are recommended. Administration of parenteral steroids and/or theophylline has also shown to be beneficial.