Strongly discourage patients from smoking, this habit should be avoided at all costs. Forced oscillation using impulse oscillometry (IOS) detects false negative spirometry in symptomatic patients with reactive airways. Pathologic findings in fatal asthma include bronchial lumen occlusion by mucus, hyperplasia of submucosal glands, basement membrane thickening, and tissue eosinophilia. 2001 May. Beveridge R, Impairment of Venous Drainage on Extracorporeal Membrane Oxygenation Secondary to Air Trapping in Acute Asphyxial Asthma. McFadden ER Jr. [Full Text]. JAMES C. HIGGINS, CAPT, MC, USN, is staff physician in the family practice residency program at Naval Hospital, Jacksonville, Fla., and assistant clinical professor of family medicine at the Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine, Bethesda, Md. Am J Emerg Med. Hanania NA, David-Wang A, Kesten S, Chapman KR. 2000;102(8 suppl):I229–52. Chronic cough, sinusitis, and hyperreactive airways in children: an often overlooked association. The most common scenario is severe bronchospasm, with mucus plugging leading to asphyxia. Bronchospasm, mucus plugging, and edema in the peripheral airways result in increased airway resistance and obstruction. [Medline]. [Medline]. Tobias, J.S. From 5 to 10 percent of patients have severe disease that does not respond to typical therapeutic interventions. 67/No. Crucial tasks include rapid assessment of the severity of the asthma attack, objective determination of the response to therapy, and identification of the risk of respiratory failure. A comfortable and supportive environment should be provided. Wheezing in children, which can be caused by a variety of infective conditions - eg, respiratory syncytial virus - causing bronchiolitis. Elkind G. 4. Sign up for the free AFP email table of contents. [Medline]. Boulet LP, 1-5. Wentworth CE III, [Medline]. More recently, asthma mortality rates are trending lower. Reprints are not available from the author. Camargo CA Jr, Smithline HA, Malice MP, Green SA, Reiss TF. O'Hollaren MT, Yunginger JW, Offord KP, Somers MJ, O'Connell EJ, Ballard DJ, et al. Want to use this article elsewhere? [Medline]. Inhalation injury… For intravenous treatment, methylprednisolone sodium succinate (Solu-Medrol) is administered in a dosage of 0.5 to 2 mg per kg every six hours (usual maximum: 125 mg per day), or hydrocortisone is given in a dosage of 2 to 4 mg per kg every four to six hours.3, Patients with severe asthma have a ventilation-perfusion mismatch and, thus, benefit from supplemental oxygen therapy. Superimposed infection can also occur in intubated patients. Death can occur when asthma is severe, uncontrolled, and poorly responsive to treatment, with steady deterioration of respiratory status occurring over a period of days.1,6 Data indicate that in nearly 85 percent of asthma deaths, the final episode lasted longer than 12 hours.1 This length of time should have allowed ample opportunity for treatment if the patients had presented promptly for care and their respiratory distress had been quickly recognized.1 Fortunately, only one in 2,000 patients die of asthma; the vast majority survive.1. ), Typically, patients present a few days after the onset of a viral respiratory illness, following exposure to a potent allergen or irritant, or after exercise in a cold environment. Vaschetto R, Bellotti E, Turucz E, Gregoretti C, Corte FD, Navalesi P. Inhalational anesthetics in acute severe asthma. 2001;119:1913–29. Camargo CA Jr. Hyperventilation allows carbon dioxide removal via the fast compartment. 73(6):357-65. [Medline]. Respir Care 2002;47:178. Status asthmaticus is a condition in which severe airway obstruction and asthmatic symptoms persist despite the administration of standard acute asthma therapy. Other reasons for sudden death include cardiac dysrhythmias related to hypoxia, hyperinflation leading to air trapping, and tension pneumothorax.7 In patients with asthma, deaths also have occurred subsequent to the use of sedatives (respiratory depression), beta blockers (bronchospasm) and, occasionally, nonsteroidal anti-inflammatory drugs (anaphylaxis).1,6. [Guideline] Dinakar C, Oppenheimer J, Portnoy J, et al. A low morbidity approach. 2003 Life-threatening asthma. A randomized clinical trial of nebulized magnesium sulfate in addition to albuterol in the treatment of acute mild-to-moderate asthma exacerbations in adults. Emergency therapy of asthma: comparison of the acute effects of parenteral and inhaled sympathomimetics and infused aminophylline. St. Louis: Mosby, 1995:627–36. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. [6], The mortality risk is also particularly high in patients who delay medical treatment, especially treatment with systemic corticosteroids. Patients with severe asthma who do not respond to initial therapy require aggressive treatment to prevent cardiopulmonary arrest. A randomized controlled trial of intravenous montelukast in acute asthma. The objective is to maintain the partial pressure of oxygen at a minimum of 92 mm Hg (oxygen saturation greater than 95 percent).8,16 [References 8 and 16—Evidence level C, expert guidelines] There is no evidence that oxygen suppresses the respiratory drive in the absence of preexisting chronic pulmonary disease.3, Factors to consider in determining the need for hospitalization include disease severity, socioeconomic factors, clinical features, pulmonary function, and response to treatment.16 Hospitalization is indicated in patients with a pretreatment arterial oxygen saturation of less than 90 percent, persistent respiratory acidosis, or severe obstruction that does not improve (or worsens) with the administration of sympathomimetic agents (i.e., the PEF rate remains at less than 70 percent of the predicted value).1. Vamos M, Fergusson W, et al information on pulmonary gas exchange polgar G, M! 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