Fast Five Quiz: Are You Familiar With Key Components of Status Asthmaticus?

Zab Mosenifar, MD


April 23, 2018

Patients are usually tachypneic upon examination and, in the early stages of status asthmaticus, may have significant wheezing. Initially, wheezing is heard only during expiration, but wheezing later occurs during expiration and inspiration.

Patients with status asthmaticus have severe dyspnea that has developed over hours to days. In most cases, the lead time is several days.

Auscultation often reveals bilateral expiratory and possibly inspiratory wheezes and crackles. Air entry may or may not be diminished or absent, depending on severity. Remember, the silent chest may herald impending respiratory failure in a patient too obstructed or fatigued to generate wheezing.

Risk factors for developing severe or persistent status asthmaticus include the following:

  • History of increased use of home bronchodilator treatment without improvement or effect

  • History of previous intensive care unit (ICU) admissions, with or without intubation and mechanical ventilatory support

  • Asthma exacerbation despite recent or current use of corticosteroids

  • Frequent emergency department visits and/or hospitalization (implies poor control)

  • Less than 10% improvement in PEF rate from baseline despite treatment

  • History of syncope or seizures during acute exacerbation

  • Oxygen saturation below 92% despite supplemental oxygen

  • Subgroup of asthma patients who are poor perceivers of dyspnea are at greater risk for intubation and death

For more on the presentation and physical examination of patients with status asthmaticus, read here.


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