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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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Zab Mosenifar. Fast Five Quiz: Are You Familiar With Key Components of Status Asthmaticus? - Medscape - Apr 23, 2018.