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

Zab Mosenifar, MD


April 23, 2018

The most important and readily available test to evaluate the severity of an asthma attack is the measurement of PEF. PEF monitors are commonly available to patients for use at home, and they provide asthmatic patients with a guideline for changes in lung function as they relate to changes in symptoms. In most patients with asthma, a decrease in peak flow as a percentage of predicted value correlates with changes in spirometry values.

A CBC count and differential may demonstrate an elevated white blood cell count, with or without a shift to the left. The CBC count may also indicate a bacterial infection. However, beta-agonists and corticosteroids may result in demargination of white cells with an increase in the peripheral white cell count.

If a patient with acute asthma has adequate peripheral oxygen saturation, is receiving further therapy, and does not warrant immediate intubation, then the usefulness of blood gas data should be weighed against the potential pain and agitation that running this test may cause in a child. Improvement or deterioration in acute asthma can generally be followed clinically. Indwelling arterial catheters reduce the pain issue and generate highly reliable and reproducible information.

Autopsy results from patients who died from status asthmaticus of brief duration (ie, developed within hours) show neutrophilic infiltration of the airways. In contrast, results from patients who developed status asthmaticus over days show eosinophilic infiltration; this is more common and is associated with eosinophil upregulation. Autopsy results also show extensive mucus production and severe bronchial smooth muscle hypertrophy. However, the predominant response, based on results from bronchoalveolar lavage studies, is eosinophilic in nature.

For more on the workup of status asthmaticus, read here.


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