About 1 in 10 Americans suffer with asthma and it has become more common in the past 20 years. While asthma is thought of as a childhood disease, it can continue and even start up in adulthood. Asthma attacks affects about half of all asthmatics and is more common in people with poorly managed asthma. Children are more likely to experience attacks. Sometimes these attacks can be so severe that it may even lead to death.
What is status asthmaticus?
Status asthmaticus is a severe type of asthma attack where the narrowing of the airway does not respond to the initial drugs to widen the airways (bronchodilators). It can be life-threatening if not treated promptly. The aim of asthma management is to prevent such attacks from occurring. These types of attacks may occur at any time and for reasons that are not always clearly identifiable. However, it tends to follow viral infections of the respiratory tract, exposure to allergens, with exercise or exposure to cold environments.
Asthmatics and care givers need to be aware of status asthmaticus. It is more than just another asthma attack. Sometimes status asthmaticus can arise suddenly with no warning signs and symptoms. It is imperative that status asthmaticus is assessed and managed by a medical professional. Most of the time status asthmaticus can be effectively treated and managed. However, the prognosis is worse in people who have underlying diseases like congestive heart failure and chronic obstructive pulmonary disease (COPD).
Causes of Severe Asthma Attacks
It is important to understand why asthma occurs. Asthma is a condition where the lower airways, and specifically the bronchi, narrow due to spasm of the muscles in the bronchial walls (bronchospasm). Swelling of the bronchial walls due to inflammation as well as the accumulation of mucus further narrows the bronchi. As a result the movement of air into and out of the lungs is hampered.
The reason for this narrowing is that the bronchi are hypersensitive. This simply means that when certain harmless substances (allergens) come in contact with the bronchial walls, it triggers an abnormal immune reaction and the bronchi narrow. This is an allergic type of reaction, hence the term allergic asthma. Status asthmaticus is a severe case of asthma and not an entirely separate condition.
Risk Factors for Status Asthmaticus
The exact cause of asthma is unknown. A number of risk factors have been identified meaning that people who have one or more of these risk factors are more likely to develop asthma. Yet not all people who have these risk factors will suffer with asthma. A genetic predisposition is a major risk factor as well as a history of atopy (allergic tendency). Gastroesophageal reflux disease (GERD) and air pollution are other known risk factors.
With status asthmaticus, the risk factors includea recent viral respiratory illness like the common cold, exposure to cold, strenuous physical activity including exercise, air pollutants such as dust or cigarette smoke, and the use of certain medication such as NSAIDs (example: aspirin) or beta-blockers. However, there are instances where a severe asthma attack (status asthmaticus) may arise with no clearly identifiable risk factor.
Signs and Symptoms
The signs and symptoms of status asthmaticus are largely the same as asthma but more severe. Since the movement of air through the airways is so hampered and oxygenation of blood is severely impaired, there may also be additional symptoms that are either minimal in milder asthmatic attacks or not present at all. These signs and symptoms of status asthmaticus includes:
- Rapid breathing with wheezing (early stages).
- Severe shortness of breath that does not significantly ease when lying down or standing up.
- Enlargement (hyperexpansion) of the chest.
- Cannot speak properly and complete full sentences with ease.
- Anxious and agitated.
- Difficulty concentrating and confused.
- Bluish tinge of the lips (warning sign).
- Prefers to stoop or hunch over.
- Neck and abdominal muscles being used to breathe.
Most of these symptoms, if not all, that are present during a milder asthma attack will ease or even resolve completely with the use of bronchodilators. However, in status asthmaticus there is little to no improvement of symptoms when bronchodilators are administered. It is important to understand that these symptoms indicate respiratory distress and require emergency medical treatment. In severe cases it can be life-threatening.
Treatment of Status Asthmaticus
Status asthmaticus requires immediate treatment by a medical professional. The treatment involves a combination of drugs and oxygen administration. Ventilation is also often necessary for these attacks. This includes non-invasive ventilation involving positive airway pressure or mechanical ventilation. Often intubation is necessary for status asthmaticus but this is determined on a case-by-case basis.
The drugs used for status asthmaticus includes beta-agonists, corticosteroids and theophylline. While these drugs may be present in inhalants for home use, status asthmaticus requires the intervention of a medical practitioner in order to minimize the respiratory distress and reduce complications. Where possible hospitalization is advisable. Underlying medical conditions like infections should be treated accordingly, such as antibiotics for bacterial infections.
NOTE: Never attempt to manage status asthmaticus at home without a medical professional. Early treatment and proper medical management is imperative.
Prevention of Severe Asthma Attacks
Ideally status asthmaticus should be avoided as far as possible. While it is not entirely preventable, these attacks can be minimized to a large degree by ensuring that asthma medication is taken as prescribed. Some patients purposely avoid the medication due to concern about the side effects. However, these concerns can be unfounded and the dangers of status asthmaticus outweighs the perceived benefits.
Avoiding triggers is equally important in preventing status asthmaticus. While viral respiratory infections are not entirely avoidable, proper care and use of prescribed drugs can minimize the risk of status asthmaticus. Never use drugs that have not been prescribed by a medical professional as some of these drugs could trigger a severe attack. Other factors like exposure to air pollutants, exercise and cold can be mitigated to some degree.
Food is usually not a trigger for status asthmaticus. However, severe asthma attacks are more likely to occur in people with food allergies which tends to worsen the asthma. This is mainly a problem in children. Therefore trigger foods need to be identified and avoided as far as possible.