Status Asthmaticus

What is status asthmaticus?

Status asthmaticus, now known as acute severe asthma, is a severe asthma attack that doesn’t get better with standard treatments. It makes it difficult to breathe, progressing to the point where you might not be able to eat or speak very well. It also might keep you from sleeping.

Status asthmaticus can come on over a few days or just a few hours. You can usually avoid it by monitoring how well you’re breathing, avoiding your triggers and following an asthma plan you create with your healthcare provider.

Severe asthma attacks are a life-threatening emergency. Call 911 or your local emergency number if you’re having trouble breathing and your inhaler isn’t helping.

What’s the difference between asthma and status asthmaticus?

Asthma is a chronic lung disease. In people with asthma, triggers like smoke, allergens and physical activity can cause their airways to swell and fill with mucus. You can usually manage asthma with medications. Status asthmaticus is a severe asthma attack that doesn’t get better with medications at home.

What are the symptoms of status asthmaticus (acute severe asthma)?

Symptoms of status asthmaticus can develop over hours or days. They include:

• Severe shortness of breath. You might not be able to speak or eat.
• Wheezing.
• Coughing.
• Fast heart rate.
• Dizziness.
• Confusion.
• Bluish fingers, lips or skin.

What causes status asthmaticus?

Asthma causes your airways to tighten (bronchospasm), swell up (inflammation) and produce a lot of mucus. Experts think inflammation and mucus cause the most hard-to-control asthma attacks rather than bronchospasms.

What are the triggers for status asthmaticus?

Any asthma triggers can cause status asthmaticus. Common asthma triggers include:

• Indoor and outdoor allergies.
• Other irritants, like smoke, fragrances or cold air.
• Physical exercise.
• Emotional stress.
• Infections, like colds, the flu or COVID-19.
• Certain medications.

What are the risk factors for acute severe asthma?

You might be more likely to have a severe asthma attack if:

• You’re unsure how to use your inhaler(s) or you’re using them improperly. This is very common — there are a lot of steps to using inhalers and it’s easy to miss one. If you don’t time your breathing just right or miss one of the steps, you might not get all of the medication to your lungs.
• You or your healthcare providers underestimate the severity of your asthma. This might mean you’re not on the right medications or dosages.
• You’re unable or unwilling to use the medications you need, or you don’t know when you’re supposed to take them to prevent severe symptoms.

What are the complications of status asthmaticus?

Acute severe asthma can lead to serious complications, including:

• Hypoxia (not getting enough oxygen to your tissues).
• Acute respiratory distress.
• Respiratory failure.

How is status asthmaticus (acute severe asthma) diagnosed?

A provider diagnoses status asthmaticus based on your symptoms and by examining you. They’ll ask you about your medical history and might perform lung function tests. They’ll start treating you right away to get your breathing under control, but they may also perform other tests, like blood tests or chest X-rays, to rule out other conditions.

How is status asthmaticus (acute severe asthma) treated?

A provider will treat you with oxygen and medications that reduce swelling and open your lungs. In severe cases, they’ll put you on a ventilator until you can breathe on your own again.

Specific medications used to treat status asthmaticus

Depending on how severe your condition is, your healthcare providers may treat you with:

• Supplemental oxygen.
• Inhaled bronchodilators. This includes beta-2 agonists (albuterol or levalbuterol) and anticholinergenics (ipratropium bromide).
• Intravenous (IV) corticosteroids (hydrocortisone or methylprednisolone).
• IV bronchodilators (magnesium sulfate).
• Epinephrine.
• IV fluids.
• Inhaled helium gas.
• Intubation and mechanical ventilation.
• Sedation.

Can you prevent status asthmaticus (acute severe asthma)?

You can reduce your risk of severe asthma attacks by:

• Making sure you know how to properly use any devices to manage your asthma. This includes inhalers and nebulizers. Ask your provider to show you, step-by-step, the best way to use them.
• Understanding when and how to treat your asthma symptoms before they become unmanageable. This might include taking readings with a peak flow meter or creating an asthma action plan worksheet with your provider.
• Knowing your triggers and doing your best to avoid them.
• Checking in with your provider regularly to make sure your asthma is manageable.
• Seeking medical attention as soon as possible if you need it.

What can I expect if I have status asthmaticus (acute severe asthma)?

If you have status asthmaticus, you can expect to stay in the hospital until your condition is under control. In severe cases, your providers might move you to an intensive care unit.

Your provider will prescribe corticosteroids (like prednisone) to take for 12 to 14 days when you go home.

When should I go to the ER?

Call 911 or go to the ER if you have severe trouble breathing or an asthma attack you can’t get under control.

What questions should I ask my doctor?

It might be helpful to ask your provider:

• What caused this?
• How do I take my medications?
• What are my treatment options?
• How can I avoid this in the future?