Status asthmaticus in adults

Abstract

Status asthmaticus is a severe, life-threatening exacerbation of bronchial asthma that fails to improve with "conventional" treatment. "Conventional" treatment has been defined as three subcutaneous injections of epinephrine given at 15-min intervals. The use of the term "status asthmaticus" has value in that it has simplified communication. However, it has the disadvantages that it is too restrictive. It draws attention away from other aspects of severe asthma; for example, that patients die at home L2 and, in some cases, within minutes of the onset of an attack/'3 It is probably more useful to talk of "severe acute asthma," rather than "status asthmaticus. "4Between 1959 and 1979, the overall mortality due to asthma in patients from 5 to 34 years of age ranged from 0.2 to 4.1 deaths per 100,000 persons. In the United States and Canada, mortality was fairly constant, being between 0.2 and 0.4 deaths per 100,000 persons, s The hospital mortality for severe acute asthma in adult patients is shown in Table 1. The mean mortality is 1.34%. Asthma remains a potentially lethal disease, and its mortality has not declined significantly over the last 20 years. The Causes of Mortality in AsthmaTable 2 lists the commonly described factors associated with mortality in asthma. Underutilization of corticosteroids has been suggested as a significant factor in a number of reports.l,20vermedication has also been incriminated. A new epidemic of deaths from asthma in New Zealand has been suggested to be due to the combination of oral theophylline with beta-agonists. 11 Clinical Picture of Severe Acute Asthma HistoryThe history of the episode of asthma can provide important clues to the assessment of the severity of the attack and possibly its treatment. Drugs the patient has taken may precipitate an attack of asthma. These drugs include the beta-blocking agents propranolol and acebutalo112'13 and nonsteroidal antiinflammatory drugs such as aspirin, naproxen, 14 indomethacin, and zome-From the