Get ready to energize your life?
Top Offers Only Today
Support your health and step-up your mental focus
post in: Health Date:08 Oct 2017, 12:56 views:4215
Severe asthma, although difficult to define, includes all cases of difficult/therapy-resistant disease of all age groups and bears the largest part of morbidity and mortality from asthma.
Acute, severe asthma, status asthmaticus, is the more or less rapid but severe asthmatic exacerbation that may not respond to the usual medical treatment. The narrowing of airways causes ventilation perfusion imbalance, lung hyperinflation, and increased work of breathing that may lead to ventilatory muscle fatigue and life-threatening respiratory failure. Treatment for acute, severe asthma includes the administration lakeway of oxygen, 2-agonists (by continuous or repetitive nebulisation and systemic corticosteroids.
Subcutaneous administration of epinephrine or terbutaline should be considered in patients not responding adequately to continuous nebulisation, in those unable to cooperate, and in intubated patients not responding to inhaled therapy. The exact time to intubate a patient in status asthmaticus is based mainly on clinical judgment, but intubation should not be delayed once it is deemed necessary. Mechanical ventilation in status asthmaticus supports gas-exchange and unloads ventilatory muscles until aggressive medical treatment improves the functional status of the patient.
Patients intubated and mechanically ventilated should be appropriately sedated, but paralytic agents should be avoided. Permissive hypercapnia, increase in expiratory time, and promotion of patient-ventilator synchronism are the mainstay in mechanical ventilation of status asthmaticus.
Close monitoring of the patient's condition is necessary to obviate complications and to identify the appropriate time for weaning.
Finally, after successful treatment and prior to discharge, a careful strategy for prevention of subsequent asthma attacks is imperative.
Keywords difficult/therapy-resistant asthma dynamic hyperinflation fatal asthma permissive hypercapnia status asthmaticus. Bronchial asthma has a wide clinical spectrum ranging from a mild, intermittent disease to one that is severe, persistent, and difficult to treat, which in some instances can asthma also be fatal 1, 2, 3,. Asthma deaths, although uncommon (one in 2000 asthmatics have increased over the last decades asthma 2, with more than 5000 deaths reported annually in the USA and 100,000 deaths estimated yearly throughout the world 1,.