Status Asthmaticus and Pending Pulmonary Failure

This chapter discusses background, prevention, diagnosis, treatment, and prognosis for status asthmaticus and pending pulmonary failure. Status asthmaticus, or acute severe asthma, is an acute exacerbation of asthma that is unresponsive to repeated treatment with beta-agonists. Risk factors for a fatal asthma attack include a recent history of poorly controlled asthma or any history of near-fatal asthma (intubation or ICU admission). About half of patients with acute severe asthma have a concomitant respiratory tract infection. The goal of therapy is not to restore patients to baseline pulmonary function, but to stabilize them quickly, correct hypoxemia, and improve bronchial obstruction while minimizing and preventing complications such as pneumothorax and respiratory arrest. In a patient with status asthmaticus, an arterial blood gas (ABG) demonstrating a normal pH and _CO2 indicates impending respiratory failure.