Status asthmaticus is a severe form of asthma that is unresponsive to usual drug therapy. It can be caused by infections, air pollutants, noncompliance with medications, or aspirin use in sensitive patients. Symptoms include rapid breathing, difficulty exhaling, anxiety, and fatigue. Management involves frequent monitoring, nebulized bronchodilators, corticosteroids, oxygen, suctioning secretions, and mechanical ventilation if needed. Nurses must closely watch for signs of respiratory failure.

1. Status Asthmaticus
Nenette Dusal, RN

2. Status asthmaticus
• A severe form of asthma in which
the airway obstruction is
unresponsive to usual drug
therapy.

3. CONTRIBUTING FACTORS

4. • Infection.
• Inhalation of air pollutants and
allergens to which sensitized.
• Noncompliance in taking medications,
including overuse of bronchodilators.
• Ingestion of aspirin or related drugs in
aspirin-sensitive patient.
• Aspiration of gastric acid.

5. CLINICAL MANIFESTATIONS

6. • Tachypnea, labored respirations, with
increased effort on exhalation.
• Suprasternal retractions, use of
accessory muscles of respiration.
• Diminished breath sounds, decreased
ability to speak in phrases or sentences.
• Anxiety, irritability, fatigue, headache,
impaired mental functioning.

7. • Muscle twitching, somnolence,
diaphoresis—from continued carbon
dioxide retention.
• Tachycardia, elevated BP.
• Heart failure and death from
suffocation.

8. MANAGEMENT AND NURSING
INTERVENTIONS

9. • Monitor respiratory rate and oxygen
saturation continuously;
• Frequently monitor arterial blood
gas levels, BP, electrocardiogram.
• Administer repeated aerosol
treatments with beta2-agonist
bronchodilators, such as albuterol or
levalbuterol

10. • Add anticholinergic ipratropium as
prescribed
• Administer with caution until the
metabolic and respiratory acidosis
and hypoxemia have been corrected
• Monitor I.V. therapy.
• Corticosteroids are given to treat
inflammation of airways; because
these act slowly, their beneficial
effects may not be apparent for
several hours.

11. • Fluids are given to treat dehydration
and loosen secretions.
• Provide continuous humidified oxygen
via nasal cannula as prescribed.
• Patients with associated chronic
obstructive pulmonary disease or
emphysema are at risk for depressed
hypoxemic ventilatory drive, thus
compounding respiratory insufficiency,
so use oxygen cautiously

12. • Initiate mechanical ventilation, if
necessary.
• Assist with mobilization of obstructing
bronchial mucus.
• Perform chest physiotherapy (chest
wall percussion and vibration).
• Administer expectorant and
mucolytic drugs as prescribed.

13. • Remove secretions by suctioning, or
prepare for bronchoscopy if needed.
• Provide adequate hydration.
• Obtain portable chest X-ray and
administer antibiotic, as prescribed, to
treat any underlying respiratory
infection.

14. • Alleviate the patient's anxiety and fear
by acting calmly and by reassuring the
patient during an attack
• Stay with the patient until the attack
subsides.

15. NURSING ALERT
In status asthmaticus, the return to normal or
increasing partial pressure of carbon dioxide
does not necessarily mean that the patient
with asthma is improving—it may indicate a
fatigue state that develops just before the
patient slips into respiratory failure.