Management of status asthmaticus

Abstract

The mortality from asthma appears to be rising again, after falling in the late 1950s. Many workers ascribed this fall to the use of long-term corticosteroid therapy. It may well be that factors, other than decreased effectiveness of long-term steroid therapy, are responsible for the present increase. 2. The management of status asthmaticus may be divided into: (a) prevention, and (b) therapy of the acute attack. (a) It should be possible using large doses of steroid therapy to prevent status asthmaticus altogether but only at the expense of serious sideeffects. However, the careful use of small doses of steroids on a long-term basis (i.e. longer than 3 months) can significantly reduce the incidence of status asthmaticus. Should an attack not respond to 24 hr of intensive therapy at home, then hospital admission is advisable, as it is felt that some of the deaths that occur at home are preventable. (b) The treatment of the acute attack is discussed in the light of the experience gained in monitoring systemic arterial gas tensions and pH during the acute episode and for the ensuing days. Hypoxaemia was invariably present and often severe. Paco2 was low or normal in most of the patients, but in the few patients in whom it was raised it was a grave prognostic sign. The pH was also low in these patients.