Mainstay of pharmacologic treatment of status asthmaticus includes short-acting, β2 agonists such as salbutamol (albuterol) administered by metered-dose inhaler with spacer or, preferably, by nebulizer and oral corticosteroids.

Emergency treatment The cornerstone of treatment is oxygen and inhaled beta 2 agonists. Beta 2 agonists can be given continuously in severe life threatening asthma.

Continuous inhaled albuterol and intravenous methylprednisolone are considered important in the management of status asthmaticus. In a report by Beach et al, a 40-year-old patient with status asthmaticus acquired an accelerated idioventricular rhythm while on this treatment.

It is difficult to understand why there is such a huge discrepancy between the management of severe asthma recommended by evidence‐based guidelines and that observed in clinical practice. The recommendations are relatively straightforward and have been widely promoted both in guidelines1,2,3 and reviews.

As a starting point for ventilating patients with severe asthma, we recommend that the ventilator initially be used in pressure control mode, setting the pressure to achieve a tidal volume of 6–8 ml/kg, respiratory rate of 11–14 breaths/min and PEEP at 0–5 cmH2O.

Patients are usually tachypneic upon examination and, in the early stages of status asthmaticus, may have significant wheezing. Initially, wheezing is heard only during expiration, but wheezing later occurs during expiration and inspiration.

Know the four steps of asthma first aid

1. Step 1: Sit the person upright. Be calm and reassuring.
2. Step 2: Give 4 separate puffs of blue/grey reliever puffer. Shake the puffer.
3. Step 3: Wait 4 minutes. Wait 4 minutes.
4. Step 4: If there is still no improvement dial triple zero (000) for an ambulance.

Asthma Resources

• Allergy & Asthma Network Mothers of Asthmatics.
• American Academy of Allergy Asthma & Immunology.
• The Asthma and Allergy Foundation of America.

Developing a plan of action During an acute asthma exacerbation like the one Marcus is experiencing, the initial priority is to stabilize the patient. Treatment goals are to decrease bronchospasms and edema and improve pulmonary function.

Treatment of bronchospasm usually starts with inhaled medications known as short-acting beta2-agonists. Ventolin or Proventil (albuterol) are common medications that may be used if you are having difficulty breathing or shortness of breath. Albuterol helps to open up your airways.

The I:E ratio denotes the proportions of each breath cycle devoted to the inspiratory and expiratory phases. The duration of each phase will depend on this ratio in conjunction with the overall respiratory rate. Increasing the I:E ratio to 1:3 will result in 1.5 seconds of inspiration and 4.5 seconds of expiration.

Treatment options. The main treatment for severe asthma is long-term control medications that help prevent asthma symptoms. These include: inhaled corticosteroids. inhaled long-acting beta-agonists. inhaled long-acting anticholinergics.

The newest asthma drug is omalizumab or xolair. This drug reduces mediator release which in turn promotes an allergic response. This asthma drug is recommended for moderate to severe asthma patients. There are a number of asthma medications on the market for each case type.

Ipratropium is sometimes used as a bronchodilator to treat a severe asthma attack, especially if albuterol is not fully effective. Intubation , mechanical ventilation and oxygen. If your asthma attack is life-threatening, your doctor may put a breathing tube down your throat into your upper airway.

Management of asthma. Although asthma cannot be cured, appropriate management can control the disease and enable people to enjoy good quality of life. Short-term medications are used to relieve symptoms. People with persistent symptoms must take long-term medication daily to control the underlying inflammation and prevent symptoms and exacerbations.