Complications of Severe Asthma
Asthma can be very complicated and can be associated with some very serious risks. A risk that can be associated with severe asthma is acute severe asthma which you may know by it's former name "Status Asthmatics," "which is severe asthma that is unresponsive to repeated courses of beta-agonist such as inhaled albuterol, levalbuterol or subcutaneous epinephrine."1 It is a medical emergency that requires prompt treatment. I like to think of this as what concerns most asthmatics, but unfortunately is an ongoing reality for a specific population of asthmatics.
Upper Respiratory Infections - URI's
Almost 50% of acute severe asthma episodes are related to upper respiratory infections (URIs). Other causes may include medical non-adherence, allergen exposure, irritant inhalation and insufficient use of inhaled and oral corticosteroids. It is mind boggling in me to think that 50% of these episodes are related to URIs. WOW! Even more proof to keep an eye on URIs. Don't be alarmed. With good control, use of your asthma action plan, and early intervention, these situations can be preventively managed in most cases.
Initial assessments of acute severe asthma include patient history that will specifically look for preventative medication use, history of hospitalization and, emergency room visits, ICU admissions and intubations, frequency of nighttime symptoms, allergens and other medical conditions.1 Physicians will do a series of tests that may include peak flows, spirometry, pulse oximetry, looking for C02 retention.
Impact of upper respiratory failure on severe asthma
An important consideration is the role of respiratory failure in acute severe asthma. It may be potentially reversed however, it is a potentially life-threatening condition.2 There are a number of approaches and it is important to note that individual responses will differ and only your care team can make these decisions with you. One approach that may be discussed is the use of mechanical ventilation, clinicians will be on the lookout for a few signs that this may be necessary which may include deteriorating status, an increase in C02 levels, exhaustion, decreased mental status, hypoxemia instability, and refractory hypoxemia.3 These are never easy decisions for clinicians or easy for families. It is important to get prompt treatment if you feel your asthma is declining. In many cases early intervention greatly improves outcomes and need for escalated treatment.
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