Status Asthmaticus: When Asthma Becomes Life-Threatening

Case : A 24-year-old woman with a known history of asthma presented to the Emergency Department with severe shortness of breath for 8 hours. She reported worsening wheezing and cough for 2 days following an upper respiratory tract infection. Despite using her salbutamol inhaler more than 10 times, she experienced no relief. She had stopped her inhaled corticosteroid therapy 2 weeks ago. On arrival, she was visibly distressed, unable to speak in full sentences, and using accessory muscles of respiration. Examination Findings: Pulse: 128/min Blood pressure: 90/60 mmHg Respiratory rate: 36/min SpO₂: 84% on room air Chest: Initially diffuse bilateral wheeze, progressing to markedly reduced air entry ("silent chest"). Investigations: ABG: pH 7.22, PaCO₂ 58 mmHg, PaO₂ 55 mmHg → Type II respiratory failure CXR: Hyperinflated lungs, no consolidation Diagnosis: Status Asthmaticus – a life-threatening asthma exacerbation unresponsive to standard inhaled bronchodilators. Management: Humidified oxygen β2 agonist nebulization (salbutamol 5mg) + (anticholinergic ipratropiumbromide0.5 mg) Intravenous Hydrocortisone 200mg stat, followed by 100mg 6 hourly OR oral prednisolone 30-60 mg/ day. I/V fluids Potassium supplements for the correction of hypokalemia caused by repeated doses of salbutamol. Sodium bicarbonate for the treatment of acidosis.

Status Asthmaticus: When Asthma Becomes Life-Threatening

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