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Severe Asthma

From ICU to Discharge
  • Brian M. Morrissey
  • Nicholas J. Kenyon
  • Timothy E. Albertson
Chapter
Part of the Current Clinical Practice book series (CCP)

Abstract

  • The in-hospital mortality rate for all patients with asthma is less than 1%, but for patients with near-fatal asthma who require intubation, the mortality rate may be as high as 5%.

  • Near-fatal asthma refers to a life-threatening asthma attack that requires ventilatory support; status asthmaticus refers to an asthma attack that does not readily respond to aggressive standard treatment.

  • /gb-agonists remain the main pharmacotherapy in status asthmaticus and near-fatal asthma (NFA).

  • African-Americans, women, and the elderly are at increased risk of fatal asthma.

  • Controlled modes of ventilation that allow for a prolonged expiratory time are favored in patients with NFA.

  • General anesthesia by either intravenous infusion or gas inhalation are therapeutic options for the patients with the most severe asthma.

  • Coordination of discharge and follow-up care can safely reduce length of hospital stay.

Keywords

Intensive Care Unit Continuous Positive Airway Pressure Severe Asthma Respir Crit Acute Asthma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Pendergraft TB, Stanford RH, Beasley R, et al. Rates and characteristics of intensive care unit admissions and intubations among asthma-related hospitalizations. Ann Allergy Asthma Immunol 2004; 93(1): 29–35.PubMedCrossRefGoogle Scholar
  2. 2.
    Corbridge TC, Hall JB. The assessment and management of adults with SA. Am J Respir Crit Care Med 1995; 151: 1296–1316.PubMedGoogle Scholar
  3. 3.
    McFadden ER Jr, Hejal R. Asthma. Lancet 1995; 345: 1215–1220.PubMedCrossRefGoogle Scholar
  4. 4.
    Sly RM. Increases in deaths from asthma. Ann Allergy 1984; 53(1): 20–25.PubMedGoogle Scholar
  5. 5.
    Lee KH, Tan WC, Lim TK. Severe asthma. Singapore Med J 1997; 38: 238–240, 243.PubMedGoogle Scholar
  6. 6.
    Scoggin CH, Sahn SA, Petty TL. SA. A nine-year experience. JAMA 1977; 238: 1158–1162.PubMedCrossRefGoogle Scholar
  7. 7.
    Mansel JK, Stogner SW, Petrini MF, Norman JR. Mechanical ventilation in patients with acute severe asthma. Am J Med 1990; 89: 42–48.PubMedCrossRefGoogle Scholar
  8. 8.
    Shugg AW, Kerr S, Butt WW. Mechanical ventilation of paediatric patients with asthma: short and long term outcome. J Paediatr Child Health 1990; 26: 343–346.PubMedCrossRefGoogle Scholar
  9. 9.
    Miller TP, Greenberger PA, Patterson R. The diagnosis of potentially fatal asthma in hospitalized adults. Patient characteristics and increased severity of asthma. Chest 1992; 102: 515–518.PubMedCrossRefGoogle Scholar
  10. 10.
    Spitzer WO, Suissa S, Ernst P, et al. The use of beta-agonists and the risk of death and near death from asthma. N Engl J Med 1992; 326: 501–506.PubMedGoogle Scholar
  11. 11.
    Kikuchi Y, Okabe S, Tamura G, et al. Chemosensitivity and perception of dyspnea in patients with a history of near-fatal asthma. N Engl J Med 1994; 330: 1329–1334.PubMedCrossRefGoogle Scholar
  12. 12.
    Sears MR, Greene JM, Willan AR, et al. A longitudinal, population-based, cohort study of childhood asthma followed to adulthood. N Engl J Med 2003; 349: 1414–1422.PubMedCrossRefGoogle Scholar
  13. 13.
    Serafini U. Can fatal asthma be prevented? A personal view. Clin Exp Allergy 1992; 22: 576–588.PubMedCrossRefGoogle Scholar
  14. 14.
    Holloway JW, Dunbar PR, Riley GA, et al. Association of beta2-adrenergic receptor polymorphisms with severe asthma. Clin Exp Allergy 2000; 30: 1097–1103.PubMedCrossRefGoogle Scholar
  15. 15.
    Taylor DR, Kennedy MA. Genetic variation of the beta(2)-adrenoceptor: its functional and clinical importance in bronchial asthma. Am J Pharmacogenomics 2001; 1: 165–174.PubMedCrossRefGoogle Scholar
  16. 16.
    Burchard EG, Silverman EK, Rosenwasser LJ, et al. Association between a sequence variant in the IL-4 gene promoter and FEV(1) in asthma. Am JRespir Crit Care Med 1999; 160: 919–922.Google Scholar
  17. 17.
    Rosenwasser LJ. Promoter polymorphism in the candidate genes, IL-4, IL-9, TGF-beta1, for atopy and asthma. Int Arch Allergy Immunol 1999; 118: 268–270.PubMedCrossRefGoogle Scholar
  18. 18.
    Koshino T, Takano S, Kitani S, et al. Novel polymorphism of the 5-lipoxygenase activating protein (FLAP) promoter gene associated with asthma. Mol Cell Biol Res Commun 1999; 2: 32–35.PubMedCrossRefGoogle Scholar
  19. 19.
    Weiss KB, Gergen PJ, Crain EF. Inner-city asthma. The epidemiology of an emerging US public health concern. Chest 1992; 101(6 Suppl): 362S–367S.PubMedCrossRefGoogle Scholar
  20. 20.
    Liu LY, Coe CI, Swenson CA, et al. School examinations enhance airway inflammation to antigen challenge. Am J Respir Crit Care Med 2002; 165: 1062–1067.PubMedGoogle Scholar
  21. 21.
    The ENFUMOSA cross-sectional European multicentre study of the clinical phenotype of chronic severe asthma. European Network for Understanding Mechanisms of Severe Asthma. Eur Respir J 2003; 22: 470–477.CrossRefGoogle Scholar
  22. 22.
    Felez MA, Roca J, Barbera JA, et al. Inhaled platelet-activating factor worsens gas exchange in mild asthma. Am J Respir Crit Care Med 1994; 150: 369–373.PubMedGoogle Scholar
  23. 23.
    Rodriguez-Roisin R. Acute severe asthma: pathophysiology and pathobiology of gas exchange abnormalities. Eur Respir J 1997; 10: 1359–1371.PubMedCrossRefGoogle Scholar
  24. 24.
    James AJ. Relationship between airway thickness and airway hyperresponsiveness. In AG Stewart, ed. Airway Wall Remodelling in Asthma. Boca Raton, CRC Press, 1997, pp. 1–27.Google Scholar
  25. 25.
    Lamblin C, Gosset P, Tillie-Leblond I, et al. Bronchial neutrophilia in patients with noninfectious SA. Am J Respir Crit Care Med 1998; 157: 394–402.PubMedGoogle Scholar
  26. 26.
    Wenzel SE, Szefler SJ, Leung DY, et al. Bronchoscopic evaluation of severe asthma. Persistent inflammati on associated with high dose glucocorticoids. Am J Respir Crit Care Med 1997; 156(3 Pt 1): 737–743.PubMedGoogle Scholar
  27. 27.
    Saetta M, Di Stefano A, Rosina C, Thiene G, Fabbri LM. Quantitative structural analysis of peripheral airways and arteries in sudden fatal asthma. Am Rev Respir Dis 1991; 143: 138–143.PubMedGoogle Scholar
  28. 28.
    Carroll NG, Mutavdzic S, James AL. Increased mast cells and neutrophils in submucosal mucous glands and mucus plugging in patients with asthma. Thorax 2002; 57: 677–682.PubMedCrossRefGoogle Scholar
  29. 29.
    Ebina M, Yaegashi H, Takahashi T, Motomiya M, Tanemura M. Distribution of smooth muscles along the bronchial tree. A morphometric study of ordinary autopsy lungs. Am Rev Respir Dis 1990; 141(5 Pt 1): 1322–1326.PubMedGoogle Scholar
  30. 30.
    Brenner BE, Abraham E, Simon RR. Position and diaphoresis in acute asthma. Am J Med 1983; 74: 1005–1009.PubMedCrossRefGoogle Scholar
  31. 31.
    FitzGerald JM, Hargreave FE. The assessment and management of acute life-threatening asthma. Chest 1989; 95: 888–894.PubMedCrossRefGoogle Scholar
  32. 32.
    Mountain RD, Sahn SA. Clinical features and outcome in patients with acute asthma presenting with hypercapnia. Am Rev Respir Dis 1988; 138: 535–539.PubMedGoogle Scholar
  33. 33.
    Martin JG, Shore S, Engel LA. Effect of continuous positive airway pressure on respiratory mechanics and pattern of breathing in induced asthma. Am Rev Respir Dis 1982; 126: 812–817.PubMedGoogle Scholar
  34. 34.
    McFadden ER Jr, Lyons HA. Arterial-blood gas tension in asthma. N Engl J Med 1968; 278: 1027–1032.PubMedGoogle Scholar
  35. 35.
    Nowak RM, Tomlanovich MC, Sarkar DD, Kvale PA, Anderson JA. Arterial blood gases and pulmonary function testing in acute bronchial asthma. Predicting patient outcomes. JAMA 1983; 249: 2043–2046.PubMedCrossRefGoogle Scholar
  36. 36.
    Mountain RD, Heffner JE, Brackett NC Jr, Sahn SA. Acid-base disturbances in acute asthma. Chest 1990; 98: 651–655.PubMedCrossRefGoogle Scholar
  37. 37.
    Sherman S, Skoney JA, Ravikrishnan KP. Routine chest radiographs in exacerbations of chronic obstructive pulmonary disease. Diagnostic value. Arch Intern Med 1989; 149: 2493–2466.PubMedCrossRefGoogle Scholar
  38. 38.
    White CS, Cole RP, Lubetsky HW, Austin JH. Acute asthma. Admission chest radiography in hospitalized adult patients. Chest 1991; 100: 14–16.PubMedCrossRefGoogle Scholar
  39. 39.
    Society BT. Guidelines on the management of asthma. Thorax. 1993; 49: S1–S24.Google Scholar
  40. 40.
    Raimondi AC, Schottlender J, Lombardi D, Molfino NA. Treatment of acute severe asthma with inhaled albuterol delivered via jet nebulizer, metered dose inhaler with spacer, or dry powder. Chest 1997; 112: 24–28.PubMedCrossRefGoogle Scholar
  41. 41.
    Rodrigo GJ, Rodrigo C. Continuous vs intermittent beta-agonists in the treatment of acute adult asthma: a systematic review with meta-analysis. Chest 2002; 122: 160–165.PubMedCrossRefGoogle Scholar
  42. 42.
    Shrestha M, Bidadi K, Gourlay S, Hayes J. Continuous vs intermittent albuterol, at high and low doses, in the treatment of severe acute asthma in adults. Chest 1996; 110: 42–47.PubMedCrossRefGoogle Scholar
  43. 43.
    Kress JP, Noth I, Gehlbach BK, et al. The utility of albuterol nebulized with heliox during acute asthma exacerbations. Am J Respir Crit Care Med 2002; 165: 1317–1321.PubMedCrossRefGoogle Scholar
  44. 44.
    Peterson GM, Boyles PJ, Bleasel MD, Vial JH. Ipratropium treatment of acute airways disease. Ann Pharmacother 2003; 37: 339–344.PubMedCrossRefGoogle Scholar
  45. 45.
    Salpeter SR, Ormiston TM, Salpeter EE. Cardiovascular effects of beta-agonists in patients with asthma and COPD: a meta-analysis. Chest 2004; 125: 2309–2321.PubMedCrossRefGoogle Scholar
  46. 46.
    Rowe BH, Bretzlaff JA, Bourdon C, Bota GW, Camargo, CA Jr. Magnesium sulfate for treating exacerbations of acute asthma in the emergency department. Cochrane Database Syst Rev 2000; (2): CD001490.PubMedGoogle Scholar
  47. 47.
    Niven AS, Argyros G. Alternate treatments in asthma. Chest 2003; 123: 1254–1265.PubMedCrossRefGoogle Scholar
  48. 48.
    Afessa B, Morales I, Cury JD. Clinical course and outcome of patients admitted to an ICU for SA. Chest 2001; 120: 1616–1621.PubMedCrossRefGoogle Scholar
  49. 49.
    Williams TJ, Tuxen DV, Scheinkestel CD, Czarny D, Bowes G. Risk factors for morbidity in mechanically ventilated patients with acute severe asthma. Am Rev Respir Dis 1992; 146: 607–615.PubMedGoogle Scholar
  50. 50.
    Mutlu GM, Factor P, Schwartz DE, Sznajder JI. Severe SA: management with permissive hypercapnia and inhalation anesthesia. Crit Care Med 2002; 30: 477–480.PubMedCrossRefGoogle Scholar
  51. 51.
    Zimmerman JL, Dellinger RP, Shah AN, Taylor RW. Endotracheal intubation and mechanical ventilation in severe asthma. Crit Care Med 1993; 21: 1727–1730.PubMedCrossRefGoogle Scholar
  52. 52.
    Marshall BE, Longnecker DE. General anesthetics. In AG Goodman, Rall TW, Nies AS, Taylor P, eds. The Pharmacological Basis of Therapeutics (8th ed.). New York, Pergamon Press, 1984; pp. 285–310.Google Scholar
  53. 53.
    Vasile B, Rasulo F, Candiani A, Latronico N. The pathophysiology of propofol infusion syndrome: a simple name for a complex syndrome. Intensive Care Med 2003; 29: 1417–1425.PubMedCrossRefGoogle Scholar
  54. 54.
    Griffin D, Fairman N, Coursin D, Rawsthorne L, Grossman JE. Acute myopathy during treatment of SA with corticosteroids and steroidal muscle relaxants. Chest 1992; 102: 510–514.PubMedCrossRefGoogle Scholar
  55. 55.
    Road J, Mackie G, Jiang TX, Stewart H, Eisen A. Reversible paralysis with SA, steroids, and pancuronium: clinical electrophysiological correlates. Muscle Nerve 1997; 20: 1587–1590.PubMedCrossRefGoogle Scholar
  56. 56.
    Shee CD. Risk factors for hydrocortisone myopathy in acute severe asthma. Respir Med 1990; 84: 229–233.PubMedCrossRefGoogle Scholar
  57. 57.
    Leatherman JW, Fluegel WL, David WS, Davies SF, Iber C. Muscle weakness in mechanically ventilated patients with severe asthma. Am J Respir Crit Care Med 1996; 153: 1686–1690.PubMedGoogle Scholar
  58. 58.
    Gooch JL. Prolonged paralysis after neuromuscular blockade. J Toxicol Clin Toxicol 1995; 33: 419–426.PubMedCrossRefGoogle Scholar
  59. 59.
    Kass JE, Terregino CA. The effect of heliox in acute severe asthma: a randomized controlled trial. Chest 1999; 116: 296–300.PubMedCrossRefGoogle Scholar
  60. 60.
    Gluck EH, Onorato DJ, Castriotta R. Helium-oxygen mixtures in intubated patients with SA and respiratory acidosis. Chest 1990; 98: 693–698.PubMedCrossRefGoogle Scholar
  61. 61.
    Cooper DJ, Tuxen DV, Fisher MM. Extracorporeal life support for SA. Chest 1994; 106: 978–979.PubMedCrossRefGoogle Scholar
  62. 62.
    Kress JP, Pohlman AS, O’Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000; 342: 1471–1477.PubMedCrossRefGoogle Scholar
  63. 63.
    Meade M, Guyatt G, Cook D, et al. Predicting success in weaning from mechanical ventilation. Chest 2001; 120(6 Suppl): 400S–404S.PubMedCrossRefGoogle Scholar
  64. 64.
    Lim TK, Chin NK, Lee KH, Stebbings AM. Early discharge of patients hospitalized with acute asthma: a controlled study. Respir Med 2000; 94: 1234–1240.PubMedCrossRefGoogle Scholar
  65. 65.
    Ebbinghaus S, Bahrainwala AH. Asthma management by an inpatient asthma care team. PediatrNurs 2003; 29: 177–183.Google Scholar
  66. 66.
    Kallenbach JM, Frankel AH, Lapinsky SE, et al. Determinants of near fatality in acute severe asthma. Am J Med 1993; 95: 265–272.PubMedCrossRefGoogle Scholar
  67. 67.
    Rebuck AS, Tomarken JL. Pulsus paradoxus in asthmatic children. Can Med Assoc J 1985; 112: 710–711.Google Scholar
  68. 68.
    Hamman L. Spontaneous mediastinal emphysema. Bull Johns Hopkins Hosp 1939; 64: 1–21.Google Scholar
  69. 69.
    Cohen CA, Zagelbaum G, Gross D, Roussos C, Macklem PT. Clinical manifestations of inspiratory muscle fatigue. Am J Med 1982; 73: 308–316.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc. 2006

Authors and Affiliations

  • Brian M. Morrissey
    • 1
  • Nicholas J. Kenyon
    • 1
  • Timothy E. Albertson
    • 2
  1. 1.Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of MedicineUniversity of California at DavisDavis
  2. 2.Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of MedicineUniversity of California at DavisDavis

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