Overview of Asthma Status

Status asthmaticus is a severe asthma attack that comes on suddenly or lasts for a long time. In status asthmaticus, despite standard treatment, asthma symptoms persist and respiratory function declines. In the United States, asthma affects approximately 7.7% of adults and 9.6% of children. Of these, 3.9% to 4.3% had severe asthma, putting them at increased risk for status asthmaticus.

Status asthmaticus can lead to respiratory failure, prolonged hospital stays, and even death. It indicates a medical emergency that requires immediate and aggressive treatment. In a population study in Denmark, approximately 1.5% of people hospitalized with status asthma did not survive.

Despite advances in emergency treatment, status asthmaticus remains a serious problem. In the United States, about 3,500 people die each year from asthma. Everyone with or without asthma should be familiar with common warning signs and symptoms.

Types of Asthma State

There are two types of SAs:

  • Slow-onset: This more common type can take a long time to unfold and is often the result of inadequate treatment. People with this status asthmaticus experience worsening symptoms over days or weeks, with occasional moments of relief and ending with symptoms that cannot be reversed with medication at home.
  • Sudden onset: People with this status asthmaticus do not experience any worsening symptoms in the first few weeks, but suddenly experience severe bronchospasm, difficulty breathing, wheezing, and coughing. This type of asthma attack is usually caused by heavy exposure to triggering substances such as pollen, dust, or food allergens.
READ ALSO:  Homeostasis and its relationship to asthma


The symptoms of status asthmaticus are not dissimilar to those of asthma, but they are much more severe. Severe air restriction combined with the severity of bronchospasm often presents with some or all of the following symptoms:

  • Difficulty breathing
  • profuse sweating
  • have trouble speaking
  • extreme fatigue and weakness
  • abdominal, back, or neck muscle pain
  • panic
  • Puzzled
  • blue lips or skin (cyanosis)
  • loss of consciousness

When to call 911

Seek emergency care if asthma symptoms do not resolve with rescue inhalers and other emergency medicines. Many people with status asthmaticus describe a “feeling of impending doom” when symptoms appear. Follow your gut and don’t hesitate to call 911.

In an emergency, these symptoms are often referred to as “severe asthma syndrome” (CAS) and indicate an increased risk of death in a child or adult.


During a severe asthma attack, the way the body normally processes breathing gas in the alveoli is compromised. This results in lower levels of oxygen and higher levels of carbon dioxide in the blood, which, in extreme cases, can lead to coma and death. Asthma also causes air to become trapped in the lungs, a condition that can lead to increased pressure in the chest. This can lead to a collapsed lung or even cardiac arrest.

risk factor

Because asthma attacks are slow, there are several warning signs that should prompt you to call your healthcare provider or seek emergency treatment. These include:

  • 20% or more drop in peak expiratory flow (PEF) using a peak flow meter
  • Increased demand for rescue inhalers
  • Nocturnal awakenings caused by asthma
  • Increased shortness of breath despite continued use of asthma medication
  • Use of one or more short-acting inhalers in the past month

Any asthma patient with a PEF drop of 30% or more, especially if a rescue inhaler is ineffective, should seek emergency medical care without exception.


Status asthmaticus is usually diagnosed by symptoms and supported by various tests that measure breathing rate and blood oxygen levels. Common diagnostic signs of status asthmaticus include:

  • panting while resting
  • inability to speak in sentences or at all
  • Increased respiratory rate at rest (greater than 30 breaths per minute)
  • Elevated resting pulse rate (greater than 120 beats per minute)
  • Agitation and irritability
  • Low blood oxygen levels (hypoxia after hypoxemia)
  • Reduced breathing capacity (measured by peak flow meter)


Status asthmaticus is always considered a medical emergency. Standard treatment options in the emergency room include:

  • Masks provide emergency oxygen therapy
  • Short-acting beta agonists (such as albuterol) via inhaler or nebulizer
  • Oral or intravenous (into a vein) corticosteroid (such as prednisone)
  • Inhaled anticholinergics (such as Atrovent)
  • Subcutaneous injection of beta agonists (such as terbutaline)
  • Magnesium sulfate intravenously
  • Oral leukotriene modifiers (such as zafirlukast or zileuton)

Because of the risk of lung injury and increased risk of death, mechanical ventilation is often considered a last resort. Less than 1% of asthma emergency department visits require mechanical ventilation.

As a last resort, extracorporeal membrane oxygenation (ECMO) is effective in some asthma patients who are lethal even with mechanical ventilation. ECMO (Extracorporeal Membrane Oxygenation) provides another last resort and final treatment modality for patients who have failed all treatments including mechanical ventilation.

It is now believed that ECMO should be considered an early treatment for patients with status asthmaticus who have poor gas exchange (insufficient oxygen intake and carbon dioxide exhalation) and who do not respond to standard emergency interventions.ECMO provides a way to restore gas exchange in the body while preventing lung damage associated with mechanical ventilation.

VigorTip words

Many asthma sufferers don’t realize how powerful their medicines are and don’t tell their healthcare provider if the medicines are no longer as effective as they used to be. If no one intervenes to correct these shortcomings, you may find it more difficult to treat asthma in an emergency.

To avoid a potentially life-threatening emergency, always let your healthcare provider know how well your medicines are working and how often you need to use your rescue inhaler.