Respiratory Conditions ~ Acute Severe Asthma
A severe acute asthma attack is an emergency situation requiring prompt assessment and management.
What does the Respiratory System do ?
The respiratory system consists of the lungs, airways and blood vessels. The function of the respiratory system is to absorb oxygen into the body and to remove carbon dioxide from the body. A normal breath requires a complex coordination between the nervous system (brain & spinal cord) and the muscles of breathing (including the diaphragm and muscles between the ribs).
Abnormal and or inadequate breathing can occur as a result of:
- An interruption to the nervous system (head injuries or spinal injuries for example)
- Barriers to the absorption of oxygen (eg fluid in the alveoli);
- Obstruction to the flow of gases through the lungs, both breathing in or out (eg asthma);
- Damage to the rib cage (in motor vehicle trauma for example);
- Pain, which makes taking a normal breath difficult.
There are many respiratory conditions which if not treated can result in respiratory failure and require the patient to be admitted to a high dependency or intensive care unit for further monitoring and ventilation support (help with breathing). This support may be through the use of oxygen masks, CPAP or via a breathing tube(endotracheal tube) and ventilator (breathing machine).
Severe Acute Asthma - what happens?
A severe acute asthma attack is an emergency situation requiring prompt assessment and management. In this disease the airways are very sensitive to stimuli (such as smoke, pollens, fumes) and react in an overwhelming way leading to severe inflammation and spasm of the airways. This causes airflow obstruction both in and out of the lungs. Generally patients will require intensive care admission for two reasons. Firstly the patient is a known asthmatic who is experiencing an attack, which is not responding to their usual emergency treatment plan. This group will experience worsening symptoms over hours to days and slowly deteriorate to where they require emergency management. The second group of people experience a sudden overwhelming attack where the airways close rapidly and the patient deteriorates quickly. Obtaining emergency assistance immediately is imperative in this last group.
What happens in intensive care?
Treatment will be aimed at identifying the cause of the acute attack and reversing the airway spasm and inflammation. Investigations such as a Chest X ray and blood tests may be done. Medications generally include nebulised Ventolin (salbutamol), intravenous Ventolin (salbutamol), oral or intravenous steroids and other additional medications. Patients with a severe attack, which leads to an intensive care admission, will require breathing assistance which may be as little as high flow oxygen mask or mask CPAP. Under some circumstances where the patient has become very tired they require full assistance using an endotracheal tube (breathing tube) and ventilator (the breathing machine). The patient will be closely monitored using an oxygen saturation monitor and a bedside monitor. You can expect the patient to have frequent chest x-rays and blood tests especially arterial blood gases (ABGs).
How long will the patient remain in Intensive Care?
A patient’s stay will usually be short in intensive care unless they have other complications.
The information contained on this page is general in nature and therefore cannot reflect individual patient variation. In addition it reflects Australian intensive care practice which may differ from other countries. It is meant as a back up to specific information which will be discussed with you by the Doctors and Nurses caring for your loved one. ICCMU attests to the accuracy of the information contained here BUT takes no responsibility for how it may apply to an individual patient. Please refer to the full disclaimer.
Asthma ~ Version 1 September 2004 (Authors C Inness & K Rolls)
First posted December 2004 and modified October 2005