Status Asthmaticus

What is it?

Status asthmaticus is a severe asthma attack that does not respond to the usual therapies. Although
reversible, it is life threatening because it can lead to respiratory failure and cardiac arrest. Status
asthmaticus requires immediate treatment.

Who gets it?

Any child with asthma can experience status asthmaticus, but the risk increases in children with asthma
that is not properly treated. Children who have had previous status asthmaticus attacks are also at higher
risk for repeated attacks. Status asthmaticus is also more likely to occur in children with an unsupportive
family, in lower-income families, and in non-white children, most likely because of poor medical care.

What causes it?

Status asthmaticus is caused by severe bronchospasm, in which the smooth muscles of the bronchi
suddenly contract and narrow the airways. Asthma attacks can be triggered by allergens, such as pollen,
smoke, and animal dander, as well as by physical exertion and cold air.

What are the symptoms?

The symptoms of status asthmaticus are extreme difficulty with breathing, which causes restlessness and
anxiety. Although coughing and wheezing are common symptoms of asthma, a child with status
asthmaticus may not cough or wheeze because there is not enough airflow. Advanced symptoms include
little or no breath sounds, inability to speak, bluish tinge to the skin (cyanosis), and heavy sweating.
Status asthmaticus can lead to unconsciousness and cardiopulmonary arrest, which can be fatal.

How is it diagnosed?

Status asthmaticus is diagnosed according to the child’s symptoms and a physical examination. The most
important diagnostic test is the arterial blood gas, which measures the concentration of oxygen and
carbon dioxide in the blood. This test can be performed by taking a blood sample, or by monitoring blood
oxygen through an electrode on the fingertip or earlobe (called oximetry). Low blood oxygen is called
hypoxemia.

What is the treatment?

To treat status asthmaticus, the child is given supplemental oxygen to increase blood oxygen levels. He
or she will also be treated with an inhaled or intravenous bronchodilator to open the airways. Other
common treatements include corticosteroids, to reduce inflammation, and anticholinergics, to block
smooth muscle contraction and the production of excess mucus. The child’s heart rate, blood pressure,
fluid levels, and blood oxygen, pH, and carbon dioxide levels are monitored carefully. Intravenous fluids
are given if the child is dehydrated. A child with severe respiratory distress, extreme lethargy, altered
consciousness, elevated carbon dioxide levels, or high blood acidity (acidosis) needs to be hospitalized in
a pediatric intensive care unit (PICU).

Self-care tips
If your child has asthma, seek treatment immediately if he or she has a severe attack that does not
respond to usual treatment. Following your doctor’s recommendations for regular asthma treatment can
help prevent status asthmaticus.

This information has been designed as a comprehensive and quick reference guide written by our health
care reviewers.  The health information written by our authors is intended to be a supplement to the care
provided by your physician.  It is not intended nor implied to be a substitute for professional medical
advice