Status Asthmaticus Management

Assessment and Diagnosis

The British Thoracic Society recommends rapidly assessing severity using objective measurements before initiating treatment to identify life-threatening features and guide management intensity 1, 2
Severe asthma features include inability to complete sentences in one breath, pulse >110 beats/min, respiratory rate >25 breaths/min, and peak expiratory flow (PEF) <50% predicted or personal best 1, 2, 3
Life-threatening features require ICU consideration and include PEF <33% predicted or personal best, silent chest, cyanosis, or feeble respiratory effort, bradycardia or hypotension, and exhaustion, confusion, drowsiness, or coma 2, 3, 4

The British Medical Journal recommends administering 40-60% oxygen immediately via face mask and maintaining oxygen saturation >92% 2, 3, 4
The British Thoracic Society suggests nebulized salbutamol 5 mg or terbutaline 10 mg with oxygen as driving gas, and adding ipratropium bromide 0.5 mg to nebulizer immediately 1, 2, 3
Systemic corticosteroids, such as prednisolone 30-60 mg orally or hydrocortisone 200 mg IV, should be started immediately 1, 2, 3, 4

The British Thoracic Society recommends repeating PEF measurement and clinical assessment to determine response and guide next steps, and considering ICU transfer if patient is deteriorating or has life-threatening features 1, 2, 3, 4
ICU transfer criteria include deteriorating PEF despite maximal therapy, worsening or persistent hypoxia or hypercapnia, exhaustion, feeble respirations, confusion, or drowsiness, and coma or respiratory arrest 2, 3, 4

The British Thoracic Society recommends discharging patients when they have been on discharge medications for 24 hours, PEF is >75% predicted or personal best, PEF diurnal variability is <25%, and there are no nocturnal symptoms 2, 3, 4
Discharge medications should include prednisolone 30-60 mg daily for 1-3 weeks, inhaled corticosteroids, albuterol nebulizer or inhaler, and a peak flow meter with written asthma action plan 2, 3, 4, 5