Treatment in Status Asthmaticus



If the patient has been in status asthmaticus (i.e., continuous and severe attack of asthma for more than 24 hours), it is important to keep in mind that he may also be dehydrated because of excessive loss of water from the lungs; by excessive perspiration and by omitting to take fluids while in an attack. Hence his fluid loss has to be replaced adequately. This besides restoring the fluid balance of the body, lessens the thickness of the tenacious sputum so that it is coughed out easily. In such a case, intravenous fluids are administered early, usually 3 to 5 litres in the first twenty-four hour period, and thereafter 3 litres daily until hydration is achieved. Ruids usually consist of 5 per cent dextrose in water; every second or third such fluid should contain sodium chloride, particularly if prolonged intravenous therapy in necessary, or if the patient is perspiring freely and he vomits or has diarrhoea. As th patient becomes hydrated and starts eating well, the intravenous administration of fluids can be curtailed.

A cyanosed patient of asthma in status asthmaticus is in need of oxygen which must be given. This can be given either through a catheter in the nose or through a ventri-mask or through a positive pressure breathing apparatus along with a bronchodilator; the last mode of therapy has proved to be more effective.

The use of expectorants in the management of asthma is one of the most important yet often neglected aspects of treatment. One of the best expectorants is potassium iodide; when it is tolerated poorly, other substances such as glyceral guiacolate and ammonium chloride may be useful. Water vapour also may be helpful in thinning bronchial secretions.
Patients with severe asthma become profoundly exhausted, lose sleep, experience increasing anxiety, and therefore, are in need of a tranquilliser, but is should be kept to a minimum, because excess of it can interfere with respiration,

Deaths from asthma can occur in spite of the antibiotics and steroids, These occur not only in older people who die of the complications of long-standing asthma, but also in younger people aged between 5 and 35 years. Majority of these deaths occur outside the hospital. These are due to the fact that the patient and his relations could not realise the severity of the situation.
A proper understanding of the patient's fears and anxieties and the allaying of these fears through sympathetic conversation helps asthma patients very much. The majority of these patients are prone to suggestion. It has been seen, time and again, that when a prescription is given or a line of treatment is started with the emphatic suggestion to the patient that this will definitely give relief, it decidedly works and the patient fulfils the expectations. Not only that, I have observed, that with whatever symptoms the patient looks better, produces a corresponding response and the hope given that "You will imporve still further", works miracle. Such an approach is helpful,but care must be taken because over-optimistic hopes, once shattered, cause more harm than good.

Aerosol Inhalers

Aerosol are the solid or liquid particles of a substance suspended in air. They are very small, less than a micron (1/1000 mm) in size.
Aerosol inhalers were used initially with bronchodilator drugs like Isoprenaline. But because this drug caused many side-effects such as palpitation and dizziness and some deaths too due to too frequent use, this mode of treatment fell into some disrepute.
With the availability of aerosol inhalers with salbutamol and corticosteroids, this form of treatment has now become very popular.

The technique of using the inhaler is as follows:

• Shake the inhaler. Remove the cap from its mouth-piece.Insert the mouth-piece in the lips and purse the lips tightlyaround it.

• Take one or two breaths with the inhaler in the mouth.

• Exhale completely, and then as you start inhaling, press thenozzle-button of the inhaler. Aerosol would go in the airwaysalongwith the air inhaled,

• Now remove the inhaler from the mouth. Keep the lipsclosed, and hold the breath as long as possible, then openthe mouth.

• You can repeat the process and take one more does ofaerosol from the inhaler. The dose that comes out eachtime on pressing the inhaler is equal and is measured.