Is your asthma getting worse and making it difficult to breathe? Is this status asthmaticus?

Do you have asthma? Or does someone in your family or friend have asthma? Then you must have heard about the times when your asthma gets worse and you find it difficult to breathe. But sometimes this asthma condition can be much more severe than you think. This asthma condition, which is so severe that it cannot be controlled with normal medications, is what we call Status Asthmaticus or Acute Severe Asthma .

What exactly is Status Asthmaticus?

Simply put, Status Asthmaticus is the most severe, extreme stage of asthma. This is when your breathing becomes increasingly difficult, even with your usual asthma medications, such as an inhaler. Imagine, you can't talk or eat, and you can't sleep properly. This condition can get worse over a few days, or it can suddenly get worse within a few hours. But the best thing is that you can largely prevent this severe condition by paying attention to your breathing patterns, avoiding triggers, and following an asthma plan that you and your doctor have developed.

Important: This type of severe asthma attack is a life-threatening emergency. If you have severe difficulty breathing and your inhaler is not helping, you should call 911 immediately or go to the nearest hospital emergency department.

What is the difference between normal asthma and this so-called status asthmaticus?

Now you may be thinking, 'So what are normal asthma and what is called Status Asthmaticus?' Yes, it is. Asthma, as we know, is a chronic lung disease . In a person with asthma, allergens such as smoke, dust, pollen, or excessive exercise can cause the airways to swell and fill with mucus. This is what happens when you develop asthma. Usually, this asthma condition can be controlled with medication.

However, Status Asthmaticus is a completely different and more severe condition. This is when you have a severe asthma attack that is not controlled by your usual asthma medications at home. This means that the condition gets worse and worse, not better.

What are the symptoms of Status Asthmaticus or severe asthma?

Symptoms of this severe asthma condition can develop gradually over a few hours or over a few days. See if these symptoms sound familiar to you:

• Severe difficulty breathing: Difficulty breathing properly. Sometimes it can be so difficult that you can't even talk or eat.
• Wheezing: A whistling sound is heard in the chest when breathing in and out.
• Cough: A persistent, unstoppable cough may occur.
• Fast heart rate: The heart rate increases significantly.
• Dizziness.
• Confusion: You may feel like you are losing consciousness and not really understanding what is happening.
• Bluish fingers, lips or skin: This is a very dangerous sign. It means that the body is not getting enough oxygen.

Why does Status Asthmaticus develop? What are the causes?

When you have asthma, your airways, or air passages, become narrowed. Doctors call this bronchospasm . Also, these airways become swollen. This is called inflammation . In addition, a lot of mucus is produced.

Now, experts believe that the main cause of severe, uncontrollable asthma attacks is not so much bronchospasm as inflammation of the airways and excessive mucus production. Specifically, it is when the airways become swollen and blocked with mucus that breathing becomes most difficult.

What are the triggers that increase status asthmaticus?

Anything that can trigger normal asthma can also cause this severe condition called Status Asthmaticus. Let's look at some of these common triggers:

• Allergies in the home and outdoors: Dust mites, pet dander, pollen, mold, etc.
• Other irritants: Cigarette smoke, perfumes, harsh odors from chemicals, cold wind.
• Physical exercise: Some people may experience an increase in asthma during exercise.
• Emotional stress: Asthma can worsen when you are very sad, scared, or anxious.
• Infections: Respiratory infections such as colds, flu, and COVID-19.
• Certain medications: For example, some painkillers like aspirin and some high blood pressure medications (beta-blockers) can worsen asthma in some people.

Who is at higher risk of developing this severe asthma condition (Acute Severe Asthma)?

You may be more likely to have a severe clothing attack like this for the following reasons:

• If you don't know how to use your inhaler properly, or if you use it incorrectly: This is very common. There are several steps to follow when using an inhaler. If you miss any of them, or if the timing of your breath is not right, not all of the medicine will reach your lungs. Then you won't get any results.
• If you or your treating doctors do not accurately assess the severity of your asthma: This may mean that you are not receiving the right medication, or the correct dosage.
• If you can't take your medications, don't want to, or don't know when to take them to prevent severe symptoms: Some people don't like taking their medications, or don't take them on time. Even then, it can be difficult to control their asthma.

What are the complications that can occur due to Status Asthmaticus?

This severe asthma condition (Acute Severe Asthma) can cause serious complications. Take a look:

• Hypoxia: This means that your body's tissues are not getting enough oxygen. This is very dangerous.
• Acute Respiratory Distress Syndrome (ARDS): A condition in which the lungs are severely damaged and breathing becomes very difficult.
• Respiratory failure: This means that your lungs are unable to breathe on their own. At this point, you may need to be connected to a ventilator.

How to recognize status asthmaticus or severe asthma?

A doctor will diagnose status asthmaticus by looking at your symptoms, examining you, asking about your medical history, and possibly doing lung function tests (e.g., spirometry).

The most important thing is that the doctors will start treatment right away to control your breathing. In the meantime, they may also do blood tests and chest X-rays to check for other conditions.

How is this treated?

A doctor will give you oxygen, medications to reduce swelling in your lungs, and open your airways. In some severe cases, you may need to be connected to a ventilator until you can breathe on your own.

What are the specific treatments for Status Asthmaticus?

Depending on the severity of your condition, doctors may use treatments such as:

• Supplemental oxygen: Oxygen is given through a nasal cannula or a face mask.
• Inhaled bronchodilators: These are given through an inhaler or a nebulizer. They widen the airways. Examples:
• Beta-2 agonists: Salbutamol (also called Albuterol) or Levalbuterol.
• Anticholinergics: Ipratropium bromide.
• Intravenous (IV) corticosteroids: These quickly reduce inflammation in the airways. Examples: hydrocortisone or methylprednisolone.
• IV bronchodilators: Medications such as magnesium sulfate are sometimes given.
• Adrenaline (Epinephrine): In some emergencies, it is given as an injection.
• Intravenous fluids (IV fluids): Used to prevent dehydration and to administer medications.
• Inhaled helium gas (Heliox): In some special cases, it is mixed with oxygen to make breathing easier.
• Intubation and mechanical ventilation: If the condition is very severe, unconsciousness is induced, a tube is inserted into the windpipe, and the patient is connected to a ventilator.
• Sedation: If the patient is agitated, sedation is sometimes given to help them adjust to the ventilator.

What can you expect if you develop status asthmaticus?

If you develop Status Asthmaticus, you will need to stay in the hospital until your condition is under control. In some severe cases, you may be transferred to the Intensive Care Unit (ICU).

When you go home, your doctor will prescribe you a corticosteroid pill (such as prednisolone) to take for about 12 to 14 days. It is very important to take this medicine exactly as your doctor tells you, for the full duration.

Can Status Asthmaticus be prevented?

Yes, it is very possible! Here are some things you can do to reduce your risk of these nasty clothing attacks:

• Know exactly how to use the devices you use to control your asthma. This includes things like inhalers and nebulizers. Ask your doctor or pharmacist to show you the best way to use them, step by step. Practice.
• Understand when and how to treat your asthma before it gets too bad to control. You can do this by measuring your breathing with a device called a ``Peak Flow Meter.'' Or, work with your doctor to create an ``Asthma Action Plan.'' This will tell you what to do when your asthma is mild, moderate, and severe.
• Know exactly what triggers your asthma and stay away from them as much as possible.
• See your doctor regularly to make sure your asthma is under control. This will help you determine if your medication dosage needs to be adjusted or if you need to start a new medication.
• If you need medical help, get it as soon as possible. Don't wait until the symptoms are severe.

When should you go to the Emergency Treatment Unit (ETU) ?

If you are having severe difficulty breathing, or if you are having an asthma attack and cannot control it with your usual inhaler, call 1990 immediately, or go to the nearest hospital Emergency Department (ETU) . Don't waste time.

What questions should you ask your doctor?

When you meet the doctor, it may be helpful to ask questions like these:

• 'Doctor, why did I get this condition?'
• 'How do I take my medicine correctly?' (Learn how to use the inhaler again)
• 'What other treatment options do I have?'
• 'How do I prevent this kind of situation from happening again?'

Finally, the most important thing (Take-Home Message)

Not being able to breathe is a scary thing. Don't panic at times like these, stay calm, and ask for help. If you have asthma, work with your doctor to understand your condition and develop a plan to manage it. Know when and how to treat your symptoms before they get worse. Having a plan in place will help you get help in an emergency without panicking. Your life is precious to you, and so is your family. So if you have asthma, it's important to control it.

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