Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 9 , ISSUE 4 ( October, 2005 ) > List of Articles


Acute respiratory failure in asthma

Said H. Soubra, Kalapalatha K. Guntupalli

Keywords : Asthma, Intensive care, Mechanical ventilation, Severe asthma

Citation Information : Soubra SH, Guntupalli KK. Acute respiratory failure in asthma. Indian J Crit Care Med 2005; 9 (4):225-234.

DOI: 10.4103/0972-5229.19764

License: CC BY-ND 3.0

Published Online: 01-04-2010

Copyright Statement:  Copyright © 2005; The Author(s).


Although asthma is a condition that is managed in the outpatient setting in most patients, the poorly controlled and severe cases pose a major challenge to the health-care team. Recognition of the more common insidious and the less common rapid onset “acute asphyxic” asthma are important. The intensivist needs to be familiar with the factors that denote severity of the exacerbation. The management of respiratory failure in asthma, including pharmacologic and mechanical ventilation, are discussed in this article. Two important complications of the positive-pressure ventilation, the dynamic hyperinflation and barotrauma, may be life-threatening. Interventions with helium-oxygen mixtures, anesthesia, and paralysis may be considered in certain situations.

PDF Share
  1. Bronchial Asthma, World Health Organization Fact Sheet Number 206,, January 2000.
  2. CDC. Asthma Prevalence and Control Characteristics by Race/Ethnicity-United States, 2002. MMWR 2004;53:145-8.
  3. Arrighi HM. US asthma mortality: 1941 to 1989. Ann Allergy Asthma Immunol 1995;74:321-6.
  4. Getahun D, Desmissie K, Rhoads GG. Recent trends in asthma hospitalization and mortality in the United States. J Asthma 2005;42:373-8.
  5. Siwick JP, Nowak RM, Zoratti EM. The evaluation and management of acute, severe asthma. Med Clin N Am 2002;86:1049-71.
  6. Rodrigo GJ, Rodrigo C, Hall JB. Acute asthma in adults: a review. Chest 2004;125:1081-102.
  7. Smith DH, Malone DC, Lawson KA, Okamoto LJ, Battista C, Saunders WB. A national estimate of economic costs of asthma. Am J Respir Crit Care Med 1997;156:787-93.
  8. Molfino NA, Nannini LJ, Martelli AN, Slutsky AS. Respiratory arrest in near-fatal asthma. N Engl J Med 1991;324:285-8.
  9. Wasserfallen JB, Schaller MD, Feihl F, Perret CH. Sudden asphyxic asthma: a distinct entity? Am Rev Respir Dis 1990;142:108-11.
  10. Robin ED, Lewiston N. Unexpected, unexplained sudden death in young asthmatic subjects. Chest 1989;96:790-3.
  11. National Heart, Lung, and Blood Institute. National Asthma Education and Prevention Program Expert Panel Report 2:Guidelines for the diagnosis and management of asthma. Publication No. 97-4051. Bethesda: National Institute of Health;1997.
  12. Camargo, Jr, CA, Spooner CH, Rowe BH. Continuous versus intermittent beta-agonists for acute asthma. The Cochrane Database of Systematic Reviews 2003, Issue 4. Article No.:CD001115. DOI:10.1002/14651858.CD001115.
  13. Kerem E, Levison H, Schuh S, O′Borodovich H, Reisman J, Bentur L, et al. Efficacy of albuterol administered by nebulizer versus spacer device in children with acute asthma. J Pediatr 1993;123:313-7.
  14. Colacone A, Afilalo M, Wolkove N, Kreisman H. A comparison of albuterol administered by metered dose inhaler (and holding chamber) or wet nebulizer in acute asthma. Chest 1993;104:835-41.
  15. Idris AH, McDermott MF, Raucci JC, Morrabel A, McGorray S, Hendeles L. Chest 1993;103:665-72.
  16. Hoshiko K, Morley J. Exacerbation of airway hyperactivity by (±) salbutamol in sensitized guinea pigs. Jpn J Pharmacol 1993;63:159-63.
  17. Hardasmalani MD, Debari V, Bithoney WG, Gold N. Levalbuterol versus racemic albuterol in the treatment of acute exacerbation of asthma in children. Pediatr Emerg Care 2005;21:415-9.
  18. Qureshi F, Zaritsky A, Welch C, Meadows T, Burke BL. Clinical efficacy of racemic albuterol versus levalbuterol for the treatment of acute pediatric asthma. Ann Emerg Med. 2005;46:29-36.
  19. Nowak RM, Emerman CL, Schaefer K, DiSantostefano RL, Vaickus L, Roach JM. Levalbuterol compared with racemic albuterol in the treatment of acute asthma:results of a pilot study. Am J Emerg Med 2004;22:29-36.
  20. Aaron SD. The use of ipratropium bromide for the management of acute asthma exacerbation in adults and children:a systemic review. J Asthma 2001;38:521-30.
  21. Fanta CH, Rossing TH, McFadden FR, Jr. Glucocorticoids in acute asthma. A critical controlled trial. Am J Med 1983;74:845-51.
  22. Rowe BH, Keller JL, Oxman AD. Effectiveness of steroid therapy in acute exacerbations of asthma:a meta-analysis. Am J Emerg Med 1992;10:301-10.
  23. Manser R, Reid D, Abramson M. Corticosteroids for acute severe asthma in hospitalized patients. The Cochrane Database of Systematic Reviews. 2001, Issue 1, Article No. CD001740. DOI:10.1002/14651858. CD001740.
  24. Edmonds ML, Camargo, Jr, CA, Pollack, Jr, CV, Rowe BH. Early use of inhaled corticosteroids in the emergency treatment of acute asthma. The Cochrane Database of Systematic Reviews 2003, Issue 3. Article No CD002308. DOI:10.1002/14651858. CD002308.
  25. Mitra A, Bassler D, Goodman K, Lasserson TJ, Ducharme FM. Intravenous aminophylline for acute severe asthma in children over two years receiving inhaled bronchodilators. The Cochrane Database of Systematic Reviews 2005, Issue 2. Article No.:CD001276.pub2. DOI:10.1002/14651858.CD001276.pub2
  26. Okayama H, Aikawa T, Okayama M. Bronchodilating effect of intravenous magnesium sulfate in bronchial asthma. JAMA 1987;257:1076-8.
  27. Rolla G, Bucca C, Caria E. Acute effect of intravenous magnesium sulfate on airway obstruction in asthmatic patients. Ann Aller 1988;61:388-91.
  28. Rowe BH, Bretzlaff JA, Bourdon C, Bota GW, Camargo CA, Jr. Intravenous magnesium sulfate treatment of acute asthma in the emergency department: a systematic review of the literature. Ann Emerg Med 2000;36:181-90.
  29. Blitz M, Blitz S, Beasely R, Diner BM, Hughes R, Knopp JA, et al. Inhaled magnesium sulfate in the treatment of acute asthma. The Cochrane Database of Systematic Reviews 2005, Issue 3. Article No. CD003898.pub3. DOI:10.1002/14651858. CD003898.pub3.
  30. Reuben AD, Harris AR. Heliox for asthma in the emergency department: A review of the literature. Emerg Med J;21:131-5.
  31. Gupta VK, Cheifetz IM. Heliox administration in the pediatric intensive care unit: An evidence-based review. Pediatr Crit Care Med 2005;6:204-11.
  32. Rodrigo G, Pollack C, Rodrigo C, Rowe BH. Heliox for non-intubated acute asthma patients. The Cochrane Database of Systematic Reviews 2003, Issue 2. Article No. CD002884. DOI:10.1002/14651858. CD002884
  33. Schaeffer EM, Pohlman A, Morgan S, Hall JB. Oxygenation in status asthmaticus improves during ventilation with helium-oxygen. Crit Care Med 1999;27:2666-70.
  34. Gluck EH, Onorato DJ, Castriotta R. Helium-oxygen mixtures in intubated patients with status asthmaticus and respiratory acidosis. Chest 1990;98:693-8.
  35. Abd-Allah SA, Rogers MS, Terry M. Helium-oxygen therapy for pediatric acute severe asthma requiring mechanical ventilation. Perditr Crit Care Med 2003;4:353-7.
  36. Bag R, Bandi V, Fromm R, Guntupalli K, Helium oxygen mixtures in asthma. J Asthma 2002;39:659-65.
  37. Kress JP, Noth I, Gehlbach BK, Barman N, Pohlman AS, Morgan S, et al. Am J Respir Crit Care Med 2002;165:1317-21.
  38. Ram FSF, Picot J, Lightowler J, Wedzicha JA. Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. The Cochrane Database of Systematic Reviews 2004, Issue 3. Article No. CD004104.pub3. DOI:10.1002/14651858. CD004104.pub3
  39. Ram FS, Wellington SR, Rowe B, Wedzicha JA. Non-invasive positive pressure ventilation for treatment of respiratory failure due to severe acute exacerbation of asthma. The Cochrane Database of Systematic Reviews 2005, Issue 3. Article No. CD004360.pub3. DOI:10.1002/14651858. CD004360. pub3.
  40. Soroksky A, Stav D, Shpirer I. A pilot prospective, randomized, placebo-controlled trial of bilevel positive airway pressure in acute asthmatic attack. Chest 2003;123:1018-25.
  41. McFadden ER. Acute severe asthma. Am J Respir Crit Care Med 2003;168:740-59.
  42. Mountain RD, Sahn SA. Clinical features and outcome of patients with acute asthma presenting with hypercapnia. Am Rev Respir Dis 1988;138:535-9.
  43. Jain S, Hanania NA, Guntupalli KK. Ventilation of patients with asthma and obstructive lung disease. Crit Care Clin 1998;14:685-705.
  44. Maslow AD, Regan MM, Israel E, Darvish A, Mehrez M, Boughton R, et al. Inhaled albuterol, but not intravenous lidocaine protects against intubation-induced bronchoconstriction in asthma. Anesthesiology 2000;93:1198-204.
  45. Guntupalli KK, Bandi V. Considerations in the mechanically ventilated severe asthmatic. Current Topics in Intensive Care No. 3. Dellinger RP (ed.), 1600 John F. Kennedy Blvd., Ste 1800 USA:Philadelphia, PA 19103-2899 W.B. Saunders Co, Ltd.; 1996. pp. 166-85.
  46. Sarma VJ. Use of ketamine in acute severe asthma. Acta Anaesthesiol Scand 1992;36:106-7.
  47. Lau TT, Zed PJ. Does ketamine have a role in managing severe exacerbation of asthma in adults? Pharmacotherapy 2001;21:1100-6.
  48. Eames WO, Rooke GA, Wu RS, Bishop MJ. Comparison of the effects of etomidate, propofol and thiopental on respiratory resistance after tracheal intubation. Anesthesiology 1996;84:1307-11.
  49. Corbridge TC, Hall JB. The assessment and management of adults with status asthmaticus. Am J Respir Crit Care Med 1995;151:1296-316.
  50. Griffin D, Fairman N, Coursin D, Rawsthorne L, Grossman JE. Acute myopathy during treatment of status asthmaticus with corticosteroids and steroidal muscle relaxants. Chest 1992;102:510-4.
  51. Leatherman JW, Fluegel WL, David WS, Davies SF, Iber C. Muscle weakness in mechanically ventilated patients with severe asthma. Am J Respir Crit Care Med 1996;153:1686-90.
  52. Peigang Y, Marini JJ. Ventilation of patients with asthma and chronic obstructive pulmonary disease. Cur Opin Crit Care 2002;8:70-6.
  53. Tuxen DV, Lan S. The effects of ventilatory pattern on hyperinflation, airway pressures, and circulation in mechanical ventilation of patients with severe air-flow obstruction. Am Rev Respir Dis 1987;136:872-9.
  54. Leatherman JW, McArthur C, Shapiro RS. Effect of prolongation expiratory time on dynamic hyperinflation in mechanically ventilated patients with severe asthma. Crit Care Med 2004;32:1542-5.
  55. Smith TC, Marini JJ. Impact of PEEP on lung mechanics and work of breathing in severe airflow obstruction. J Appl Physiol 1988;65:1488-99.
  56. Darioli R, Perret C. Mechanical controlled hypoventilation in status asthmaticus. Am Rev Respir Dis 1984;129:385-7.
  57. Rosengarten PL, Tuxen DV, Dziukas L, Scheinkestel C, Merrett K, Bowes G. Circulatory arrest induced by intermitted positive pressure ventilation in a patient with severe asthma. Anaesth Intensive Care 1991;19:118-21.
  58. Williams TJ, Tuxen DV, Scheunkestel C, Czarny D, Bowes G. Risk factors for morbidity in mechanically ventilated patients with acute severe asthma. Am Rev Respir Dis 1992;146:607-15.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.