Weissman Brandon, Chowdhury Shafayath, Shen Kevin, Singh Sumi
Department of Otolaryngology, Lake Erie College of Osteopathic Medicine, Elmira, USA.
Department of Anesthesiology and Critical Care, Lake Erie College of Osteopathic Medicine, Elmira, USA.
Cureus. 2025 Aug 8;17(8):e89652. doi: 10.7759/cureus.89652. eCollection 2025 Aug.
Asthma is one of the most prevalent chronic respiratory illnesses, significantly impacting patients through shortness of breath and even death. Acute exacerbations are usually controlled with a short-acting beta agonist, such as an albuterol inhaler, as well as long-acting agents to prevent the occurrence of exacerbations and status asthmaticus. Status asthmaticus is an emergent episode of asthma that is refractory to standard treatment. This disease presents as tachycardia, tachypnea, and dyspnea. The forced expiratory volume measures the severity of asthma in one second and the serial peak expiratory flow rate. Proper treatment is vital for patient survival. This case report reviews the proper treatment of a patient in her mid-30s presenting to the emergency department due to an asthmatic attack refractory to albuterol. The patient went through a five-stage treatment plan. First, the patient was treated with inhaled beta-2 agonist (albuterol) and corticosteroids (prednisone, dexamethasone, and methylprednisolone). The patient did not improve with these treatments and was given the anticholinergic agent ipratropium bromide in an attempt to increase bronchodilation. Nebulized racemic epinephrine was then added to the patient to optimize maximum bronchodilation and vasoconstriction in an attempt to reduce airway edema and inflammation. To reduce ventilator peak airway pressures through sedation and paralytics, rocuronium and cisatracurium (Nimbex) were administered. Ketamine was added as a sedative and bronchodilator. Propofol and midazolam (Versed) were used to sedate the patient for mechanical ventilation. After the acute episode, maintenance therapy included inhaled corticosteroids (budesonide), a long-acting beta-2 agonist (arformoterol), a long-acting muscarinic antagonist (revefenacin), and montelukast (a leukotriene receptor antagonist). This case illustrates the importance of status asthmaticus treatment as a vital, stepwise process that focuses on bronchodilation, maintaining the airway, mechanical ventilation, sedation, and reducing inflammation and paralysis.
哮喘是最常见的慢性呼吸道疾病之一，通过呼吸急促甚至死亡对患者产生重大影响。急性加重通常用短效β受体激动剂（如沙丁胺醇吸入器）以及长效药物来控制，以预防加重和哮喘持续状态的发生。哮喘持续状态是一种对标准治疗无效的哮喘急症。这种疾病表现为心动过速、呼吸急促和呼吸困难。一秒用力呼气量和连续呼气峰值流速可衡量哮喘的严重程度。恰当的治疗对患者的生存至关重要。本病例报告回顾了一名35岁左右因沙丁胺醇治疗无效的哮喘发作而就诊于急诊科的患者的恰当治疗过程。该患者经历了一个五阶段治疗方案。首先，患者接受吸入性β2受体激动剂（沙丁胺醇）和皮质类固醇（泼尼松、地塞米松和甲泼尼龙）治疗。这些治疗后患者病情未改善，于是给予抗胆碱能药物异丙托溴铵，试图增强支气管扩张。随后给患者加用雾化消旋肾上腺素，以优化最大程度的支气管扩张和血管收缩，试图减轻气道水肿和炎症。为通过镇静和使用麻痹剂降低呼吸机气道峰值压力，给予了罗库溴铵和顺式阿曲库铵（Nimbex）]。添加氯胺酮作为镇静剂和支气管扩张剂。使用丙泊酚和咪达唑仑（Versed）对患者进行机械通气镇静。急性发作后，维持治疗包括吸入性皮质类固醇（布地奈德）、长效β2受体激动剂（阿福莫特罗）、长效毒蕈碱拮抗剂（瑞弗那新）和孟鲁司特（白三烯受体拮抗剂）。本病例说明了哮喘持续状态治疗作为一个至关重要的、逐步进行的过程的重要性，该过程侧重于支气管扩张、维持气道、机械通气、镇静以及减轻炎症和麻痹。
