Acute severe asthma. How to recognize and respond to a life-threatening attack.

A disturbing increase in mortality from asthma has occurred over the past decade. Asthmatic patients who are over age 55 and have coexisting cardiac or pulmonary disease, those who have a history of mechanical ventilation, and those who require continuous outpatient use of corticosteroids to control symptoms have an increased risk of severe or fatal exacerbations of their disease. Patients hospitalized for severe asthma should receive inhaled beta 2-adrenergic agonists for bronchodilation and intravenous corticosteroids. Patients requiring mechanical ventilation have about a 20% incidence of pneumothorax and an enhanced risk of nosocomial pneumonia, and their mortality rate approaches 20%. Once severe asthma improves, patients must have their outpatient regimen strengthened by the use of oral corticosteroids, inhaled corticosteroids, and/or inhaled cromolyn sodium (Intal).