Acute Severe Asthma

It is important to differentiate routine asthma care from that in acute severe asthma. This section will focus on acute or near-fatal asthma, a condition that is largely reversible so related deaths should be considered avoidable. Interventions are aimed at preventing respiratory and secondary cardiac arrest (AHA & ILCOR 2000, Scottish Intercollegiate Guidelines Network (SIGN) & British Thoracic Society (BTS) 2003).

Most deaths related to acute severe asthma occur outside hospital. Contributing factors include:

• patients and their relatives seek medical care late because they do not understand or recognise the severity of the attack;

• emergency services or medical professionals may be slow to respond;

• patients with less severe asthma attacks may seek emergency care but after treatment are discharged home and deteriorate further.

Cardiac arrest may occur in patients with severe asthma as a result of any of the following:

• hypoxia from mucus plugging or severe bronchospasm;

• cardiac arrhythmias from hypoxia or as a side-effect of beta agonists and aminophylline;

• tension pneumothorax.

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