Acute severe asthma

Meet the patient

A 24-year-old woman with poorly controlled asthma — salbutamol reliever only, no inhaled corticosteroid — arrives with worsening wheeze over six hours. She is unable to speak, sitting upright and using accessory muscles; respiratory rate 32, heart rate 132, SpO₂ 88 percent on room air, with a palpable pulsus paradoxus. The chest is silent on auscultation. She is drowsy but responsive.^[1]

The two questions that decide her next hour are the two that decide every asthma attack: how obstructed is the airway? (the peak flow, the silent chest and the saturation answer) and is she tiring? (the arterial blood gas answers — a normal or rising PaCO₂ is the alarm). Hold those two and the whole ladder slots into place.^[1]

References24ShowHide

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