Acute Severe Asthma

What is acute severe asthma?

An acute severe asthma attack is an emergency situation requiring immediate medical attention. People with asthma have sensitive airways that over-react to triggers in the air such as smoke, pollen and fumes. During an asthma attack, their airways become inflamed and start to spasm, obstructing the flow of air both in and out of their lungs.

What does the respiratory system do?

The respiratory system provides oxygen to the body, and removes the waste gas carbon dioxide.

As well as needing lungs to breath, we also need an airway (trachea), a well-functioning nervous system (brain and spinal cord) and working breathing muscles (the diaphragm and the muscles between the ribs).

Read more about the respiratory system

When is admission to an Intensive Care Unit needed?

There are two main situations when admission to an Intensive Care Unit ( ICU ) is needed for asthma. The first situation is when someone who is normally able to keep their asthma under control has an asthma attack that for some reason does not respond to normal treatment. Their symptoms get worse, slowly deteriorating to the point where they require emergency management.

The second situation is when someone experiences a sudden overwhelming asthma attack, during which their airways begin to rapidly close. People in this situation can deteriorate very quickly, and need emergency help immediately.

What happens in Intensive Care?

When someone is admitted to ICU for an acute asthma attack, the doctors and nurses will try to identify the cause of the asthma attack and reverse the airway spasm and inflammation.

Tests such as a chest x-ray, and blood tests may be done and medications may be given, such as Ventolin (given intravenously and/or by nebuliser) and steroids (given orally or intravenously).

Breathing assistance will also be given either via a high flow oxygen mask or by continuous positive airway pressure (CPAP).  If the person receiving treatment has become very tired and unable to breathe, they may need an endotracheal tube (breathing tube) and ventilator (breathing machine) (see Breathing support for more information). Their condition will be closely monitored using several monitoring devices such as a bedside monitor including heart rate and saturation (see Equipment).

How long they need to stay in the ICU will depend on how acute their attack is, but the stay will likely be relatively short unless there are complications.

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The information on this page is general in nature and cannot reflect individual patient variation. It reflects Australian intensive care practice, which may differ from that in other countries. It is intended as a supplement to the more specific information provided by the doctors and nurses caring for your loved one. ICNSW attests to the accuracy of the information contained here but takes no responsibility for how it may apply to an individual patient. Please refer to the full disclaimer.