Which of the following treatment goals is best for the client with status asthmaticus?
A. Avoiding intubation.
B. Determining the cause of the attack.
C. Improving exercise tolerance.
D. Reducing secretions.
Correct Answer: A. Avoiding intubation
Inhaled beta-adrenergic agents, I.V. corticosteroids, and supplemental oxygen are used to reduce bronchospasm, improve oxygenation, and avoid intubation. A favorable response to initial treatment of status asthmaticus should be a visible improvement in symptoms that sustains 30 minutes or beyond the last bronchodilator dose and a PEFR greater than 70% of predicted.
Option B: Determining the trigger for the client’s attack is a later goal. Eighty percent to 85% of asthma fatalities are in the subgroup of slow-onset asthma exacerbation, perhaps reflecting an inadequate disease control over time. In contrast to the sudden onset of exacerbation phenotype, which presents mostly with clear airways, slow-onset exacerbation patients have extensive airway inflammation and mucus plugging.
Option C: Status asthmaticus can be prevented if triggers and stress factors are avoided, and compliance with the medicines is good. Identify those individuals who are at a greater risk of exacerbation, such as extremes of ages. Environmental management is essential in patients with environmental allergies. Inpatient education by trained lay people resulted in improvement in compliance with inhaler management and post-discharge care.
Option D: Typically, secretions aren’t a problem in status asthmaticus. Albuterol is preferred over metaproterenol in that class because of its higher beta 2 selectivities and longer duration of action. The dose-response curve and duration of action of these medications are adversely affected by a combination of patient factors, including pre-existing bronchoconstriction, airway inflammation, mucus plugging, poor patient effort, and coordination.
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