Clinical Features and Outcome of Management of Severe Asthma (Status asthmaticus) in the Intensive Care Unit of a Tertiary Medical Centre

ME Khadadah, BO Onadeko, HT Mustafa, KEH Metwali
Correspondence: Dr M E Khadadah, mousaa@hsc.kuniv.edu.kw

ABSTRACT
Aim of the Study The recognition and management of severe acute asthma have attracted considerable attention since the seventies because of the morbidity and mortality that may accompany the condition. Recognition and appropriate management of severe acute asthma is essential. Admission to intensive care, intubation and ventilation risks versus benefit have been argued. We highlight these controversies by documenting our experience and comparing it to others in the literature
Methodology We prospectively document our experience over a two-year period in the management of severe asthma in the intensive Care Unit (ICU). Patients were established asthmatics, who came in severe exacerbation. Attention was paid to the duration of onset of acute attack, time to presentation, spirometric and blood gas data, the type of treatment given, factors responsible for complications and mortality were identified. The findings in this study were compared with those in similar studies in the literature.
Results A total of 30 patients were studied. Twenty-one patients were ventilated and 9 were not. 82% had a history of asthma longer than 5 years. The duration of symptoms before admission to ICU was very short (one day or less in 57%). Hypercapnia was significantly higher in intubated patients. The duration of stay in ICU and hospital was longer for intubated patients (P<0.02). Complications were higher in intubated patients.
Conclusion ICU care provides an excellent setting for management of acute severe asthma. The reported high morbidity and mortality in ICU can be improved. Without ICU care the mortality and morbidity increases,so physicians should not hesitate to admit asthmatics early to ICU.

Keywords: Asthma, Hypercapnia, Mortality, Morbidity, ICU
Singapore Med J 2000; 41(5): 214-217