Acute Severe Asthma

What is acute severe Asthma?

Asthma is a chronic inflammatory disease of the airways characterised by reversible airways obstruction and bronchospasm.

Acute severe Asthma is severe asthma that does not respond well to immediate care and is a life-threatening medical emergency. Ensuing respiratory failure results in hypoxia, carbon dioxide retention and acidosis. The exact mechanism underlying the development of an acute severe asthma attack remains elusive but there appear to be two phenotypes:

  • Gradual-onset – in about 80%, severe attacks develop over more than 48 hours. These are associated with eosinophilic infiltration and slow response to therapy.
  • Sudden-onset – often in association with significant allergen exposure. Patients tend to be older and to present between midnight and 8 am. This type of attack is associated with neutrophilic inflammation and a swifter response to therapy.


  • What does the Respiratory system do?
  • Abnormal and or inadequate breathing
  • Acute Severe Asthma 
  • What Happens in Intensive Care?
  • How long will my loved one remain in Intensive Care?


What does the Respiratory System do ?

The respiratory system consists of the lungs, airways and blood vessels. The respiratory system inhales oxygen into the body and exchanges oxygen by removing carbon dioxide from the body. A normal breath requires a complex coordination between the nervous system (brain & spinal cord) and the muscles of breathing (including the diaphragm and muscles between the ribs).

Abnormal and or inadequate breathing can occur as a result of:

  • An interruption to the nervous system (head injuries or spinal injuries for example)
  • Barriers to the absorption of oxygen (eg fluid or secretions in the alveoli);
  • Obstruction to the flow of gases through the lungs, both breathing in or out (eg asthma);
  • Damage to the rib cage such as rib fractures or flail chest(in motor vehicle trauma for example);
  • Pneumothorax(deflation of one part of the lung)
  • Haemothorax(infiltration with blood to parts of the lung)
  • Pain, which makes taking a normal breath difficult.

A number of respiratory conditions can result in respiratory failure and require Intensive Care or High dependency Unit admission. It is often that respiratory failure results in ventilation support (help with breathing). This support may be through the use of oxygen masks, BIPAP or Non- Invasive Ventilation(NIV) or via a Breathing Tube (endotracheal tube) and Ventilators (Breathing Machines)


Severe Acute Asthma – what happens?

A severe acute asthma attack is an emergency situation requiring prompt airway management. The airway is very sensitive to stimuli (such as smoke, pollens, fumes) and react with severe inflammation and spasm of the airways. The airflow in the lungs is obstructed.

If your loved one is a known asthmatic experiencing an asthma attack, which is not responding to their usual emergency treatment plan and is experiencing worsening symptoms over hours to days and slowly deteriorate to where they require emergency management in Intensive Care.

Sometimes Asthma Patients experience a sudden overwhelming attack where the airways shut down and the Patient deteriorates quickly. Obtaining emergency assistance immediately is imperative in this last group.

What happens in Intensive Care?                        

  • After the diagnosis of the acute asthma attack has been made, efforts will be directed towards treating and reversing the airway obstruction(spasm)
  • Initially oxygen and respiratory support might be commenced via na oxygen mask or via Non- Invasive Ventilation(NIV) or BIPAP ventilation
  • In Intensive Care your loved one will very likely require a Breathing Tube (endotracheal tube) and mechanical ventilation on Ventilators (Breathing Machines)
  • Medications given are nebulisers such as Ventolin(Salbutamol), Atrovent, Pulmicort. Salbutamol may also be given intravenously. Furthermore, steroids/ cortisone and other medications may be given to control the asthma attack.
  • Your loved one will be closely monitored using a Bedside Monitors.
  • Frequent Chest X-rays and blood tests (Blood& Pathology tests in Intensive Care)especially arterial blood gases (ABGs) will be performed regularly.

How long will your loved one remain in Intensive Care?                        

Your loved one will usually stay in intensive care for a few days if they have no other complication.

Any Questions?

Of course, if you have any questions or concerns, please discuss them with the ICU nurses and doctors.

All Intensive Care interventions and procedures carry a degree of potential risk even when performed by skilled and experienced staff. Please discuss these issues with the medical and nursing staff who are caring for your loved one.

The information contained on this page is general in nature and therefore cannot reflect individual patient variation.It is meant as a back up to specific information which will be discussed with you by the Doctors and Nurses caring for your loved one. INTENSIVE CARE HOTLINE 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.

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