Management of status asthmaticus

Status asthmaticus is a medical emergency that requires careful evaluation and aggressive therapy. The mainstay of medical therapy is frequent administration of beta-agonist inhalations, combined with early corticosteroid use. Intravenous magnesium can be used as an adjunctive measure. If available, nebulized ipratropium bromide can be added to the regimen if side effects or poor response occurs to maximal dosages of beta-agonists. Nonconventional therapies should be considered only if conventional treatment fails. Signs and symptoms of deteriorating airflow and respiratory muscle fatigue should determine the need for mechanical ventilation. If mechanical ventilation is required, controlled hypoventilation may be best.