[Treatment of the severe asthma attack and status asthmaticus]

For the treatment of severe attacks of asthma, too, inhalable beta 2-sympathomimetic agents form the basis of drug therapy. It is, further, necessary to apply these agents systemically together with theophylline, the best approach to pre-status and status asthmaticus being continuous i.v. application following a bolus administration (dose of beta 2-sympathomimetic 0.04 mg/kg x min, for theophylline 10-15 micrograms/kg x min). Furthermore, 50-200 mg prednisolone equivalent are administered i.v. Secretolysis and increased expectoration are ensured by a copious supply of liquids, inhalation of saline mists, administration of acetyl cysteine or ambroxol, together with physical-therapeutic measures. Also important is the administration of oxygen and the calming of the anxious, agitated patient by adopting a relaxed, calm approach and devoting the patient sufficient attention. The uncritical use of sedatives (cave: depressive effect on respiration) is to be rejected. If, despite increasing the dose of the beta 2-sympathomimetic agent (approx. 0.06 micrograms/kg x min), no improvement is seen after 1-2 hours, or if global respiratory failure develops or exhaustion of the respiratory musculature is threatening, intensive monitoring and care should be initiated. If necessary, the patient is intubated and ventilated; in therapy-refractory situations, bronchoalveolar lavage should be employed as an adjunctive measure.