Successful Non-Invasive Management of Near-Fatal Asthma with Severe Hypercapnic Respiratory Failure: A Case Report

Asthma exacerbations can be life-threatening if not promptly recognized and treated. Although necessary, intubation and mechanical ventilation can cause barotrauma, hemodynamic instability, and increased mortality. Documenting near-fatal asthma case with severe hypercapnia, recovering without intubation is uncommon and offers useful clinical insight.

A 45-year-old Somali woman with poorly controlled bronchial asthma presented to the emergency department with acute severe dyspnea following a three-day prodrome of fever, cough, rhinorrhea, and sore throat. On arrival, she was semi-conscious, in respiratory distress, with a silent chest, hypoxemia (SpO₂ 47%), and hypercapnia (PaCO₂ 106.4 mmHg). She received immediate bag-valve-mask breathing, high-flow oxygen, intravenous corticosteroids, repeated nebulized bronchodilators, inhaled budesonide, and magnesium sulfate. The patient showed remarkable clinical improvement within an hour, including restored awareness, bilateral wheezing, SpO₂ at 99% on oxygen, and normalized arterial blood gases. After monitoring in the ICU, she switched to oral medication and returned home without endotracheal intubation on the fourth day.

For life-threatening asthma, GINA, BTS/SIGN, and ERS/ATS recommend systemic corticosteroids, frequent bronchodilators, and intravenous magnesium sulfate as the main treatment, with intubation reserved for respiratory collapse. This case sheds light on how severe hypercapnic respiratory failure patients can recover without invasive airway procedures in resource-limited emergency settings with timely, guideline-adherent care.

Early non-invasive treatments for life-threatening asthma can provide positive outcomes, even in near-fatal asthma cases. Intubation and related risks were avoided through close supervision, timely corticosteroids, nebulized bronchodilators, and intravenous magnesium sulfate.