Severe acute asthma: symptoms and treatment

All asthmatic patients are at risk of suffering a severe acute asthma crisis in the course of their life. These episodes can become deadly.

Hospitalizations and their attention at the level of emergency services they are a fundamental aspect in the asthmatic's attendance.

Severe acute asthma is a very frequent reason for consultation in emergency services, being adolescents and young adults who most need medical attention. This pathology is slightly more frequent in women than in men

What is asthma?

Asthma It is an inflammatory disease of chronic character of the airway associated with hyperreactivity, reversible airflow limitation and respiratory symptoms.

The respiratory system is formed by:

  • Nostrils.
  • Larynx.
  • Windpipe.
  • Alveoli, bronchioles and bronchi.

The involvement of asthma occurs mainly in the bronchi and bronchioles that have the function of driving the air in and out of the lung.

In asthma, what happens is that the wall of these structures becomes inflamed and becomes thicker, there is less production of mucus and the muscle that surrounds the walls of the bronchi it contracts causing the light to narrow and breathing becomes difficult.

Some asthmatic patients they also affect the nose and sinuses, what is known as rhinosinusitis.

There are many factors that can trigger an asthma crisis through the inflammation of the airway, the contraction of the smooth muscle of the same or both.

Exposure to allergens, air pollution and respiratory infections they are the main triggers clinically identified.

What are the symptoms of severe acute asthma?

The symptoms they are presented differently in each person, both in frequency and in severity. Among the most common are:

  • Difficulty breathing, tightness or pain in the chest and cough or wheezing when breathing.
  • Low values ​​of maximum expiratory flow.
  • Symptoms that do not respond to the use of a fast-acting inhaler.

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Treatment of severe acute asthma

Severe acute asthma it is a medical emergency that must be evaluated and treated quickly. The evaluation is a process with two different dimensions:

  • A static evaluation, with the objective of determine the severity of the crisis.
  • A dynamic evolution, in order to evaluate the response to treatment.

The intensity of the treatment will be determined by the severity of the crisis. However, whatever the treatment, the objectives are shared, these being the following:

  • Correct hypoxemia (decrease in oxygen levels in the body) by administering oxygen.
  • Alleviate airway obstruction through the repeated administration of inhaled bronchodilators.
  • Decrease inflammation, as well as the prevention of relapse, through the administration of systemic corticosteroids.


Hypoxemia, which as we have seen is the decrease in oxygen levels in the body, can be corrected, usually, by small increments of the inspired oxygen fraction through masks or nasal cannulas.

Inhaled bronchodilators: beta agonists

Short-acting inhaled beta agonist drugs they are the medications of choice in the treatment of severe acute asthma. They have a fast onset of action (5 minutes) with 6 hours duration and few side effects.

The inhalation route has a faster onset of action and fewer side effects than systemic administration. This last route should only be considered when the response to inhalation treatment is poor.


The main justification for the use of anticholinergics in the treatment of severe acute asthma is the increase in vagal tone at the level of the airway.

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This benefit can be demonstrated more clearly when therapeutic protocols consisting of repeated and high doses are used. A reduction in hospitalizations is shown, increases in lung function and a decrease in costs.

Systemic corticosteroids

Systemic corticosteroids should be considered in the treatment of most asthma attacks. These drugs are not bronchodilators, but they are extremely effective in reducing airway inflammation. The results of different studies suggest:

  • These drugs they need approximately between 6 and 24 hours to trigger their action anti-inflammatory
  • There are not too many changes between administering it orally or intravenously.
  • It has not been possible to demonstrate dose-effect relationships. Therefore, there is no benefit in the use of very high doses.