Pulmonary Disorders II
Data for magnesium sulfate administration in severe asthma exacerbations are mixed. In addition,
data exist using nebulized magnesium rather than intravenous, but evidence is currently not robust
enough to recommend (Front Allergy 2023;4:1211949).
Centers equipped with extracorporeal membrane oxygenation may offer this as a bridge to recovery if
a patientβs respiratory acidosis cannot be managed by invasive MV alone (Global Initiative for Asthma
2024; Chest. 2023;163(1):38-51)
Methylxanthines (theophylline and aminophylline) do not improve lung function or other outcomes in
hospitalized adults. Use is associated with severe adverse effects.
considered if there is evidence of concurrent infection.
Helium-oxygen (heliox) is a blended gas (mixture of about 70%-80% helium and 20%-30% oxygen) that
decreases airway resistance, leading to improved airflow and ventilation. Evidence does not support the
routine use of heliox. Use of heliox in status asthmaticus may delay the need for intubation by allowing
other therapies to work or as a delivery mechanism for nebulized SABAs (Global Initiative for Asthma
2024).
Patient Case
Questions 5 and 6 pertain to the following case.
A 30-year-old woman (weight 115 kg) with status asthmaticus is admitted to the ICU. She has a history of
severe refractory asthma that has required endotracheal intubation three times in the past 6 months. Her medi-
cal history includes hypertension, diabetes, obesity, and bipolar disorder. She has used at least three canisters of
albuterol per month for the past 2 months to manage her symptoms.
Which best represents the patientβs risk factors for higher mortality?
The patient is endotracheally intubated and placed on MV. Which would be the most appropriate initial
therapy for this patient with life-threatening asthma exacerbation?
every 6 hours.
every 6 hours, and methylprednisolone 40 mg intravenously daily.
every 6 hours, and methylprednisolone 125 mg intravenously every 6 hours.