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 patient’s 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 patient’s 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.