"Status Asthmaticus"

I remember so well that time when I was still a medical senior in UST, I saw a 27 year old male who died because of asthma. His story is still fresh in my memory.

It was late in the afternoon, I was on duty as a rotator at the department of Internal Medicine. He came in all alone with difficulty of breathing. When I saw him dyspneic, I immediately listened to his lungs, it was very tight and with too many wheezes. But his words were comprehensible so after getting the PEFR I did nebulization while informing my intern and the resident on duty. They saw the patient and told me to continue nebulizing every 20-30 minutes and check fo his vitals. After the first neb, he was able to talk to me in phrases and managed to tell me that at that same moment his wife was giving birth to their first son at Fabella Hospital, a 20 minute ride to UST. He became very excited that he began to feel he was having an asthma attack. He forgot his Salbutamol inhaler so he ran to Fabella's ER only to be told to wait because there were too many patients. After 20 minutes waiting, he decided to go to UST Hospital. He was smiling with joy in his eyes as he looked at me.

After the second nebulization, he started to feel dyspneic again. I did my auscultation and heard more wheezes and the PEFR became worse. I told my intern, who decided to give him an IV steroids. After another 15 minutes, he was becoming more dyspneic and his lips became bluish green. I knew we had to do intubation. And so we did. He was intubated and was subsequently admitted to the ICU.

I felt very sad as I thought of his newborn child and his wife. I was really praying hard for his recovery. It sent shivers to my spine to think of a new life in exchange of another life. After two hours, the hospital was in CODE and we rushed to the ICU. My patient was now being resuscitated. After 10 minutes, he succumbed to death...

There may be factors contributing to his death but ever since that time, I make sure I have my inhaler at hand. When I laugh hard I always try to control myself. Asthma may be reversible but only God knows when it's not.

SCHOOL OF ASTHMA

He came in because of 2 weeks cough and cold with difficulty of breathing. A.R., is a 55 year old male, non-smoker, non-alcoholic beverage drinker and a Catholic community volunteer. He did not take any drugs for his complaints but said he maintained his Symbicort and Virlix. He was diagnosed to have asthma since childhood.

He was bothered by a moderate grade fever he experienced the night before, which prompted consult. Upon examination , he had congested turbinates, slightly hyperemic pharynx and wheezes on both his upper lung fields. He said, since January, he had 3 attacks of asthma. He took Azithromycin for the first 2 attacks and cotrimoxazole for the last one. He's afraid to take another antibiotic regimen because of it's possible injury to his liver. He also took Simvastatin for his high cholesterol levels from dec to feb of this year. His narration is interspersed with bouts of cough and dyspnea.

He was in exacerbation.
Whenever I see asthma patients, I am always filled with empathy. Suffering from the same chronic disease, I know what my patient is experiencing. But what is asthma really?

Asthma is basically an inherited disease. I always tell my father that his legacy will always be with me forever and may even become the cause of my death.However, acquiring asthma is not uncommon.

The pathophysiology of asthma is explained by 3 things: reversible airway obstruction , airway inflammation and hyperactive airways.It used to be that they explained the difficulty of breathing by bronchospam alone. Recently though, they believe that asthma is truly an inflammatory disease.

There are trigger factors for asthma, most common is dust and dust mites. Mine though is different- I usually have exacerbations after laughing so hard or when I have upper respiratory tract infection either viral or bacterial.

Aggressive treatment for asthma is now the recommendation. In the past, I remember, whenever my attacks occur in the evening, my father gets irritated and he'll tell me to overcome myself and not rely on drugs . I am glad though that during those times my mom would patiently rub my back and accompany me till morning up to the time my father decides to buy my medication. It's a good thing I didn't die of status asthmaticus, which happens to patients who develop irreversible airway obstruction.

Asthma is categorized based on severity. If you have persistent asthma with severe symptoms, it is warranted that you take a maintenance drug in the form of corticosteroids(inhaled) and a long acting beta agonist such as salmeterol or formoterol, however , during acute attacks , emergency relievers,short acting beta agonists like salbutamol, should come in handy. Nebulization 3x every 20 minutes with salbutamol may also help. Should theses drugs provide no relief after 30 min or an hour, patient should be sent to the emergency room for possible IV steroid treatment and oxygen.

For A.R.,I had to give antibiotic because, apparently , he is compliant with his maintenance medications. I also advised him to rest and drink a lot of fluids.

As for me, I always have an inhaler in my bag plus a dose of montelukast in the evening as maintenance . In most instances, I avoid laughing out loud as I don't want to find myself using my inhaler in times where I am obviously with a happy company.