Background: Status asthmaticus is an acute exacerbation of asthma that is persistent and
intractable and remains unresponsive to initial treatment with bronchodilators and systemic corticosteroids
and that the condition can result in hypoxemia, hypercarbia, and secondary respiratory failure.
Objective: To review treatment and recent patents on management of status asthmaticus.
Method: A PubMed search was completed in Clinical Queries using the key term "status asthmaticus".
The search included meta-analyses, randomized controlled trials, clinical trials, reviews and
pertinent references. Patents were searched using the key term "status asthmaticus" from
www.google.com/patents, www.uspto.gov, and www.freepatentsonline.com.
Results: Supplemental oxygen should be given to maintain an oxygen saturation of ≥ 92% in room air.
Mainstay of pharmacologic treatment of status asthmaticus includes short-acting, β2 agonists such as salbutamol
(albuterol) administered by metered-dose inhaler with spacer or, preferably, by nebulizer and oral
corticosteroids. There is no advantage to intravenous corticosteroids unless the child cannot tolerate oral
corticosteroids (e.g., protracted vomiting), or unable to take oral corticosteroid (e.g., intubated or unconscious).
Inhaled ipratropium bromide and intravenous magnesium sulfate should be considered in children
with severe asthma exacerbations not responsive to conventional therapy. Subcutaneous and intramuscular
β2 agonists such as terbutaline and epinephrine may be considered for children with severe asthma exacerbation
who have poor air entry, are uncooperative with nebulized therapy, or have poor response to nebulized
therapy. Monoclonal anti-IgE antibody (omalizumab) and humanized monoclonal antibodies targeting
interleukin pathway have shown great promise in severe refractory eosinophilic asthma. Failing therapeutic
interventions necessitate non-invasive or invasive ventilation support. Severe exhaustion, deteriorating
consciousness, poor air entry, worsening hypoxemia, hypercapnia, and cardiopulmonary arrest are
indications for mechanical ventilation and intubation. For chronic treatment of asthma, inhaled corticosteroids,
bronchodilator, and oral montelukasts are the mainstay. Some formulations of herbal medicine are
efficacious but evidence of other modalities of complementary and alternative medicine are generally
lacking. This review also discusses recent patents related to the management of asthma. These recent patents
describe a few immunomodulating medications useful for the treatment of chronic severe asthma.
There have been no recent patents for the management of status asthmaticus.
Conclusion: Inhaled bronchodilators and systematic corticosteroids are the mainstay of therapy in
the management of severe and status asthmaticus.