The status asthmaticus is the most frequent complication of the bronchial asthma threatening the life of patients and requiring emergency intensive therapy. Lethality in the status asthmaticus makes about 5 %. Doctors describe anaphylactic and metabolic forms of the status asthmaticus.
Anaphylactic form occurs infrequently and is characterized by rapidly increasing bronchial obstruction mainly due to the bronchospasm with the development of acute respiratory failure. This form of the status asthmaticus represents the anaphylactic reaction either to medications, which the patient is sensitized to, or non-allergic bronchospasm to non-steroidal anti-inflammatory drugs in aspirin asthma, or the complication of prescribed by mistake not-selective β- adrenergic blockers.
The metabolic form of the status asthmaticus occurs more often. It develops gradually against the background of the exacerbation of the bronchial asthma and is characterized by resistance to bronchodilatory agents, significant disturbances of a bronchial drainage without phlegm expectoration, progressing disorders of gas exchange and blood acid-base balance, hypovolemia and hemoconcentration, hypokaliemia, the syndrome of acute pulmonary hypertension, a systemic arterial hypertension, sinus a tachycardia, infrequent cardiac arrhythmias, occurrence of paradoxical pulse with significant decrease of the pulse wave in inspiration.
The level of respiration in the status asthmaticus is distinctly displaced to the inspiratory direction due to the strain of the muscles realizing the inspiration to create the negative intrapleural pressure, but the depth of the exhalation decreases, and the breathing becomes superficial. Doctors describe the following stages of the status asthmaticus.
•    The First Stage of the status asthmaticus is the initial stage of relative compensation. This stage is characterized by all basic attributes of the status asthmaticus, the functional lung volume is reduced up to 30 % of due volume. Doctors detect a moderate hypoxemia, hypocapnia and compensated respiratory alkalosis due to hyperventilation.
•    The Second Stage of the status asthmaticus is the stage of decompensation. This stage is characterized by increased bronchial obstruction with functional lung volume of 20 % of due volume or less. Doctors detect the development hypoventilation, the increase of hypoxemia, the appearance of hypercapnia and respiratory acidosis. Over certain usually lower pulmonary areas there are zones of dumb lung, where the breathing phenomena are not heard during auscultation because of airway obstruction with the phlegm.
•    The Third Stage of the status asthmaticus is the stage of hypercapnic acidotic coma. This stage is characterized by progressive neurologic disorders, increased respiratory acidosis, a systemic hypotension, and occurrence of severe arrhythmias.

Treatment of the status asthmaticus

This treatment is carried out in the conditions of the intensive care unit or in the specially equipped hospital rooms. Doctors carry out the rehydration infusing large volumes of isotonic solutions under the control of the level of the central venous pressure and urination, the correction of electrolytic aberrations such as hypokaliemia, normalization of blood acid-base balance in case of the respiratory acidosis development with blood рН higher than 7,30 by means of sodium hydrocarbonate introduction. The infused solutions are heparinized, but it is more convenient to inject heparin solutions hypodermically by 5000-10000 IU every 6 hours. Doctors prescribe expectorant agents; parenteral treatment with bromhexine or ambroxol is preferable. Slow in-line oxygen therapy to support the oxygen pressure in the arterial blood above 60 mm Hg is also carried out

Doctors also use bronchial spasmolytics such as aminophylline in an initial dose of 6 mg/kg. The medication is introduced by means of drop infusion intravenously during 15-20 minutes, and then in a supporting dose of 0.6 mg/ (kg•h). In serious heart diseases, cardiac rhythm disturbances, accompanying liver diseases both initial and supporting doses of aminophylline are reduced by half. Moreover, when calculating the initial dose of aminophylline it is necessary to take into account previous therapy. Adrenergic bronchodilators are contra-indicated in the metabolic form of the status asthmaticus, but in anaphylactic form of the status asthmaticus one can introduce intravenously aminophylline 0.5-1 ml of 5 % solution or alupent in a dose of 0.5 mg (1 ml of 0.05 % solution).