Can individuals with asthma (asthmatics) experience severe bronchospasm to the point of airway obstruction, resulting in an inability to move air?

From the Guidelines

Yes, individuals with asthma can experience severe bronchospasm to the point of airway obstruction, resulting in an inability to move air, a condition that can rapidly progress to respiratory failure if not promptly recognized and treated. This severe airway constriction occurs because the smooth muscles surrounding the bronchial tubes contract excessively, the airway lining becomes inflamed and swollen, and mucus production increases dramatically, all combining to obstruct airflow 1. During a severe asthma attack, the airways can constrict so tightly that the person cannot move air in or out of their lungs, leading to respiratory failure. Signs of impending respiratory failure include an inability to speak, altered mental status, intercostal retraction, worsening fatigue, and a PaCO2 of 42 mm Hg or greater 1.

Key Considerations

• Severe bronchospasm in asthmatics requires immediate emergency treatment, typically with high-dose inhaled bronchodilators and systemic corticosteroids.
• Oxygen therapy is essential, and some patients may require intubation and mechanical ventilation if they cannot maintain adequate oxygen levels.
• Other treatments, such as intravenous magnesium sulfate, heliox, and other therapies, may be considered in life-threatening exacerbations or those that remain severe after 1 hour of intensive conventional treatment 1.
• The selective use of intravenous magnesium sulfate has been adopted by many academic emergency departments for patients with severe asthma exacerbations.

Management

• High-dose inhaled albuterol (2-4 puffs every 20 minutes or continuous nebulization) and systemic corticosteroids (such as prednisone 40-60mg orally or methylprednisolone 125mg IV) are crucial in managing severe asthma attacks.
• Epinephrine (0.3-0.5mg IM) may be considered in critical situations.
• People with asthma should have an action plan from their doctor and carry rescue medication at all times, as this level of bronchospasm represents a true medical emergency requiring immediate intervention.

From the FDA Drug Label

The use of albuterol sulfate inhalation solution can be continued as medically indicated to control recurring bouts of bronchospasm During this time most patients gain optimum benefit from regular use of the inhalation solution. If a previously effective dosage regimen fails to provide the usual relief, medical advice should be sought immediately, as this is often a sign of seriously worsening asthma that would require reassessment of therapy.

Severe bronchospasm can occur in individuals with asthma, and if a previously effective dosage regimen of albuterol fails to provide relief, it may be a sign of seriously worsening asthma. This suggests that asthmatics can experience severe bronchospasm to the point of airway obstruction, resulting in an inability to move air. Key points include:

• Bronchospasm: a potentially severe condition that can occur in asthmatics
• Airway obstruction: a possible consequence of severe bronchospasm
• Worsening asthma: a condition that requires immediate medical attention and reassessment of therapy 2

From the Research

Asthma and Airway Obstruction

• Individuals with asthma can experience severe bronchospasm, which can lead to airway obstruction and an inability to move air 3, 4.
• Severe asthma attacks can require hospitalization, tracheal intubation, and mechanical ventilation 3.
• The characteristics of patients who require tracheal intubation and mechanical ventilation due to asthma include a history of smoking, non-adherence to medication, and reliance on short-acting beta(2)agonists (SABAs) alone 3.

Pathophysiology of Severe Asthma

• Severe asthma is characterized by severe pulmonary hyperinflation due to marked limitation of expiratory flow 4.
• Inflammation plays a key role in the pathogenesis of severe asthma, with persistent inflammation observed in patients with severe asthma despite treatment with high-dose glucocorticoids 5.
• Air trapping is a major determinant of persistent airway obstruction in asthmatics, and its presence is significantly associated with chronic persistent airflow obstruction 6.

Management of Severe Asthma

• Close observation and aggressive administration of bronchodilators, such as SABAs and ipratropium bromide, and oral or intravenous corticosteroids are necessary to manage acute severe asthma 4.
• Adjunctive therapies, such as intravenous magnesium sulfate, may be considered to avoid intubation 4.
• Inhaled corticosteroids (ICS) are a crucial component of asthma management, but their use can be associated with adverse effects, such as hypothalamic-pituitary-adrenal axis suppression and osteoporosis 7.