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Status asthmaticus is a severe asthma attack (bronchial hyper-activity) that does not respond to the usual treatment. Status asthmaticus is a medical emergency.


  • ensure that a patient brings his/her inhaler
  • when appropriate, encourage a patient to use a short-acting beta2-agonist inhaler prior to the dental appointment

Signs and symptoms#

  • expiratory and inspiratory wheezing
  • expiratory breathing is harder and longer than inspiratory breathing
  • inability to complete a sentence in one breath
  • respiratory rate >25 breaths/min.
  • dyspnea
  • sense of suffocation
  • distended chest
  • non-productive cough
  • tachycardia (pulse >110 beats/min.)

During severe attacks#

  • diaphoresis and flushing
  • use of accessory muscles of respiration (sternocleidomastoid, shoulder, and abdominal muscles)
  • possible confusion and agitation
  • bradycardia (pulse <50 beats/min.)
  • cyanosis


  • be calm and reassuring
  • discontinue dental treatment
  • clear the mouth of all foreign objects
  • place the patient in a slightly upright position
  • have the patient’s use own medication readily available
  • administer short-acting beta₂-agonist, such as albuterol inhaler (Proventil, Ventolin), 2 puffs every 2 min
  • administer supplemental oxygen 6-8 L/min by nasal cannula, mask or laryngeal mask airway (LMA)
  • monitor blood pressure, pulse, and respiratory rate

Severe attack#

  • administer epinephrine 1:1,000 dilution, 0.3 cc SC for adults, or 0.01 cc/kg SC for children; can be repeated in 15 min
  • if no improvement of signs and symptoms, alert emergency medical services (EMS)

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