Complications
May be the trigger for acute exacerbation or may be a complication of hypersecretory asthma. In hypersecretory asthma, however, the presence of lobar consolidation or collapse is not always diagnostic of pneumonia, as mucus secretion leads to airway obstruction and lobar collapse via mucus plugging. However, bacterial superinfection of compromised lung segments may subsequently lead to pneumonia. Antibiotics are indicated only in the presence of other signs of pneumonia such as increased white blood cell count or fever.
Rare but important complications of acute asthma exacerbations.[144][145] Pneumothorax may also be caused by barotrauma associated with mechanical ventilation. Pneumomediastinum rarely requires intervention.[144] Pneumothorax is an important potential cause of death, and tension pneumothoraces should be managed with emergency needle thoracocentesis. Nontension pneumothoraces should prompt intercostal chest catheter insertion.
Impending respiratory failure is indicated by decreased oxygen saturations, exhaustion, and rising carbon dioxide levels. Respiratory failure is an indication for mechanical ventilation. The role of noninvasive ventilation in acute asthma management in children has been reviewed.[121] The application of positive pressure in the setting of severe acute bronchospasm may be beneficial in preventing airway collapse and reducing the mechanical load on already tired muscles of respiration.[146] This may be achieved using high-flow humidified nasal cannulae (HFNC), or noninvasive ventilation (NIV; either continuous positive airways pressure, CPAP, or bi-level noninvasive ventilation), applied using either a nasal or full-face mask interface. Sedation is occasionally necessary for patient tolerance, but should be used with caution. Appropriate use of NIV may avoid the subsequent need for invasive ventilation.
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