Be ready for sudden change in asthma patients' status

Patients may rapidly decompensate

"Normal-looking" asthma patients, whose condition is poorly controlled with treatment, or patients who are not compliant with treatment, may show up in your ED after weeks of deteriorating gradually, warns Anissa Washington, RN, BSN, ED nurse at St. John's Mercy Medical Center in St. Louis, MO.

"Their effort to breathe eventually becomes tiring, and the patient may suddenly decompensate," says Washington.

Consider the patient's vital signs, including pulse oximetry, listen to breath sounds, and perform a thorough medical history, says Washington. Ask about history of sudden exacerbation, intensive-care unit admission, recent hospital and ER visits, use of inhalers or sudden withdrawal from corticosteroids, drug use, and comorbidities, she says.

"Interventions, such as supplemental oxygen, breathing treatments and appropriate medications, should promptly be administered to these patients," says Washington. "Additional monitoring such as pre and post-peak flows, cardiac monitoring and arterial blood gases are also necessary."

Monitor closely

Just because you've administered a medication doesn't mean your asthma patient will respond, says William Downum, RN, an ED nurse at St John's Mercy Medical Center in St. Louis, MO. "Assess for signs of respiratory failure," he says. "Close monitoring of your asthma patient is a number-one priority." Here are Downum's recommendations:

  1. Visually inspect the chest for sternal retractions and intercostal retractions, and use of accessory muscles.
  2. Reassess your patient after each treatment and medication given.

Many times, a single breathing treatment given in the ED doesn't solve the problem, says Downum. "Children may have been given nebulizers at home, before coming to the hospital," he says. "Follow-up breathing treatments, continuous nebulizers, and IV [intravenous] medications may be required to improve the patient's condition." (See clinical tip on giving treatments, below.)


For more information on caring for asthma patients in the ED, contact:

William Downum, RN, Emergency Department, St John's Mercy Medical Center in St. Louis, MO. E-mail:

Anissa Washington, RN, BSN, Emergency Department, St. John's Mercy Medical Center, St. Louis, MO. E-mail:

Clinical Tips

Always give asthma meds without delay

When caring for an asthma patient, William Downum, RN, an ED nurse at St John's Mercy Medical Center in St. Louis, MO, says to always give medications and breathing treatments in a timely manner. "If you have an order to give three breathing treatments 20 minutes apart, it will have less effect if you give the treatments 45 minutes or an hour apart," he explains.