A 3–year-old boy is brought to the casualty by his mother with progressive shortness of breath for 1 day. The child has a history of bronchial asthma. On examination, the child is blue, gasping and unresponsive What will you like to do first –: (A) Intubate, (B) Administer 100 % oxygen by mask, (C) Ventilate with bag and mask, (D) Administer nebulised salbutamol
Answer is B. The symptoms given by the child shows that he is suffering from life-threatening asthma.
Presence of any of the following indicates life-threatening Asthma.

a) Cyanosis                
b) Silent chest                      
c) Poor respiratory effects
d) Altered sensorium
e) Exhaustion, fatigue       
f) PEFR < 30 % of predicted and O2 saturation of < 90 %
Management of life-threatening asthma (status asthmaticus)

Immediate O2 inhalation
Injection of terbutaline or adrenaline (s.c.)
Inhalation of salbutamol or terbutaline and ipratropium
Injection of hydrocortisone 10mg/kg.


After the above-mentioned steps, an arrangement is made to transfer the patient to ICU.