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Emergency Medical Minute


Sep 27, 2022

Contributor: Aaron Lessen, MD

Educational Pearls:

  • The management of severe asthma or COPD exacerbation is complex, especially when the patient requires intubation/ventilation
  • Asthma is an obstructive airway disease that can cause air trapping and hyperinflation of the lungs
  • To avoid worsening hyperinflation patients typically require slower respiratory rates, lower tidal volumes, and increased expiratory time when on a ventilator
    • Patients on a ventilator require very close monitoring to prevent worsening hyperinflation and associated complications including barotrauma and hypotension/cardiac arrest secondary to decreased venous return
  •  If patient condition starts to worsen, decrease respiratory rate and tidal volume
    •  In these cases, a decreased oxygen saturation is acceptable until their condition improves
  • If patient status continues to worsen, consider disconnecting the ventilator and pushing on the chest for approximately 30 seconds to help force out trapped air
  • If patient continues to decompensate, consider the possibility of a pneumothorax and determine if a chest tube is necessary
  • Remember to continue asthma/COPD management including albuterol/duonebs, steroids, magnesium, and alternatives including as heliox


Demoule A, Brochard L, Dres M, et al. How to ventilate obstructive and asthmatic patients. Intensive Care Med. 2020;46(12):2436-2449

Garner O, Ramey JS, Hanania NA. Management of Life-Threatening Asthma: Severe Asthma Series. Chest. 2022

Laher AE, Buchanan SK. Mechanically Ventilating the Severe Asthmatic. J Intensive Care Med. 2018;33(9):491-501


Summarized by Mark O’Brien, MS4 | Edited by John Spartz MD & Erik Verzemnieks, MD


In an effort to promote diversity, equity, and inclusion in Emergency Medicine, The Emergency Medical Minute is proud to present our 2nd annual Diversity and Inclusion Award. We support increasing the representation of underrepresented groups in medicine and extend this award to individuals applying to emergency medicine residencies during the 2022-2023 cycle. For information on award eligibility and the application process, visit