Asthma Management is Life-Threatening in Intensive Care Units

Life-threatening asthma is an acute medical emergency characterized by severe airflow obstruction, mucus plugging, and dynamic hyperinflation that may progress to respiratory failure requiring intensive care. This narrative review synthesizes definitions, epidemiological context, pathophysiological mechanisms, and clinical management strategies relevant to patients with life-threatening asthma in intensive care units (ICUs). The review draws on clinical practice guidelines, official Indonesian health information, medical textbooks, and published studies cited in the manuscript, including the Global Initiative for Asthma (GINA) 2025 report and relevant literature on acute severe asthma management. The evidence was organized according to the recognition of disease severity, risk factors for clinical deterioration, pharmacological interventions, noninvasive respiratory support, invasive mechanical ventilation, and extracorporeal membrane oxygenation (ECMO). The synthesis highlights the importance of rapid clinical assessment, prompt administration of inhaled short-acting bronchodilators and systemic corticosteroids, appropriate selection of respiratory support, and strategies to minimize dynamic hyperinflation during invasive mechanical ventilation. ECMO may be considered for selected patients with refractory respiratory failure at specialized centers; however, reported clinical outcomes vary according to patient characteristics, disease severity, and institutional expertise. Current evidence does not establish a universally optimal treatment escalation pathway applicable to all patients. These findings underscore the importance of integrating pathophysiological understanding, continuous clinical monitoring, evidence-based guidelines, and multidisciplinary expertise into individualized clinical decision-making. As this article is a narrative review without a formal risk-of-bias assessment or quantitative meta-analysis, its conclusions should be interpreted as a synthesis of available clinical evidence rather than definitive comparative evidence of treatment effectiveness.