When Breathing Isn’t Second Nature: Adolescent Perspectives on Status Asthmaticus

Introduction: Status asthmaticus is a common reason for admission to the pediatric intensive care unit (PICU). Adolescent patients are at high risk of critical and near-fatal asthma, yet barriers to management of asthma from the adolescent perspective have not been directly studied. We aimed to 1) explore the lived experiences of adolescents with asthma and the events leading to hospital admission for acute exacerbations, and 2) identify factors amenable to intervention.


Methods: Adolescents (12-18 years) admitted with status asthmaticus, with English or Spanish preference, were approached when no longer requiring continuous nebulized albuterol or positive pressure ventilation. Adolescents’ experiences with the onset of their asthma flare, including initial symptoms and how they sought medical attention, were explored via semi-structured interviews. Qualitative data was analyzed using reflexive thematic analysis.


Results: Analysis of 18 interviews identified six themes: 1. Fear and isolation; 2. Lack of control, 3. Feelings of guilt, 4. Focus on acute management and activity avoidance, 5. Burdened with educating others, and 6. Wanting to be “normal.”

Participants described feeling fearful and expressed constant worry because triggers were “everywhere,” causing disruptions in day-to-day life. Many carried guilt, expressing that “if only” they had had their inhaler or asked for help earlier their admission would have been prevented. Multiple participants lacked awareness of controller therapies and described cessation of physical activity to avoid provoking symptoms. Participants described struggling to convey the urgency of their symptoms and feeling burdened with educating others about asthma. Participants wanted to be treated "like other kids,” while also expressing they felt under supported.


Conclusions: Adolescents with asthma experience psychosocial challenges that contribute to their need for hospital admission. Reports of heavy reliance on rescue inhalers and avoidance of physical activity suggest current outpatient assessments may fail to identify patients who could benefit from escalation of controller therapy. Future efforts should address psychosocial impacts of living with asthma, promoting community-based education, and refinement of symptom assessment.