Upon arrival at Tam Anh General Hospital Hanoi, the patient was in acute respiratory failure. Her SpO₂ was 89% (normal is above 95%), her respiratory rate was 26 breaths/minute, and her pulse was 144 beats/minute. She exhibited cyanosis, respiratory muscle retraction, and significantly reduced alveolar breath sounds. Doctor Pham Thi Le Quyen, Deputy Head of the Respiratory Department, stated that these were warning signs of a severe asthma attack, indicating critically narrowed airways and difficulty for air to enter and exit the lungs. Without timely intervention, the patient faced a risk of respiratory and cardiac arrest.

Doctors initiated intensive emergency treatment with bronchodilators, repeated nebulization, systemic corticosteroids, oxygen support, and other resuscitation measures. However, as respiratory failure progressed, Ms. Thao was intubated and transferred to the intensive care unit for invasive mechanical ventilation.

Arterial blood gas results revealed the patient had acidosis and ventilation-perfusion mismatch due to the critical asthma attack. Elevated blood lactate levels of 3,01 mmol/L indicated prolonged oxygen deprivation. Immunological tests also showed elevated total IgE, consistent with the allergic predisposition common in bronchial asthma patients.

Previously, Ms. Thao had been hospitalized for an emergency due to an acute asthma attack but did not continue maintenance treatment with anti-inflammatory medication. Seven months later, she experienced nasal congestion, a cough with white phlegm, and progressively worsening shortness of breath. She self-administered bronchodilators to alleviate symptoms, but her condition did not improve.

A nurse checks the patient's blood pressure. Photo. Tam Anh General Hospital

After one day of intensive resuscitation, her respiratory function improved, and the patient was extubated.

Presenting the case at the Vietnam Respiratory Society's Annual Scientific Conference on 26/7/2026, Doctor Quyen noted that previously, the patient had only experienced occasional asthma symptoms. However, years of not using controller medication and relying solely on rescue inhalers led to prolonged airway inflammation, culminating in a critical bronchial asthma attack.

According to Doctor Quyen, this is a common mistake when many people assess asthma based solely on symptom frequency. In reality, the number of symptomatic episodes does not fully reflect the risk of acute asthma attacks. Even individuals with mild asthma can experience critical attacks if not properly treated and managed. Patients require regular monitoring and assessment of their risk for acute asthma exacerbations.

Hoang Duong