Buzz
Bronchial asthma occurs due to inflammation and blockage in the bronchial tubes, which are responsible for allowing air to flow in and out of the lungs. In 2009, the American Institute of Asthma, Allergy, and Immunology reported that one in every twelve people in the U.S. is diagnosed with asthma, compared to one in fourteen people in 2001. During an asthma attack, the muscles around the bronchial tubes tighten and swell, narrowing the airways and making it difficult to breathe. Triggers for an asthma attack include exposure to allergens (such as pollen, grass, or trees), air pollutants (like smoke or strong fragrances), illnesses (such as the flu), stress, extreme weather conditions (like intense heat), or physical exertion. Learning how to recognize when you or someone else is having an asthma attack and knowing the appropriate actions to take can save lives.
Steps
Assess the Situation
Identify the early symptoms of an asthma attack. People with chronic asthma may occasionally wheeze and need medication to manage their symptoms. An acute asthma attack differs as it causes more severe, longer-lasting symptoms and requires emergency attention. Early symptoms indicating an impending asthma attack include:
- Itchy throat
- Feeling restless or irritable
- Feeling anxious or upset
- Fatigue
- Dark circles under the eyes
Recognizing the Early Signs of an Asthma Attack. Asthma attacks can progress into life-threatening situations that require immediate emergency care. It's important to know how to identify the signs of an asthma attack so that treatment can begin as soon as possible. While the signs and symptoms of an asthma attack vary from person to person, the most common symptoms include:
- Wheezing and whistling sounds when breathing. Usually, wheezing is heard when exhaling, but sometimes it can also be heard when inhaling.
- Coughing. Some people may cough to clear the airways and breathe in oxygen. This is often more pronounced at night.
- Shortness of breath. Those experiencing an asthma attack often report feeling out of breath. Their breathing may be rapid, shallow, and quicker than normal.
- Chest tightness. Asthma attacks are often accompanied by a feeling of tightness in the chest or pain on one side.
- Peak Expiratory Flow (PEF) is low. If the patient uses a peak flow meter (a small device that measures the maximum exhalation speed to monitor breathing capacity) and the reading ranges from 50% to 79%, it indicates an asthma flare-up.
Recognizing Asthma Symptoms in Children. Children experiencing asthma attacks typically show symptoms similar to adults, such as wheezing or whistling sounds during breathing, shortness of breath, chest tightness, or pain.
- Rapid breathing is a common sign of an asthma attack in children.
- Children may display “retractions,” where their neck appears to stretch out, they breathe from their stomach, or you can see their ribs while breathing.
- For some children, persistent coughing is the only symptom of an asthma attack.
- In other cases, asthma symptoms in children may only manifest as coughing, which can worsen during viral infections or at night.
Assess the Current Situation. Evaluate the current condition and determine whether emergency care is needed and what steps to take. Patients with mild symptoms may use fast-acting medication. Those showing more severe symptoms should be evaluated by a healthcare professional. If the asthma attack is severe, call emergency services before taking any action to treat the attack. It’s essential to recognize what is happening:
- A person having an asthma attack but not requiring emergency services may:
- Have mild wheezing without signs of severe distress
- Be able to cough to clear the airway and inhale more air
- Breathing quickly but still able to talk and walk
- Not appear anxious or in pain
- Be able to tell you they have asthma and where their medication is
- A person in critical condition and requiring emergency care may:
- Look pale, even with bluish lips or fingertips
- Experience the above symptoms but in a more intense and severe manner
- Struggle to breathe, using chest muscles
- Have extremely short, labored breaths
- Wheezing loudly on both inhalation and exhalation
- Show signs of increased anxiety
- Be confused or less responsive than usual
- Find it difficult to walk or speak due to shortness of breath
- Experience persistent symptoms
Managing an Asthma Attack
Have a Localized Response Plan. Once diagnosed with asthma, you should work with your doctor to develop a response plan for asthma attacks. This plan essentially serves as a step-by-step guide to follow when you experience an acute asthma attack. The plan should be written down and include emergency contact numbers, as well as the phone numbers of family and friends who can accompany you to the hospital if necessary.
- Once diagnosed, consult your doctor to identify the specific symptoms that indicate worsening asthma and what actions to take when an asthma attack occurs (e.g., taking medication, going to the emergency room, etc.)
- Ensure you know how to use an emergency inhaler.
- Write this plan down and carry it with you at all times.
Avoiding Triggers. In general, it's important to remember that preventing symptoms is the best way to manage and treat asthma. If you're aware of situations that trigger your asthma attacks (such as exposure to pets, extreme hot or cold weather), you should do your best to avoid them.
Purchase a Prescription Inhaler. There are two types of emergency medications that your doctor may prescribe: a metered-dose inhaler (MDI) or a dry powder inhaler (DPI).
- The MDI is the most common type of inhaler. This device delivers asthma medication via a small canister that uses a propellant to push the medication into the lungs. An MDI can be used alone or with a spacer (breathing chamber) that separates the mouth from the inhaler, allowing for normal breathing and improving medication delivery to the lungs.
- The DPI inhaler delivers asthma medication in dry powder form, without a propellant. Brands of DPI inhalers include Flovent, Serevent, and Advair. DPI inhalers require you to inhale quickly and deeply, making them more difficult to use during an asthma attack. As a result, these are less commonly used than standard MDI inhalers.
- Regardless of which inhaler your doctor prescribes, always remember to carry it with you.
Using an MDI. It's important to note that during an asthma attack, you should only use the MDI with emergency medication, such as a bronchodilator (e.g., albuterol), and not corticosteroids or long-acting beta-2 agonist bronchodilators. Shake the inhaler for 5 seconds to mix the medication.
- Before using the inhaler, exhale fully to empty your lungs as much as possible.
- Lift your chin and place the spacer or inhaler mouthpiece tightly in your mouth.
- If using a spacer, you can breathe normally and slowly to inhale the medication. If using the inhaler directly, start inhaling and press the inhaler once.
- Continue to breathe in until you can no longer inhale.
- Hold your breath for 10 seconds, then repeat the process, but usually more than once, allowing at least 1 minute between doses. Always follow your asthma action plan.
Using a DPI. DPI inhalers vary by manufacturer, so you need to read the instructions carefully before use.
- Exhale as much as possible.
- Place the DPI mouthpiece tightly in your mouth and inhale deeply until your lungs are full.
- Hold your breath for 10 seconds.
- Remove the DPI from your mouth and exhale slowly.
- If your prescribed dose involves multiple puffs, repeat the process after one minute.
Recognizing When Emergency Care is Needed. If asthma symptoms worsen despite using medication, you need emergency care. Call emergency services immediately if possible. However, if you're struggling to breathe and cannot speak clearly, you must have someone else call for help, whether it's a family member, friend, or even a passerby.
- Your asthma action plan should include the local emergency contact number. Also, your doctor should help you identify when symptoms worsen and when you are in a critical situation, so you know when to seek help. If symptoms don't improve significantly after using the inhaler for a few minutes, call emergency services immediately.
Rest While Waiting for Emergency Responders. Sit down and rest as you await the arrival of emergency personnel. Some asthma patients find that sitting in a 'tripod' position—leaning forward with hands on the knees—can be helpful as this posture alleviates pressure on the diaphragm.
- Try to stay calm. Anxiety can worsen symptoms.
- Ask someone nearby to sit with you and help you stay calm while waiting for emergency help.
Assisting Others
Help the Patient Find a Comfortable Position. Most people with asthma feel more comfortable sitting rather than standing or lying down. Keep the patient sitting upright to allow the lungs to expand and make breathing easier. Have them lean slightly forward, resting against you or a chair. Some asthma patients may prefer the 'tripod' position, leaning forward with their hands on their knees to reduce diaphragm pressure.
- Anxiety can worsen an asthma attack, but it doesn't trigger it. This means that during an asthma attack, the patient’s reaction may be more frantic compared to when they are calm. Anxiety causes the body to release cortisol, which narrows the bronchial tubes (the air passages to the lungs).
- It is important that you remain calm and reassure the patient, as this can help them stay calm as well.
Calmly Ask, 'Do You Have Asthma?' Even if the patient cannot speak due to wheezing and coughing, they may nod or point to their inhaler or action plan.
- Ask the person if they have their asthma action plan with them. Many asthma patients carry an emergency action plan. If they do, retrieve the plan and assist them in following the instructions.
Remove Known Triggers from the Scene. Asthma attacks can worsen due to certain triggers or allergens. Ask the patient if there is anything nearby that might be provoking their asthma and, if they can respond, try to move them away from the trigger or out of the environment (e.g., pollen or weather-related factors).
- Animals
- Smoke
- Pollen
- High humidity or cold weather
Inform the Patient That You Are Searching for Their Inhaler. This helps the patient remain calm and reassures them that you are assisting them, not causing harm.
- Women often store their inhalers in their handbags, while men usually keep them in their pockets.
- Some asthma patients, especially children or the elderly, may use a plastic device called a spacer attached to their inhaler. The spacer helps deliver medication to the mouth with less effort, making it easier to inhale.
- Children and the elderly who experience asthma attacks may also carry a nebulizer to inhale medication through a mask. This device is user-friendly as patients can breathe normally, making it ideal for children and older adults. However, it is bulkier than an MDI inhaler and requires electricity to function.
- If the patient does not have an inhaler, call emergency services immediately, especially for children or the elderly. Those experiencing an asthma attack without an inhaler are at a higher risk of suffocation.
Prepare the Patient to Take Medication from the Inhaler. If the patient is hunched over, temporarily raise their upper body.
- If a spacer is being used with the MDI, attach it to the inhaler after shaking it. Open the mask cover.
- Assist the patient in tilting their head back if necessary.
- Instruct the patient to exhale as fully as possible before using the inhaler.
- Allow the patient to administer the medication themselves. It’s essential that the correct dosage is used, so it’s best to let the patient control the process. Assist them in holding the inhaler or spacer close to their mouth if needed.
- Most asthma patients will pause for one or two minutes between each puff.
Call Emergency Services. Monitor the patient until emergency help arrives.
- Even if the patient appears to improve after using the inhaler, it’s still best for emergency medical professionals to evaluate them. If the patient refuses to go to the hospital, they can make that decision after being fully informed about their health condition.
- Continue to assist the patient with the inhaler if necessary; even if the asthma attack does not subside, the medication will help prevent further complications by relaxing the airways.
Managing an Asthma Attack Without an Inhaler
Call Emergency Services. If you or the patient do not have an inhaler, it is crucial to call local emergency services immediately. You can take additional steps while waiting for help to arrive. However, always ask the emergency dispatcher for guidance on what to do next.
Take a Hot Shower. If you're at home, taking a hot shower or soaking in a warm bath can turn the bathroom into a great recovery spot thanks to the steam it generates.
Practice Breathing Exercises. Many people become fearful and panicked during an asthma attack, which can increase the rate of breathing. However, panic often worsens the attack by limiting the amount of oxygen reaching the lungs. Try to breathe slowly and consciously. Inhale through your nose while counting to 4, and exhale while counting to 6.
- Try pursing your lips when exhaling. This technique can help you exhale slowly and keep your airways open for a longer period of time.
Find a Caffeinated Drink. Caffeine's chemical structure is similar to common asthma medications, and a small amount of coffee or soda may help open up the airways and alleviate respiratory issues.
- This type of medication, known as theophylline, can help prevent and treat wheezing, shortness of breath, and chest tightness. While coffee or tea may not contain enough theophylline to counteract an asthma attack, it could still be an alternative option.
Utilize Common Household Medications. Some medications can help alleviate the effects of an asthma attack in an emergency situation, though they should never replace professional medical care.
- Use fast-acting antihistamines (allergy medications) if you or the patient suspect an allergen is triggering the attack. This may happen if you are outdoors on a day with high pollen levels. Some common antihistamines include Allegra, Benadryl, Dimetane, Claritin, Alavert, Tavist, Chlor-Trimeton, and Zyrtec. Herbal antihistamines like Echinacea, ginger, chamomile, and saffron may also help. If you find tea with these ingredients, it could provide some relief, though their antihistamine effects tend to be limited. Be cautious when using natural herbs or supplements as some people may be allergic to certain ingredients.
- Use over-the-counter pseudoephedrine medications like Sudafed. Sudafed is a decongestant, but it can also help relax the airways when the patient has an asthma attack without an inhaler. It's best to crush the pill and mix it with warm water or tea before taking it to reduce the risk of choking. Note that while this medication is effective, it may take 15 to 30 minutes to work. Also, keep in mind that pseudoephedrine can raise heart rate and blood pressure.
Advice
- If you are treating a mild asthma attack but do not feel any improvement, you should visit a doctor to prevent the condition from worsening. The doctor may prescribe oral steroids to help control the attack.
- By following the treatment plan as soon as symptoms appear, you can often prevent the asthma attack from becoming more severe.
- Asthma symptoms like coughing, wheezing, shortness of breath, or chest tightness may be relieved with an inhaler. In some cases, the symptoms may subside on their own.
- Ensure that your inhaler and other asthma medications are not expired or out of stock.
Warning
- No asthma medication is allowed to be sold without a doctor's prescription. Every diagnosed asthma patient must have an emergency action plan and always carry an inhaler with them.
- Asthma can be life-threatening. If you or someone nearby does not improve after using an inhaler for several minutes, you or someone nearby should call emergency services immediately and wait for assistance.
- If you are unsure of what to do, call emergency services right away.
