Asthma Attack

Overview

An asthma attack, also known as an asthma exacerbation, occurs when the airways in the lungs become inflamed, swollen, and narrowed due to various triggers. Symptoms may include severe shortness of breath, chest tightness or pain, coughing, and wheezing. Asthma attacks can range from mild to severe, with minor attacks improving with prompt home treatment, while severe attacks may become life-threatening emergencies. It is crucial to recognize and treat an asthma flare-up early by following the treatment plan developed with a healthcare professional.

Understanding the disease

Symptoms

Symptoms of an asthma attack may include severe shortness of breath, chest tightness or pain, coughing or wheezing, low peak expiratory flow (PEF) readings if using a peak flow meter, and signs and symptoms that fail to respond to the use of a quick-acting (rescue) inhaler. Asthma attack symptoms may vary from person to person, and it is essential to work with a doctor to identify personal signs and symptoms of worsening asthma and what to do when they occur. If asthma symptoms do not improve or worsen after taking medication as directed by a doctor, emergency treatment may be necessary.

Risk Factors

Risk factors for developing an asthma attack include:

1. Having a history of severe asthma attacks or previous hospitalizations or emergency room visits for asthma.
2. Requiring more than two quick-acting (rescue) inhalers per month.
3. Experiencing asthma attacks with no apparent triggers.
4. Having other chronic health conditions, such as sinusitis, nasal polyps, cardiovascular disease, or chronic lung disease.
5. Exposure to environmental factors like tobacco smoke or air pollution.
6. A family history of asthma or allergies.
7. Living in an area with high pollution.
8. Being male.
9. Being Black or Puerto Rican.
10. Obesity.
11. Previous allergic reactions, including skin reactions, food allergies, or hay fever, also called allergic rhinitis.
12. Respiratory conditions, such as a chronic runny or stuffy nose, inflamed sinuses, or pneumonia.
13. Gastroesophageal reflux disease (GERD).

Development

Asthma attacks develop when the airways in the lungs become swollen, inflamed, and produce extra mucus, leading to narrowed bronchial tubes. This can occur due to various triggers, such as exposure to allergens, irritants, or respiratory infections. The airways' muscles contract, causing symptoms like coughing, wheezing, and difficulty breathing. Asthma attacks can range from minor, which improve with prompt home treatment, to severe, life-threatening emergencies. Recognizing and treating asthma flare-ups early is crucial to preventing serious asthma attacks.

Assessment and Diagnosis

Triage

You should see a doctor if you suspect an asthma attack, especially if the symptoms are severe, such as severe breathlessness or wheezing, the inability to speak more than short phrases due to shortness of breath, having to strain your chest muscles to breathe, low peak flow readings when you use a peak flow meter, or if there's no improvement after using a quick-acting (rescue) inhaler. It's important to follow the treatment plan you've worked out with your doctor ahead of time, and if symptoms don't improve with home treatment, seeking emergency care might be necessary.

Diagnosis

To diagnose an asthma attack, a healthcare provider may perform several tests and evaluations, including:

1. Pulse oximetry: This non-invasive test measures the amount of oxygen in your blood. A low oxygen saturation level may indicate poor breathing and asthma.
2. Lung function tests, also called spirometry: These tests measure how much air your child can exhale and how quickly. Your child may have these tests at rest, after exercising, and after taking asthma medication.
3. Exhaled nitric oxide test: If the diagnosis of asthma is uncertain after lung function tests, a healthcare provider might recommend measuring the level of nitric oxide in an exhaled sample of your child's breath.
4. Peak flow measurement: This simple test involves using a peak flow meter to measure how fast your child can force air out of the lungs. A decreased peak flow rate may indicate asthma.
5. Chest X-ray: In some cases, a chest X-ray may be ordered to rule out other conditions that may mimic asthma, such as pneumonia. If your child experiences asthma symptoms, it is important to follow the asthma action plan discussed with their doctor. This generally involves using a quick-acting (rescue) inhaler to receive airway-expanding medication, such as albuterol or levalbuterol. If symptoms persist or worsen, seek medical attention immediately.

Management and Treatment

Complications

Potential complications of an asthma attack include:

1. Respiratory arrest: In severe cases, an asthma attack can cause the airways to become so narrow that breathing stops completely, leading to respiratory arrest.
2. Permanent lung damage: Repeated asthma attacks can cause permanent damage to the airways and lung tissue, leading to a reduced lung function over time.
3. Reduced quality of life: Frequent asthma attacks can disrupt daily activities such as sleep, school, work, and exercise, affecting the overall quality of life for the individual and their family.
4. Increased healthcare costs: Asthma attacks can result in frequent visits to the emergency room, hospitalizations, and increased healthcare costs.
5. Emotional and psychological effects: Living with asthma and experiencing frequent attacks can lead to emotional and psychological stress, anxiety, and depression.

Home Remedies

For an asthma attack, it is important to follow the treatment plan you have worked out with your doctor ahead of time. This typically includes using a quick-acting (rescue) inhaler, such as a bronchodilator, which can help relax the muscles around the airways and make breathing easier. If you do not have a rescue inhaler, seek medical attention immediately. Home remedies for managing asthma symptoms and preventing attacks include:

1. Staying away from asthma triggers, such as pollen, pets, mold, and dust mites.
2. Avoiding cigarette smoke and polluted air.
3. Using a humidifier to add moisture to the air, especially during dry weather or when using forced hot air heat.
4. Practicing good hygiene to prevent respiratory infections, such as washing hands frequently and avoiding close contact with people who are sick.
5. Maintaining a healthy weight and engaging in regular physical activity, as obesity and a lack of exercise can increase the risk of asthma symptoms. It is essential to work closely with your healthcare provider to manage your asthma and develop a personalized treatment plan that addresses your specific needs and triggers.

Treatment

To treat an asthma attack, follow your personalized treatment plan developed with your doctor. This plan should outline what to do when your asthma starts getting worse and how to handle an asthma attack in progress. Key treatments include:

1. Quick-acting (rescue) inhaler: Use a short-acting bronchodilator, such as albuterol, to help quickly open up the airways.
2. Anti-inflammatory medications: Depending on your condition, your doctor may recommend the use of anti-inflammatory inhalers, corticosteroids, or oral corticosteroids to reduce inflammation and swelling in the airways.
3. Peak flow meter: Monitor your peak expiratory flow (PEF) readings to assess the effectiveness of your treatment. PEF readings ranging from 51% to 79% of your personal best indicate the need for quick-acting (rescue) medications.
4. Oxygen therapy: In severe cases or if oxygen levels are low, oxygen therapy may be administered to help increase oxygen levels in the blood.
5. Emergency medical attention: In cases of a severe asthma attack, particularly if symptoms do not improve with home treatment, seek emergency medical care. Remember to work closely with your doctor to adjust and refine your treatment plan as needed. Regularly review your asthma control and make adjustments to your medications and management strategies to ensure optimal management of your asthma.

Preparing for medical consultation

To prepare for an appointment for an asthma attack, you should:

1. Review your asthma action plan: Take your asthma action plan with you and discuss it with your doctor, ensuring that it includes information on how to treat an asthma attack.
2. Bring your peak flow meter results and medications: Bring your peak flow meter results and all of your asthma medications to the appointment, including your inhalers, so your doctor can evaluate their effectiveness.
3. Discuss your symptoms: Be prepared to discuss your asthma symptoms and how severe they are, including when they occur and which triggers worsen your symptoms.
4. Demonstrate inhaler use: Be prepared to demonstrate the correct use of your metered-dose inhaler to your doctor, as improper use can reduce its effectiveness.
5. Prepare a list of questions: Write down any questions you have for your doctor, such as how to better manage your asthma, what to do during an asthma attack, or if any lifestyle changes are recommended.
6. Note any recent stressors: Share any major stresses or recent life changes that may have impacted your asthma, as these can affect its severity. By being well-prepared for your appointment, you can ensure that you get the most out of your visit and receive appropriate guidance and treatment for your asthma attack.