Asthma attack
During an asthma attack, also called an asthma exacerbation, the airways become swollen and
inflamed. The muscles around the airways contract and the airways produce extra mucus, causing the
breathing (bronchial) tubes to narrow.
During an attack, you may cough, wheeze and have trouble breathing. Symptoms of a minor asthma
attack get better with prompt home treatment. A severe asthma attack that doesn’t improve with home
treatment can become a life-threatening emergency.
The key to stopping an asthma attack is recognizing and treating an asthma flare-up early. Follow
the treatment plan you worked out with your doctor ahead of time. Your treatment plan should
include what to do when your asthma starts getting worse, and how to deal with an asthma attack in
progress.
Symptoms of Asthma attack
Asthma attack signs and symptoms include:
- Severe shortness of breath, chest tightness or pain, and coughing or wheezing
- Low peak expiratory flow (PEF) readings, if you use a peak flow meter
- Symptoms that fail to respond to use of a quick-acting (rescue) inhaler
N.B – Signs and symptoms of an asthma attack vary from person to person. Work with your doctor to
identify your particular signs and symptoms of worsening asthma and what to do when they occur.
If your asthma symptoms don’t improve or get worse after you take medication as your doctor
directed, you may need emergency treatment. Your doctor can help you learn to recognize an asthma
emergency so that you’ll know when to get help.
When to see a doctor
If your asthma flares up, immediately follow the treatment steps you and your doctor worked out in
your written asthma plan. If your symptoms and peak expiratory flow (PEF) readings improve, home
treatment may be all that’s needed. If your symptoms don’t improve with home treatment, you may
need to seek emergency care.
When your asthma symptoms flare up, follow your written asthma plan’s instructions for using your
quick-acting (rescue) inhaler. PEF readings ranging from 51% to 79% of your personal best are a
sign you need to use the quick-acting (rescue) medications prescribed by your doctor.
Causes of Asthma Attack
An overly sensitive immune system makes your airways (bronchial tubes) become inflamed and swollen
when you’re exposed to certain triggers. Asthma triggers vary from person to person. Common asthma
attack triggers include:
- Pollen, pets, mold and dust mites
- Upper respiratory infections
- Tobacco smoke
- Inhaling cold, dry air
- Gastroesophagealreflux disease (GERD)
- Stress
For many people, asthma symptoms get worse with respiratory infections, such as those caused by the
common cold. Some people have asthma flare-ups caused by something in their work environment.
Sometimes, there isn’t an apparent cause for an asthma attack.
Risk factors of Asthma Attack
Anyone who has asthma is at risk of an asthma attack. You may be at increased risk of a serious
asthma attack if :
- You’ve had a severe asthma attack in the past
- You’ve previously been admitted to the hospital or had to go to the emergency room for
asthma - You’ve previously required intubation for an asthma attack
- You use more than two quick-acting (rescue) inhalers a month
- Your asthma attacks tend to sneak up on you before you notice symptoms have worsened
- You have other chronic health conditions, such as sinusitis or nasal polyps, or cardiovascular
or chronic lung disease
Complications of Asthma Attack
Asthma attacks can be serious. They can :
Interrupt everyday activities such as sleep, school, work and exercise, causing a significant
impact on your quality of life and can disrupt the lives of those around you.
Send you to the emergency room, which can be stressful and costly. Lead to respiratory arrest and
death.
Prevention of Asthma Attack
The best way to avoid an asthma attack is to make sure your asthma is well controlled in the first
place. This means following a written asthma plan to track symptoms and adjust your medication.
While you may not be able to eliminate your risk of an asthma attack, you’re less likely to have
one if your current treatment keeps your asthma under control. Take your inhaled medications as
prescribed in your written asthma plan.
These preventive medications treat the airway inflammation that causes asthma signs and symptoms.
Taken on a daily basis, these medications can reduce or eliminate asthma flare-ups and your need to
use a quick-acting inhaler.
See your doctor if you’re following your asthma action plan but still have frequent or bothersome
symptoms or low peak flow readings. These are signs your asthma isn’t well controlled, and you need
to work with your doctor to change your treatment.
If your asthma symptoms flare up when you have a cold or the flu, take steps to avoid an asthma
attack by watching your lung function and symptoms and adjusting your treatment as needed. Be sure
to reduce exposure to your allergy triggers, and wear a face mask when exercising in cold weather.
Diagnosis of Asthma Attack
For adults and children over 5 years old, lung (pulmonary) function tests are used to check how
well the lungs are working. Poor lung function is a sign that your asthma isn’t well controlled. In
some cases, lung function tests are also used in asthma emergencies to help your doctor understand
the severity of an asthma attack or how well treatment is working.
Lung function tests include :
Peak flow
Your doctor may take a peak flow reading when you come in for a scheduled visit or for emergency
treatment during an asthma attack. This test measures how quickly you can breathe out. You may also
use a peak flow meter at home to monitor your lung function.
The results of this test are known as peak expiratory flow (PEF). A peak flow test is done by
blowing into a mouthpiece as hard and as fast as you can with a single breath (expiration).
Spirometry
During spirometry, you take deep breaths and forcefully exhale into a hose connected to a machine
called a spirometer. A common spirometry measurement is forced expiratory volume, which measures
how much air you can breathe out in one second.
The results of this test are known as forced expiratory volume (FEV). Spirometry can also measure
how much air your lungs can hold and the rate at which you can inhale and exhale.
Nitric oxide measurement
This exam measures the amount of nitric oxide gas you have in your breath when you exhale. High
nitric oxide readings indicate inflammation of the bronchial tubes.
Pulse oximetry
This test measures the amount of oxygen in your blood. It’s measured through your fingernail and
only takes seconds.
Treatment of Asthma Attack
If you and your doctor have worked out an asthma plan, follow its directions at the first sign of
an asthma attack.
This generally means taking two to six puffs of a quick-acting (rescue) inhaler to get
airway-expanding medication, such as albuterol (ProAir HFA, Proventil HFA, Ventolin HFA, others)
and levalbuterol (Xopenex), deep into your lungs. Small children and those who have trouble with
inhalers can use a nebulizer. After 20 minutes, you can repeat the treatment one time if necessary.
If you continue to wheeze or feel breathless after treatment, visit your doctor or urgent care that
day.
If you’re having symptoms of a severe asthma attack, such as difficulty speaking because you’re so
short of breath, use your quick-acting (rescue) medication and get to a doctor’s office or urgent
care immediately.
Your doctor may recommend that you continue to use quick-acting medication every three to four
hours for a day or two after the attack. You might also need to take oral corticosteroid medication
for a short time.
Emergency treatment of Asthma Attack
If you go to the emergency room for an asthma attack in progress, you’ll need medications to get
your asthma under immediate control. These can include :
Short-acting beta agonists, such as albuterol
These are the same medications as those in your quick-acting (rescue) inhaler. You may need to use
a machine called a nebulizer, which turns the medication into a mist that can be inhaled deep into
your lungs.
Oral corticosteroids
Taken in pill form, these medications help reduce lung inflammation and get your asthma symptoms
under control. Corticosteroids can also be given intravenously, typically to patients who are
vomiting or who are experiencing respiratory failure.
Ipratropium (Atrovent HFA)
Ipratropium is sometimes used as a bronchodilator to treat a severe asthma attack, especially if
albuterol is not fully effective.
Intubation, mechanical ventilation and oxygen
If your asthma attack is life-threatening, your doctor may put a breathing tube down your throat
into your upper airway. Using a machine that pumps oxygen into your lungs will help you breathe
while your doctor gives you medications to bring your asthma under control.
After your asthma symptoms improve, your doctor may want you to stay in the emergency room for a
few hours or longer to make sure you don’t have another asthma attack. When your doctor feels your
asthma is sufficiently under control, you’ll be able to go home. Your doctor will give you
instructions on what to do if you have another attack.
If your asthma symptoms don’t improve after emergency treatment, your doctor may admit you to the
hospital and give you medications every hour or every few hours. If you’re having severe asthma
symptoms, you may need to breathe oxygen through a mask. In some cases, a severe, persistent asthma
attack requires a stay in the intensive care unit (ICU).
Lifestyle and home remedies for Asthma Attack
All asthma attacks require treatment with a quick-acting (rescue) inhaler such as albuterol. One of
the key steps in preventing an asthma attack is to avoid your triggers.
If your asthma attacks seem to be set off by outside triggers, your doctor can help you learn how
to minimize your exposure to them. Allergy tests can help identify any allergic triggers.
Washing your hands frequently can help reduce your risk of catching a cold virus.
If your asthma flares up when you exercise in the cold, it may help to cover your face with a mask
or scarf until you get warmed up.
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