Asthma Attack - What to Do
This is the third in a series of articles about asthma, and gives information about what to do in an attack. If you are interested in reading the other two articles, information will follow at the end of this piece.
Many people die of asthma each year (around 1400 in the UK annually), and many of those deaths could be prevented with better control of asthma symptoms, so that attacks don't occur. Often attacks don't appear out of the blue, there is a lead up to them in the preceding days, so it's important to recognise when symptoms are worsening, and then visit your doctor or asthma nurse.
Signs of Poorly Controlled Asthma
An increase in your symptoms, whether that's a cough, wheeze, tight chest or difficulty breathing.
Needing to use your reliever inhaler more often. More than three times a week means your asthma is not well controlled.
Your reliever inhaler does not relieve your symptoms for as long, or does not work so well.
Your asthma disturbs your sleep, or you have symptoms while exercising.
If you measure your 'peak flow' you may notice that it is lower than usual, or that you have more variation between the morning and evening scores than usual.
One or more of these symptoms would indicate that you should see your asthma nurse or doctor.
So What is an Attack?
Usually, this is where the airways go into spasm, making it very difficult to breathe, and is the result of increased inflammation in the airways. Attacks fall into three categories:
Moderate Asthma Attack
During a moderate attack, a person experiences increased symptoms, they are likely to be wheezy, breathless and tired. If they measure their peak flow this is likely to be 50-75% of their best. They can begin treatment by taking four to six puffs of their reliever, preferably through a 'spacer' and this can be repeated every ten to twenty minutes. But it is important to have an urgent appointment with a doctor.
Severe Asthma Attack
During a severe asthma attack, a person is likely to be too breathless to talk in whole sentences. They will (gasp) talk in (gasp) very (gasp) short bursts. They will look as if they are working very hard at breathing, they may be using muscles in their shoulders and neck to help them get breath. Their breathing rate and pulse will be fast. If they measure their peak flow, it is likely to be 33-50% of their personal best.
This is a medical emergency, call an ambulance, as the person may need oxygen, and higher doses of nebulised reliever medication, plus steroids, BUT, begin treatment with four to six puffs of reliever, through a spacer if possible, and repeat it every ten to twenty minutes.
Life Threatening Asthma
Sadly, severe attacks can progress to life threatening asthma. The person may be becoming irritable as the level of oxygen drops and carbon dioxide rises in their body, they may refuse treatment or refuse to go to hospital. They may look bluish around their lips. Their pulse may become slow and erratic, and their wheezing may stop. they may become exhausted and unconscious. It is doubtful that they could measure their peak flow, but if they could it would be less than 33% of their personal best. It is also unlikely that they would be able to use an inhaler at this stage. This is a serious emergency, and the person may well need ventilation in an intensive care unit. If the person becomes unconscious, you may need to start CPR until help arrives.
It is absolutely vital to prevent attacks from happening if at all possible, which is why it it so important to take preventer medication regularly, morning and night, and not to stop it without consulting with your doctor or asthma nurse. However, if a person has had previous severe attacks requiring hospitalisation, if they have previously been admitted to intensive care with asthma, or if they have been diagnosed with 'brittle asthma' it is vital to seek medical help sooner rather than later when an attack begins.
Brittle asthma is diagnosed when a person has attacks out of the blue when their asthma appears well controlled otherwise, or in a person with wide daily variablility in their peak flow readings.