What to Do If You're Having An Asthma Attack

asthma attack
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An asthma attack is a sudden worsening of your asthma symptoms caused by a narrowing of your airways, or bronchoconstriction, as a result of inflammation, swelling, and mucus. You and your loved ones need to:

Fatal Asthma Attack Risk

Only one-third of asthma deaths occur in the hospital.

This means that many asthma patients are either not recognizing the symptoms that indicate they should be seeking emergency care, not seeking care, or are not being hospitalized with their worsening asthma.

An Asthma Care Plan

For anyone who has asthma, an asthma care plan is essential to prevent the worsening of your symptoms and a full on asthma attack. The asthma care plan is your guide to determining how well your asthma is controlled. It identifies what actions need to be taken when asthma worsens or when you develop distinct symptoms of an asthma attack.

With your input, your doctor will develop your asthma care plan. Most plans have three components:

  1. Stage of severity, identified by the peak expiratory flow rate
  2. A list of symptoms to watch for
  3. Specific actions to take based on peak flow or symptoms

Make sure you understand the plan and do not be afraid to ask questions. Also, make sure any caregivers and schools understand the asthma care plan as well.

Avoid Triggers

Indoor and outdoor triggers are among the most common that you need to avoid to prevent worsening asthma. People spend as much as 90 percent of life indoors and should be on the look out for the following:

  • Dust mites are small indoor insects that cannot be seen with the naked eye. It's important to know what increases your dust mite exposure.
  • Mold thrives in interiors on wet, damp, or humid surfaces like bathrooms, kitchens, and basements. If mold is a problem in your home, controlling moisture may lead to better control of your asthma.
  • Body parts, urine, and droppings of cockroaches and other pests contain specific proteins that can trigger allergy symptoms.
  • Environmental tobacco smoke contains cancer-causing chemicals such as benzene, vinyl chloride, and arsenic that may irritate the lungs airways and lead to asthma symptoms. 

Identifying these indoor allergens that affect your asthma can lead to significant improvements. Either avoid them altogether or develop a plan to deal with the trigger.

Know Your Symptoms

Everyone with asthma is different. Some people will have frequent attacks while others may go a long period between attacks. You need to monitor your asthma symptoms, like chest tightness, wheezing, shortness of breath, and chronic cough. The action plan that you and your healthcare provider develop should focus on how to treat such symptoms.

Know Your Peak Flow

A peak flow meter is the key to determining how your asthma is doing and preventing an asthma attack. It tells you how well you are breathing and its use is a key part of the asthma care plan.

If peak flow numbers are declining, your asthma is getting worse and you need to act quickly to prevent an attack. You need to take medications based on the instructions in your asthma care plan to stop the symptoms from getting more severe and turning into a full blown attack.

Know Your Medications

Understanding the purpose of each medication in your treatment of asthma is very important. Some medications are designed for the acute relief of asthma symptoms and an asthma attack while others are used for the long-term control of asthma.

Taking a long-term beta agonist control medication during an acute asthma attack can actually lead to the worsening of asthma.

Your asthma care plan should outline which specific medications to take depending on peak flow and other symptoms.

Early Warning Signs

As the parent of a child with asthma or someone with asthma, it is very important that you recognize and treat the early warning signs of an asthma attack. Appropriate management early on in an asthma attack may prevent a trip to the emergency room, an admission to the hospital, or worse. Generally, early warning signs of worsening asthma and an asthma attack include:

  • A drop in peak expiratory flow rate
  • Increased cough
  • Wheezing
  • Chest tightness
  • Some difficulty performing normal daily activities
  • Individual factors noticed over time that indicate worsening asthma or an asthma attack

You will likely be in the "yellow zone" of the asthma care plan when developing these symptoms. Based on your asthma care plan, follow the instructions about taking extra doses of quick-relief medications and initiating other treatments like a course of oral corticosteroids. The asthma care plan will have instructions regarding how to proceed and when to call your doctor.

Most of the time when symptoms are identified and treated early, you will notice a prompt improvement in both peak flow and symptoms. However, you need to be prepared if your symptoms don’t improve. Make sure you discuss your asthma care plan with your health care provider. If you or your child is frequently needing to step up asthma treatment because of symptoms or worsening peak flows, or frequent asthma attacks, this is a sign of poor control and adjustments to the plan may be needed.

Indications for Emergency Care

One of the most important skills as a patient or parent of a child with asthma is to know when you need to call your doctor or just head straight to the emergency room. All of the following symptoms are indications that you or your child need to seek a healthcare provider for emergency care immediately:

  • Wheezing that occurs while breathing both in and out
  • Coughing that has become continuous
  • Difficulty breathing
  • Tachypnea or breathing very fast
  • Retractions where your skin is pulled in as you breath
  • Shortness of breath
  • Difficulty talking in complete sentences
  • Becoming pale
  • Becoming anxious
  • Blue lips or fingernails called cyanosis

If you or your child has any of these symptoms, they are in the "red zone" of the asthma care plan and should begin following those instructions immediately, which should also include seeing a healthcare provider. Make sure that you keep your emergency numbers and details of who to contact in an emergency situation in an easily identifiable place, like the refrigerator or a bulletin board near your phone. It is also a good idea to carry this information with you. 

When you or your child's asthma is under control, you should be free of asthma symptoms and able to do most of your normal activities. Prompt identification and action of an asthma attack and worsening asthma symptoms will prevent complications and frequent visits to the emergency department.

Sources:

National Heart, Lung, and Blood Institute. Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma

Asthma. In Chest Medicine: Essentials Of Pulmonary And Critical Care Medicine. Editors: Ronald B. George, Richard W. Light, Richard A. Matthay, Michael A. Matthay. 5th edition.

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