Signs and Symptoms of Asthma Needing Emergency Care

Do You Know When It's Time To Head To The ED?

Cyanosis
Cyanosis. ADAM

Fatal asthma attacks remain on the rise throughout the world.

While we are not exactly sure why, only 1 in 3 asthma deaths occurs in the hospital. This tells me that one-factor patients are doing poorly with is identifying when they need to seek emergency care.

One of the keys to not needing emergency care is to make sure you have an asthma action plan. The plan gives you treatment instructions based on your peak flow or symptoms and when you need to seek additional help.

The action plan is your road map to optimal asthma control.

The following signs and symptoms are worrisome and should trigger you to seek care immediately.

1. Wheezing While Breathing In & Out

In general when asthmatics begin to experience a worsening of asthma symptoms, wheezing occurs on expiration.

As asthma worsens you may begin to hear wheezing on both inspiration (breathing in) and expiration (breathing out). If you notice this and you are following your action plan it is probably time to head to the doctor’s office or the ER.

However, not hearing any wheezing can be even worse. No wheezing is a sign of very poor air movement. So do not be reassured or assume your difficulty breathing is not asthma if you do not hear wheezing.

2. Difficulty Breathing

Anytime you experience shortness of breath you want to consider calling your doctor or heading to the emergency room. Difficulty breathing is never normal and indicates something is not right.

If you have an asthma action plan, you can follow the instructions based on your peak flows or symptoms. If you have had asthma for a long time than you can let the severity of your symptoms guide what you think you need to do. If symptoms are proportionately worse than what you have experienced in the past, the safest thing to do is to seek care.

It is especially important to seek care if you do not seem to be responding to your rescue inhaler or not responding as you have in the past. Likewise, if you or your doctor are not sure that you have asthma, difficulty breathing should be a trigger for you to seek care.

3. Retraction And Other Signs Of Distress

There are certain physical signs that your asthma is worsening or may not be responding to treatment. Retractions are when your skin gets pulled inward between ribs as you inhale. Nasal flaring is an out flaring of the nostrils when you breathe in. Another sign of distress is the muscles of the neck contracting with each breath in as if the muscles are lifting the ribs up to move air into your lungs. All of these physical findings are indicators that you are working harder to breathe and your body is experiencing trouble getting enough oxygen to all the parts of the body that need it.

You can see video examples of these findings in the links below:

    If these signs worsen or do not significantly improve with treatment then you need to call your doctor or seek care.

    4. Continuous Coughing

    Coughing is a sign of airway inflammation and irritation. Your doctor will use frequency of nighttime coughing to gauge your asthma control. However, coughing that has become continuous is a sign of a severe asthma exacerbation or that your treatment is not working. If you are continually coughing or cough with very little physical activity it is time to seek care.

    5. Breathing Fast

    Breathing fast or tachypnea is another sign of distress. As your asthma control deteriorates you will breathe faster. Your body is attempting to compensate for needing more oxygen by increasing the rate of breathing. The faster you are breathing, the more serious is the problem. Newborns and infants breathe much faster than adults at baseline so talk with your doctor about normal respiratory rates for kids. Breathing fast is one of the first signs that you are experiencing a severe asthma attack.

    6. Not Being Able To Speak In Complete Sentences

    If a phone conversation wears you out or if you are not able to explain to a friend what is going on without getting short of breath, you are having a significant asthma exacerbation. If you are unable to talk comfortably or if this does not improve after using your rescue inhaler, you need to seek medical care.

    7. Becoming Pale Or Blue

    Cyanosis or turning blue is a sign of low oxygen levels. You will commonly see this finding around the lips or in the extremities. Pale extremities can sometimes be due to cold ambient temperature, but blue lips is always a medical emergency.

    8. Severe Anxiety

    As your breathing becomes more labored, you may get very anxious. If your treatments are not working and your anxiety is worsening you need to seek medical care.

    If you experience any of the symptoms mentioned in this article, you need to seek medical care. If you are following your asthma action plan and do not quickly begin to see an improvement in your asthma symptoms you also need to seek care.

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    Sources

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

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