About 300 million people worldwide suffer from asthma and about 250,000 die from the disease each year. There is an increasing trend of asthma incidence and people living in developed countries are affected most. It is a chronic inflammatory disease condition characterized by hyper-responsiveness of small airways in lungs to various allergenic substances present in inhaled air.
Most asthmatics have a genetic predisposition that they are sensitive to various allergens which normal people can tolerate. This hyper sensitivity triggers an overwhelming immune reaction against such allergens upon exposure to leading to widespread spasm, increased mucous secretion and swelling of small airways in lungs. As a result airways get narrower and it becomes more difficult to breath. Usually the expiration becomes more difficult than inspiration. Apart from difficulty in breathing, these changes can give rise to a persistent dry cough and a characteristic sound heard from patient’s chest on expiration called wheeze.
An attack of asthma can be precipitated by:
- Allergens – pollen, house dust mite, dust, smoke, animal fur
- Upper respiratory tract infection –e.g. common cold
- Cold air – winter season
- Cigarette smoke
- Exercise
- Some medications
- Stress
While an attack of asthma can present as persisting dry cough at night or early morning, some wheeze and mild chest tightness; acute severe asthma can be very frightening and life threatening experience for the person. There is severe narrowing of airways leading to difficulty in breathing as well as difficulty in oxygen transfer to lungs. Initially the patient will try to breathe rapidly using all accessory chest muscles to compensate this, but with time this effort will cause fatigue and patient (especially children) may stop breathing, which can prove fatal unless urgently intervened. Asthma attack can occur within minutes of exposure to the allergen or it can be delayed hours depending on the type of immune mechanisms involved.
Signs and symptoms of acute severe asthma
- Difficulty in breathing with prolonged expiration phase.
- High rate of respiration. (>30 cycles/min in adults)
- Characteristic wheeze during expiration.
- Severe cough
- Difficulty in speaking, sleeping and feeding due to cough or rapid breathing.
- Anxiety and distress.
- Patient will be seated or leaning forwards with hands clenching on to some support (e.g. chair) and will breathe with very high effort.
- Features of hypoxia – bluish tinge in lips, tongue and nail beds (cyanosis)
Signs of life threatening asthma
If a patient having above features begins to show those stated below means that he/she is exhausted on effort to breathe and soon may stop breathing altogether.
- Low rate of respiration.
- Silent chest.
- Deep cyanosis
- Patient looks lethargic and exhausted
- Altered level of consciousness
First aid management for Asthma Attack
- Reassure the patient and calm him/her down.
- If the patient shows signs of acute severe or life threatening asthma call for medical help urgently.
- Encourage patient to take slow and deep breaths as much as possible. Take the patient away from a cold environment, loose tight clothing and ensure adequate ventilation.
- Help the patient to sit in a position that they find most comfortable to breathe; leaning forward with arms resting on a table or back of a chair helps most.
- Do not lie the patient down as it increases effort on breathing.
- If the patient has a blue colored reliever inhaler, help him/her to use it. Usually up to 5 consecutive puffs can be taken every 5 – 10 minutes during a severe attack depending on the type of inhaler and the response.
- When taking the inhaler, patient’s lips must cover and seal the mouthpiece of the device and must breathe in as much as possible while releasing the drug. Then the breath should be held as much as possible. If patient has a spacer device (specially children and elderly) connect it to the inhaler for better drug delivery to the lungs.
- A mild to moderate attack of asthma can be managed with inhalers alone.
- Check the patients breathing, pulse rate and level of consciousness regularly.
- If the patient loses consciousness attend to maintenance of airway.
- If patient stops breathing start CPR immediately and continue until medical help arrives.
Prevention of asthma exacerbations
- Keep the house clean, vacuum out dust regularly.
- Avoid carpets in house.
- Avoid pets with fur and feathers
- Use a bed made of synthetic materials.
- Change bed sheets and pillow cases regularly.
- Keep away from dust and smoke as much as possible.
- Use asthma controller medications (if prescribed) regularly.
