Treat Asthma Attacks

Asthma is caused by an inflammation and obstruction of the bronchial tubes, the tubes that help the lung inhale and exhale air. In 2009 the American Academy of Asthma, Allergy and Immunology stated that one in every 12 people in the United States had a diagnosis of asthma, compared to one in 14 in 2001.[1] During an asthma attack, the muscles around the bronchial tubes tighten and swell, which narrows the air passages and thus makes it difficult for the person to breathe. Common triggers of asthma attacks include exposure to an allergen (like grass, tress, pollen, etc.), irritants in the air (such as smoke or strong smells), illnesses (like the flu), stress, extreme weather conditions (such as extreme heat), or physical exertion and exercise.[2] Learning to recognize when you or someone else is having an asthma attack and knowing what to do can help save a life.

Steps

Evaluating the Situation

  1. Recognize early symptoms of an asthma attack. People with chronic asthma may wheeze occasionally and require the use of their asthma medication to control symptoms. An attack is different in that it results in more severe symptoms which last longer and require immediate attention. Early symptoms that an attack may be imminent include: [3]
    • Itchy neck
    • Feeling irritable or short-tempered
    • Feeling nervous or edgy
    • Fatigue
    • Dark circles under the eyes
  2. Recognize the onset of an asthma attack. An asthma attack can deteriorate into a life-threatening situation that requires immediate medical attention. Know how to identify an asthma attack so that you can begin treatment as soon as possible. Although signs and symptoms of an asthma attack vary depending on the person, the most common symptoms include:[4]
    • Wheezing or whistling while breathing. Most often the wheezing is heard when a person is breathing out (exhaling) but can sometimes also be heard when they are breathing in (inhaling).[2]
    • Coughing. Some sufferers may cough in an attempt to clear the airway and get more oxygen into their lungs. This may be especially aggravated at night.[2]
    • Shortness of breath. People suffering from asthma attacks will complain of being short of breath. They may be breathing in short shallow breaths that appear to be faster than normal.[4]
    • Chest tightness. Attacks are often accompanied by a feeling that chest feels tight or that there is pain on the left or right side.[4]
    • Low peak expiratory flow (PEF) readings. If the person uses a peak flow meter, a small device that measures the maximum speed of expiration in order to monitor a person's ability to exhale air, and the measurements range from 50% to 79% of your personal best, this is indicative of an asthma flare-up.
  3. Know the symptoms of asthma in a child. Children will often have the same symptoms as adults with asthma, such as wheezing or whistling when breathing, shortness of breath, and chest tightness or pain.
    • Fast breathing is common in an asthma attack in children.
    • Children may show 'retractions' where you can see their neck pulling, belly breathing, or their ribs when they breathe.
    • In some children a chronic cough can be the only symptom of an asthma attack.[5]
    • In other cases, symptoms of asthma in children are limited to coughing that is made worse with viral infections or when they are sleeping.[2]
  4. Evaluate the specific situation. Assess what is happening to determine if emergency medical attention is needed and what treatment should be done at the scene. Individuals who are having mild symptoms may be able to use their medication which should work immediately. Those individuals in greater distress should be seen by emergency medical personnel. In the case of a severe asthma attack, call or have someone nearby call emergency medical services before proceeding to treat the attack. Know how to distinguish which situation you have on your hands:[4]
    • People with asthma who need their medication but may not require immediate medical attention will:
      • be wheezing slightly but not appear in distress
      • may be coughing to clear their airway and get more air
      • have some shortness of breath but able to talk and walk
      • do not appear to be anxious or in distress
      • will be able to tell you they have asthma and where their medication is located
    • People who are in significant distress and will require immediate medical attention:
      • may appear pale or even have a bluish color to their lips or fingers
      • have the same symptoms as above but intensified and more severe
      • strain their chest muscles to breathe
      • experience severe shortness of breath, which results in short panting breaths
      • wheeze audibly with inspiration or expiration
      • have increased anxiety about the situation
      • possibly be confused or less responsive than normal
      • have trouble walking or talking because of shortness of breath
      • demonstrate persistent symptoms

Treating Your Own Asthma Attack

  1. Have an action plan in place. Once you are diagnosed with asthma, create an asthma action plan with your allergist or physician. This plan is basically a step-by-step process of what to do when you face an acute attack. The plan should be written down and include emergency phone numbers as well as those of family and friends who can meet you at the hospital if needed.[4]
    • When you get the diagnosis, consult with your doctor to identify your particular symptoms of worsening asthma and what you should do when they flare up (e.g. take medication, go to the emergency room, etc).[4]
    • Make sure you know how to use your rescue inhalers.
    • Write this plan down and keep it with you at all times.
  2. Avoid your asthma attack triggers. In general, note that prevention of symptoms is the best way to manage and treat asthma. If you know what situations trigger your asthma attacks (such as being around furry animals or extremely hot or cold weather), then try to avoid these when possible.[6]
  3. Get the inhaler prescribed by your physician. There are two different type of rescue medications that you may have been prescribed your doctor, a Metered Dose Inhaler (MDI) or a Dry Powder Inhaler (DPI).
    • MDIs the are most common inhalers. They deliver asthma medication through a small aerosol canister equipped with a chemical propellant that pushes the medication into the lungs. An MDI can be used alone or with a breathing chamber ("spacer") that separates your mouth from the inhaler, and which can allow you to breathe normally to receive the medication and help the medication get into the lungs more efficiently.
    • A DPI inhaler means of delivering dry powder asthma rescue medication without propellant. Brand names of DPI medications include Flovent, Serevent, or Advair. A DPI requires you to breathe in quickly and deeply, which makes them difficult to use during an asthma attack. This makes them less popular than the standard MDIs.[7]
    • Whichever you have been prescribed, make sure you are always carrying it with you.
  4. Use a MDI. Note that when suffering an asthma attack, you only want to use an MDI filled with the rescue medication, bronchodilators (such as albuterol) , and not corticosteroids or long-acting beta-2 agonist bronchodilators. Shake the inhaler for five seconds to mix the medication in the canister. [8]
    • Before using the inhaler, push out as much air in the lungs as you can.
    • Lift your chin and seal your lips around the air chamber or the end of the inhaler.
    • Using an air chamber, you would breathe normally and slowly to get the medication. Using the inhaler, start to breathe in and press the inhaler once.
    • Keep breathing in until you can’t get in any more air.
    • Hold your breath for 10 seconds and repeat at least one time, but often more, allowing at least one minute between uses. Always follow the instructions on your asthma plan.
  5. Use a DPI. DPIs vary consistently from manufacturer to manufacturer, so care should be taken in reading the instructions before using.
    • Breathe out as much air as possible.
    • Seal your lips around the DPI and breathe in strongly until your lungs are full.
    • Hold your breath for 10 seconds.
    • Remove the DPI from your mouth and exhale slowly.
    • If more than one dose is prescribed, repeat after one minute has passed.
  6. Recognize an asthma emergency. If your asthma symptoms worsen even after taking your medication, you may need to get emergency medical assistance. If you can call emergency services, you should do so. However, if your breathing is too labored and you cannot speak clearly, you may need someone to call for you, such as a friend or family member nearby or a passersby.[4]
    • A good action plan will include the local number for emergency services. In addition, your doctor will have helped you identify when your symptoms are becoming more severe and when you are entering an emergency situation so that you'll know when to get help. Call your local emergency number if your attack is not significantly relieved by your rescue inhaler in several minutes.
  7. Rest while awaiting emergency personnel. Sit and rest while emergency personnel are coming to your aid. Some asthmatics find sitting in the "tripod" position—leaning forward with their hands on their knees—to be helpful because it can relieve pressure on the diaphragm.
    • Try to stay calm. Becoming anxious can increase your symptoms.
    • Ask someone in the vicinity to sit with you to help you stay calm until emergency help arrives.

Helping Someone Else

  1. Help the individual find a comfortable position. Most people with asthma will be more comfortable sitting and not standing or lying down. Keep the person upright to assist with lung expansion and ease of breathing. Let the person lean slightly forward onto you or a chair for support. Some asthmatics may sit in a "tripod" position by leaning forward with their hands on their knees to relieve pressure on their diaphragm.
    • Asthma is exacerbated by anxiety but it is not triggered by anxiety. This means that during an attack the individual will respond more rapidly when he is calm. Anxiety releases cortisol in the body which constricts the bronchioles, the passages by which air passes through the nose and/or mouth to the air sacs of the lungs.[9]
    • It's important that you stay calm and reassuring as this can assist the person in maintaining calm.
  2. Calmly ask "Do you have asthma?" Even if the person cannot verbally answer due to wheezing or coughing, he may nod or gesture towards his inhaler or an instruction card.
    • Ask the person if he has a written asthma emergency action plan. Many individuals who are prepared for asthma attacks will carry a written emergency plan with them. If the person has one, take it out and help him follow the plan.[9]
  3. Remove all known triggers in the immediate area. Asthma is often exacerbated by specific triggers or allergens. Ask the individual if something in the immediate area might be triggering an attack and if the person communicates a response, try to remove the trigger or remove the person from the trigger if it is environmental (like pollen or weather-related).[10]
    • Animals
    • Smoke
    • Pollen
    • High humidity or cold weather
  4. Inform the person that you are looking for his inhaler. Do this to keep the person calm and reassure him that you are working with him, not against him.
    • Women may keep their inhaler in their handbags and men in a pocket.
    • Some asthmatics, especially children or the elderly, may have a clear plastic tube called a spacer that attaches to the inhaler. A spacer delivers the medicine into the mouth with less force, making it easier to inhale.
    • Children and elderly people who suffer frequent asthma attacks may also carry nebulizers, which deliver asthma medication through a mouthpiece or mask. They are easy to use, because the patient breathes normally and are thus ideal for the young and old, but are somewhat bulkier than the MDIs and require electricity to work.
    • If the person does not have an inhaler, call emergency medical services, especially if the asthmatic is young or elderly. People suffering from asthma attacks without inhalers are serious risk of asphyxiating.
  5. Prepare the person to receive medication from the inhaler. If the person has his head resting downward, temporarily lift his upper body back.
    • If there is a spacer for the MDI, attach it to the inhaler after shaking. Remove the cap from the mouthpiece.
    • Help the person tilt his head back if necessary.
    • Have the asthmatic exhale as much as possible before using the inhaler.
    • Allow the person to administer his own medication. Inhaler dosages must be appropriately timed, so allow the asthmatic control of this process. Help the person support the inhaler or spacer against his lips if necessary.
    • Most asthmatics will pause for a minute or two between puffs.
  6. Call emergency services. Monitor the asthmatic until paramedics arrive.
    • Even if the asthmatic seems to get better after using their inhaler, it is best if a paramedic or healthcare professional can assess the person. If the person does not want to go to the hospital, he can make that decision after being informed of his health status.
    • Continue to help the person with their inhaler if necessary; even if the asthma attack does not decrease in severity the medication will help keep it from worsening by relaxing the airways.

Treat An Asthma Attack Without An Inhaler

  1. Call emergency services. If you or another person do not have an inhaler, it is important to call your local emergency phone number. There are also other steps you can take while awaiting emergency services. However, you should always ask emergency services what they advise while you're on the phone with them.
  2. Run a hot shower. If at home, running a hot shower or bath can transform the bathroom into a good recovery zone due to the steam.[11][12]
  3. Practice breathing exercises. Many people get anxious and panic when they suffer an asthma attack and this can increase breathing. However, panicking usually aggravates the asthma attack because it restricts the amount of oxygen that the lungs get. Try to do slow, conscious breathing. Breathe in through your nose for a count of four and then out for a count of six.[12]
    • Try pursing your lips as you exhale. This can help slow your exhales and keep the airways open for a longer time.
  4. Find a drink with caffeine. Caffeine's chemical structure is similar to common asthma medications, and a small amount of coffee or soda can help relax the airways and reduce respiratory problems.[13][12]
    • The drug in question here is called theophylline, which can help prevent and treat wheezing, shortness of breath and chest tightness.[14] There may not be enough theophylline present in coffee or tea to counteract the asthma attack, but it is one alternative option.
  5. Make use of common household drugs. Certain drugs may help relieve the effects of an asthma attack in the case of emergency, although they should never be taken in lieu of getting emergency assistance.
    • Administer a fast-acting antihistamine (allergy medicine) if you or the asthmatic thinks an allergen has triggered the reaction. This may be the case if you are outside on a day with a high pollen index. Antihistamines include: Allegra, Benadryl, Dimetane, Claritin, Alavert, Tavist, Chlor-Trimeton, and Zyrtec, to name a few. Echinacea, ginger, chamomile, and saffron are all natural antihistamines. If you can find any teas that contain these ingredients, this might help relieve some symptoms, although the effect of antihistamines in general is likely to be minimal. Be careful when using natural herbs or supplements as some people are allergic to the ingredients. [15]
    • Use a over-the-counter pseudoephedrine like .Sudafed. Sudafed is a nasal decongestant, but it could help during an asthma attack when an inhaler is not present because it can help open the bronchioles. It's best to break the pill down with a mortar and pestle and dissolve in warm water or tea before administering to limit the risk of choking. Note as well that while it does work, it can take up to 15 to 30 minutes to be effective. Keep in mind as well that pseudoephedrine can increase the heart rate and blood pressure.[16]



Tips

  • Symptoms of asthma, such as coughing, wheezing, shortness of breath or chest tightness, are reversible with inhaled medications. In some cases, the symptoms reverse on their own.
  • If you have been treating your asthma attack and it is mild, but not getting better, see your doctor to help prevent it from getting worse. He or she may prescribe oral steroids to help stop the attack.
  • Make sure your inhaler and any other medications you take for asthma are not expired or run out. Call your doctor if you need a refill before you run out if possible
  • If you follow your action plan as soon as you start to have symptoms, you can often avoid it becoming a severe attack.

Warnings

  • Asthma can be life-threatening. If yo or the person you are with do not receive relief from an inhaler in several minutes, you or someone nearby should call your local emergency medical number and wait for assistance.
  • If you are ever in doubt about what to do, call emergency services immediately.
  • There are no over-the-counter medications approved to treat asthma. All people diagnosed with asthma should have an emergency plan and carry their inhaler with them at all times.

Related Articles

Sources and Citations

  1. ↑ http://www.aaaai.org/about-the-aaaai/newsroom/asthma-statistics.aspx
  2. ↑ 2.0 2.1 2.2 2.3 http://acaai.org/asthma/symptoms/asthma-attack
  3. ↑ http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000062.htm
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 http://www.mayoclinic.org/diseases-conditions/asthma-attack/basics/symptoms/con-20034148
  5. ↑ http://acaai.org/asthma/symptoms/asthma-attack
  6. ↑ http://acaai.org/asthma/about
  7. ↑ http://www.aaaai.org/conditions-and-treatments/library/at-a-glance/inhaled-asthma-medications.aspx
  8. ↑ Kaiser Permanente, 1994, "Healthwise Handbook", ISBN: 1-877930-06-7
  9. ↑ 9.0 9.1 http://kidshealth.org/teen/your_mind/friends/friend_flareup.html
  10. ↑ http://www.cdc.gov/asthma/triggers.html
  11. ↑ Kaiser Permanente, 1994, "Healthwise Handbook", ISBN: 1-877930-06-7
  12. ↑ 12.0 12.1 12.2 http://bottomlinehealth.com/how-to-survive-an-asthma-attack-without-an-inhaler/
  13. ↑ http://well.blogs.nytimes.com/2010/11/29/asthma-symptoms-try-caffeine/
  14. ↑ http://www.nlm.nih.gov/medlineplus/druginfo/meds/a681006.html
  15. ↑ http://www.asthma.partners.org/NewFiles/BoFAChapter5.html
  16. ↑ http://www.thesurvivaldoctor.com/2012/05/03/asthma-attack-without-inhaler-9/
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