What to do during an emergency asthma attack ? : Part-2


This article explains alertness one needs to display when suffering from an emergency asthma attack of severe intensity which needs medical support and treatment. Early signs, symptoms and proper diagnosis can save life and prevent respiratory failure.

Introduction

An asthma attack is also known as an asthma exacerbation. It is a condition in which bronchial tube becomes narrow and this is caused when airways become inflamed and swollen. Muscles surrounding airways contract. Also, airways produce more amount of mucus. All these will result in an asthma attack which can either be minor or major. If it is minor i.e., less severe then an emergency treatment action plan prescribed to patient itself will be enough to relieve the attack. If symptoms are worst i.e., if asthma attack is of severe intensity then in an absence of emergency medical treatment can take the form of a life-threatening situation.

Risk factors

All asthmatic individuals throughout lifetime at one point or another are at high risk of suffering from an emergency asthma attack. However, severity of that attack may vary.

Following are the factors which increases the risk of asthma attack-

  • If patient has already suffered from serious asthma attack in the past which required intensive medical treatment and intubation then he is at high risk of suffering from it again.
  • If patient is using too much of quick-acting inhalation to control asthma.
  • If asthma attacks are becoming very frequent and occur all of a sudden i.e., when patient even before starts noticing that his symptoms have become worst, asthma attack sneaks up on him from nowhere.
  • If patient is suffering from other chronic diseases and disorders too like lung diseases, heart related diseases, sinusitis, nasal polyps etc.he is at high risk of suffering from emergency asthma attack.


Diagnosis

In asthma emergencies, lung function tests are carried out to determine severity of an asthma attack. Based on that severity, treatment is carried out.

Following are the lung function tests which are carried out-

  • Peak flow- This test will determine how quickly a patient can breathe out. Results obtained are called as expiratory flow. Patient is asked to blow inside a mouth piece hard and fast.
  • Pulse oximetry- This test is done to determine oxygen level present in blood and is done through patient's fingernail which takes few seconds.
  • Spirometry- Patient is asked to forcefully exhale inside a hose after deep inhalation. Hose is attached to spirometer. This test helps to determine volume of air exhaled out in one second. Results so determined are known as forced expiratory volume. It also determines lung capacity for holding air and rate of inhalation and exhalation.
  • Measurement of nitric oxide-This test measures amount of nitric oxide present in air which is exhaled out. High amount means more inflamed airways have become. Patient is asked to blow into an analyzer or into a nitric-oxide-impervious container.


Signs and severity of an asthma attack

  • Mild or moderate asthma attack -
    Patient experiences some difficulty in breathing but is able to carry out other functions like walking, talking etc. Wheezing sound is heard and there is complain of cough. Quick acting inhalers can bring relief.
  • Severe asthma attack -
    In severe asthma attacks, patient experiences obvious difficulty in breathing. Complains of cough and wheezing sound. Skin between ribs get tugged in. Unable to speak full sentences in one breath. Quick acting reliever inhalers are not able to last long.
  • Fatal asthma attack -
    Patient gasps for breath and skin turns blue. He no longer wheezes or displays cough. He looks exhausted and collapses. In every breath, he can barely speak 1-2 words. Reliever drugs show no effect.


Early signs of an asthma attack

Just before an asthma attack occurs or at the onset of its phase, it displays certain signs which can be considered as warning signs or an alarming phase. To avoid severity, one should start precautionary measures in this phase itself. These signs are the earliest signs which state that asthma is not getting any better but in fact becoming more worse. These signs occur before symptoms of asthma. If they are recognized then one can stop an asthma attack or at least reduce its severity.

Following are the early signs of an asthma attack -

  • Cough increases especially experienced at night time
  • Breathing becomes short
  • Mood swings, feeling upset and marked tiredness
  • Patient displays signs of allergies like running nose, cough, congestion, headache, sore throat, frequent sneezing etc
  • Interfered sleep
  • Coughing both during and after exercise and other physical activities
  • Peak flow meter readings become low
  • Lung function decreases on a peak flow meter


Symptoms of an emergency asthma attack which need medical support

Certain symptoms during an asthma attack are the indications that patient requires an urgent medical help. Either patient or the person nearest to him without any delay should call for medical help as soon as possible.

Following are the symptoms which should never be taken lightly -

  • Cough, difficulty in breathing, tightness experienced in chest and other asthma related symptoms getting worst with time
  • Breathlessness experienced isn't allowing person to sleep, eat or even speak
  • Difficulty in catching breath as it is getting faster, even when patient is immobile. Breath becomes rapid and shallow
  • Experiencing high anxiety
  • Rescue inhalers not working at all
  • Lips and fingernails turning blue in color. Also known as cyanosis
  • Loss of consciousness
  • Confusion and exhaustion experienced
  • Skin around ribs appears to be sucked in and out
  • Sound of wheezing can be heard clearly when breathing both in and out. If wheezing stops but other symptoms still persist then there is an urgent need of medical support
  • Hunching over
  • Feeling of distressed
  • Not able to speak more than one or two words per breath
  • Skin shows pale color


Emergency medical treatment

In hospitals, doctors try to control asthma attack by making use of following medications and treatment procedures-
  • Short-acting beta agonists -
    These medicines are also present in quick-acting inhalers but in hospitals will be administered deep inside the lungs with the help of nebulizer. It is a machine which administers drug inside the lungs in the form of mist.
  • Corticosteroids and aminophylline -
    To control asthma attack, corticosteroids are given orally. If symptoms worsen then intravenous administration is done. Usually intravenous route is preferred to control asthmatic attack in case of individuals suffering from respiratory system failure and in case of those who are vomiting frequently. On the other hand, aminophylline is administered intravenously.
  • Magnesium sulphate -
    This drug is administered intravenously in case of fatal asthma attacks and in case of those individuals in whom other drugs in high doses have not shown any improvement in symptoms.
  • Intubation, oxygen supply and ventilation -
    Oxygen supply using a machine is preferred in case of an emergency asthma attack. This will facilitate easy breathing as oxygen gets pumped into the lungs. Meanwhile doctor will continue administering drugs intravenously to control the attack. In severe attacks, a tube will be put down in the throat of the patient inside the upper airway. This is for breathing purpose and done in case of life-threatening emergency asthma attack.


Even after asthma symptoms improve, patient is kept under medical supervision in an emergency room for some time to reduce the risk of another attack. If conditions are preferable then patient is discharged and is asked to follow a proper treatment plan in case another attack arises. However, if symptoms of asthma do not improve even after medical emergency care then patient is hospitalized. An oxygen mask is given to the patient and drugs are administered every few hours. If condition is quite intensely severe then patient is shifted to intensive care unit. Hospitalization usually lasts from 3 to 5 days. Drugs like corticosteroids, bronchodilators, nebulized albuterol etc are administered. Patient may need to stay a little longer in ICU until he shows improvement in asthma episodes. In case of respiratory failure, patient is admitted to ICU where he is kept under monitoring and respiratory support is provided.

Complications

Asthma attack can be serious if medical help is not given early. If an individual is not able to control his attack through prescribed treatment plan then he should call his doctor or an ambulance as soon as possible. Any delay can lead to death. If patient reaches emergency room early enough during emergency asthma attack then his life can be saved. If any delay is made and respiratory failure occurs then patient cannot be saved. In such cases, patient ceases breathing before he even arrives in the hospital. Less amount of oxygen supply and pneumothorax cause severe irreversible damage to his respiratory organs. Sudden and severe asthma attacks prevents an asthmatic patient to smoothly carry out his daily activities like sleeping, working, exercise, walking, interacting etc. It causes a very strong impact on quality of life of patient as well as lives on those around him. A very severe sudden asthma attack can be both expensive as well as stressful.

Conclusion

Asthma attacks most of the times are of mild or moderate severity and thus can be controlled by a patient itself if he properly follows treatment plan prescribed by doctor. Know more about the care and treatment procedures to be adopted during and after an asthma attack by going through What to do during an emergency asthma attack: Part-1. When it is severe in intensity, it needs urgent medical attention. Hospitalization and close monitoring is needed to keep patient stable and lower the asthmatic symptoms. If medical attention and care is not provided then patient may develop complications like respiratory failure and further delay can be life-threatening. Thus, it is important to never become careless towards asthmatic symptoms and get them diagnosed as soon as possible. It is very important to identify early signs of an asthma attack so that medical emergency can be prevented.


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