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An asthma attack, also known as an asthma exacerbation, is a sudden worsening of asthma symptoms brought on by tightness of the muscles surrounding the airways. It occurs when the airways swell and inflame. The breathing (bronchial) tubes narrow as a result of the muscles around the airways contracting and producing more mucus.
During an asthma attack episode, the individual may experience symptoms such as coughing, wheezing, and difficulty breathing. Timely at-home care can help alleviate mild asthma attack symptoms. However, if medication and treatment for asthma are not administered promptly, the wheezing and breathing difficulties can intensify. When using a peak flow meter during an asthma attack, the measurement is likely to be lower than the average value. If a severe asthma episode persists despite home care, it can escalate into a life-threatening emergency.
In order to prevent severe attacks and keep asthma under control, it’s critical to recognize and treat even minor symptoms of an asthma attack. Early diagnosis and treatment of an asthma episodes are essential to preventing an asthma attack. Observe the treatment regimen that you developed with your healthcare provider in advance. The treatment strategy should outline what to do if and when the asthma begins to worsen, as well as how to handle an asthma attack that is already occurring.
Symptoms
Individuals have different signs and symptoms of an asthma episode. Signs and symptoms of an asthma attack include:
- Frequent coughing or wheezing, especially during at night
- Chest pain or tightness
- Severe shortness of breath
- Difficulty in speaking
- If utilizing a peak flow meter, low readings for peak expiratory flow (PEF)
- Symptoms that do not improve after using a rescue inhaler.
In order to effectively manage everyday symptoms, the patient’s treatment strategy will require occasional adjustments as asthma can change over time. Failing to maintain good control of their asthma increases the likelihood of experiencing an asthma attack. Persistent lung inflammation can lead to asthma flare-ups occurring unpredictably at any time.
In the event of an asthma flare-up, it is important to adhere to the treatment measures outlined in the written asthma plan provided by the healthcare provider. If the peak expiratory flow (PEF) values improve and symptoms subside, home treatment may be adequate.
Since an asthma attack’s intensity can quickly worsen, it’s crucial to treat these symptoms as soon as they are noticed. The patient may require emergency care if their asthma symptoms do not improve or if they worsen after taking the prescribed medication. A healthcare provider can assist a patient in learning to recognize an asthma emergency so that they will know when to seek medical attention.
Causes
When exposed to specific triggers, an excessively sensitive immune system causes the airways (bronchial tubes) to swell and become inflamed. Asthma triggers vary from person to person. Pollen, mold, dust mites, tobacco smoke, cold or dry air, stress, and even gastroesophageal reflux disease (GERD) are some of the common triggers for asthma attacks.
Respiratory infections, including those brought on by the common cold, often make asthma symptoms worse for many people. Certain things in their workplace can trigger asthma attacks in certain people. An asthma attack may occasionally be without a clear reason.
Risk factors
Anyone with asthma is susceptible to experiencing an asthma attack. However, certain factors can increase the risk of a severe asthma attack. These factors include:
- History of severe asthma attack, or intubated due to an asthma attack.
- Previously been hospitalized or required an ER visit due to asthma.
- Patient uses more than two rescue (quick-acting) inhalers each month.
- Asthma attacks are frequently unnoticed by patients until symptoms have gotten worse.
- Patient has additional ongoing medical issues, such as sinusitis, nasal polyps, cardiovascular disease, or chronic pulmonary disease.
Diagnosis
Lung (pulmonary) function tests are used to assess how effectively the lungs are functioning in adults and children older than 5 years old. A sign that asthma is not effectively controlled is poor lung function. Lung function tests may occasionally be utilized in asthma emergencies to inform the healthcare provider of the severity of an asthma attack or the effectiveness of treatment. Test may include the following:
- Peak flow: When doing a peak flow test, blow into a mouthpiece as forcefully and quickly as you can in one breath (expiration). When a patient arrives for an appointment or needs emergency care due to an asthma attack, the healthcare provider can take a peak flow reading. The patient’s ability to exhale fast is tested throughout this procedure. To keep track of their lung health at home, they could also utilize a peak flow meter.
- Spirometry: During spirometry, it is important for the patient to take deep breaths and exhale forcefully into a hose connected to a device known as a spirometer. One of the common parameters measured during spirometry is the forced expiratory volume (FEV), which quantifies the amount of air a person can exhale in one second.
Spirometry can also assess the lung’s capacity to hold air and the rate of inhalation and exhalation.
- Nitric oxide measurement: The amount of nitric oxide gas in their breath during this examination is measured. Nitric oxide levels that are high point to bronchial tube inflammation.
- Pulse oximetry: The blood’s oxygen content is determined by this test. It takes only a few seconds and is measured through the fingernail.
Treatment
To ensure that airway-expanding medications such as albuterol or levalbuterol reach deep into the lungs, it is typically recommended to take two to six puffs from a quick-acting (rescue) inhaler. For individuals, particularly young children or those who struggle with using inhalers, nebulizers can be used as an alternative. If necessary, the treatment can be repeated after 20 minutes. However, if wheezing or shortness of breath persists despite treatment, it is important to seek immediate medical attention from a healthcare provider.
Use the quick-acting (rescue) drug and get to a healthcare provider’s office right away if the patient is experiencing signs of a severe asthma attack, such as trouble speaking due to shortness of breath.
For a day or two following the attack, the healthcare provider can advise the patient to keep taking quick-acting medication every three to four hours. Additionally, they could require a brief course of oral corticosteroid therapy.
- Emergency treatment: In order to immediately control the asthma if a patient visits the emergency room with an asthma attack already in progress, they will need medication. A few of these are:
- Short-acting beta agonists: Medications like albuterol. These medications are the same ones found in the rescue (quick-acting) inhaler. They might have to make use of a nebulizer, a device that transforms medicine into a mist that can be breathed deep into the lungs.
- Oral corticosteroids: These medicines, when taken as pills, assist decrease lung inflammation and regulate the symptoms of asthma. Corticosteroids can also be administered intravenously; often, patients who are vomiting or are having respiratory failure receive this treatment.
- Ipratropium: Sometimes, when albuterol is not entirely effective, ipratropium is used as a bronchodilator to treat a severe asthma attack.
- Intubation, mechanical ventilation and oxygen: The healthcare provider might insert a breathing tube into the upper airway if the asthma attack is life-threatening. While the healthcare provider administers the meds to treat the asthma, the patient will be assisted in breathing by a device that pumps oxygen into the lungs.
Following the improvement of asthma symptoms, the patient may be required to remain at the emergency room for several hours or more to ensure they don’t have another episode of asthma attack. The patient will be discharged once the healthcare provider determines that their asthma is adequately controlled. In the event of a subsequent attack, the healthcare provider will provide further instructions.
If asthma symptoms do not improve after receiving emergency care, the healthcare provider may admit the patient to the hospital and administer medication at regular intervals, typically every hour or every few hours. In cases of severe asthma symptoms, the patient may need to utilize an oxygen mask for breathing assistance. In certain instances of a severe and ongoing asthma attack, a stay in the intensive care unit (ICU) may be necessary.
