Asthma attack

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.