How to control acute asthma attacks?
Acute asthma is defined as an acute exacerbation of wheezing, unresponsive to usually effective therapy and necessitating care in an emergency room or hospital ward. An acute asthma attack is characterised by airways narrowing and inflammation, hyperinflation, impairment of pulmonary function, alterations in alveolar ventilation and hypoxaemia. In acute asthma, symptoms often start out similar to a usual attack; coughing, wheezing, shortness of breath and recession (drawing in the flesh between the ribs and sternum). In an acute attack, however, the symptoms persist, and become more marked
or even change in nature. An asthma attack can be frightening, both to the person experiencing it and to others around. Even when relatively mild, the symptoms provoke anxiety and alarm. A severe asthma attack is a life-threatening emergency that requires immediate, skilled, professional care. If not treated adequately and quickly, a severe asthma attack can cause death.
An initial assessment of the response of the patient to properly administered B-2 agonists is essential in the planning of further treatment. Patients are classified as responders or non-responders. For patients able to use a peak expiratory flow meter an improvement of the peak expiratory flow rate (PEFR) to more than 80% of predicted values for the patient's height (or the patient's best previously recorded PEFR), is considered a satisfactory response. In patients unable to use a peak expiratory flow meter, the respiratory rate is regarded as the single most important measurement. A respiratory rate above 40/min is indicative of respiratory distress. In addition the presence of rib or sternal retractions, impaired speech or difficulties with feeding (in infants) also indicates an inadequate response to therapy. Patients who have not responded to two properly administered B-2 agonsits at home require further management in an emergency room. Patients who have responded to B-2 agonists should maintain their response for 1 hour before being classified as responders.
An acute attack may require hospitalization. Laboratory tests, an electrocardiogram (ECG), and a chest x-ray are performed to determine lung function, oxygen levels, and other indications of severity or rule out other causes. Because people with severe asthma commonly have low blood oxygen levels, a doctor may check the level of oxygen either by using a sensing monitor on a finger or ear or by taking a sample of blood from an artery. Supplemental oxygen may be given during attacks. However, in severe attacks, a doctor also needs to monitor carbon dioxide levels, and this test requires a sample of blood from an artery. A doctor may also check pulmonary function, usually with a spirometer or a peak flow meter. Usually, a chest x-ray is needed only in severe asthma attacks. People experiencing very severe asthma attacks may need to have an artificial airway passed through their mouth and throat (intubation) and be placed on a mechanical ventilator (see Respiratory Failure: Mechanical Ventilation).
People who have asthma are generally able to treat most attacks without assistance from a health care professional. Typically, they use an inhaler to deliver a dose of a short-acting beta-adrenergic agonist, move into fresh air (away from cigarette smoke or other irritants), and sit down and rest. A corticosteroid (commonly called a steroid) is usually given if the patient does not respond to beta2-agonist treatments. They may be given intravenously or orally. Unfortunately, according to one study, almost one in four adolescents who are hospitalized due to uncontrollable asthma do not respond to steroid treatment. Of some promise are reports intravenous immunoglobulin may be effective in such patients. An attack usually subsides in 5 to 10 minutes. An attack that does not subside in 15 minutes or that gets worse is likely to require additional treatment supervised by a doctor. Intravenous fluids may be needed if the person is dehydrated. Antibiotics also may be needed if a doctor suspects a lung infection; however, most such infections are due to viruses for which (with a few exceptions) no treatment exists. Antibiotics may be given if sinusitis, pneumonia, or bronchitis is suspected or present.
More information on asthma
What is asthma? - Asthma is a chronic inflammatory respiratory disease characterized by periodic attacks of wheezing, shortness of breath, and a tight feeling in the chest.
What types of asthma are there? - Types of asthma include child-onset asthma, adult-onset asthma, exercise-induced asthma, cough-variant asthma, occupational asthma, nocturnal asthma.
What's bronchial asthma? - Bronchial asthma is a disease of the lungs in which an obstructive ventilation disturbance of the respiratory passages evokes a feeling of shortness of breath.
What is exercise-induced asthma? - Exercise-induced asthma is a form of asthma that some people have during or after physical activity. Exercise-induced asthma is common.
What is adult-onset asthma? - Adult onset asthma generally is the onset of asthma for the first time in someone of middle age or older. Adult-onset asthma develops after age 20.
What is status asthmaticus? - Status asthmaticus is a severe asthma episode that does not respond to standard treatment. Status asthmaticus is caused by severe bronchospasm.
What causes asthma? - Asthma is caused by inhaling an allergen that sets off the chain of biochemical and tissue changes leading to airway inflammation, bronchoconstriction, and wheezing.
What're the asthma triggers? - Many risk factors have been linked to triggering asthma attacks. There are two basic types of asthma triggers, allergic triggers, non-allergic triggers.
Asthma and allergy - Asthma attacks (worsening of asthma symptoms) can be triggered by allergies. Allergy is the leading cause of asthma.
What is an asthma attack? - An asthma attack occurs when the small and medium-sized airways become inflamed and constricted after being exposed to a trigger.
Asthma in children - Asthma is the most common chronic condition of childhood. Asthma symptoms can interfere with many school activities for children.
Asthma and pregnancy - During pregnancy, asthma or asthma episodes will become worse for an estimated one-third of pregnant women, particularly women who have severe asthma.
Asthma in adults and older people - Identifying asthma in the elderly can be difficult because asthma symptoms can be confused with symptoms of heart or lung diseases.
What're the complications of asthma? - Uncontrolled asthma in pregnant women puts them at higher risk for complications that can include early labor, hypertension, gestational diabetes.
What are the symptoms of asthma? - The symptoms of asthma include labored breathing, constriction of the chest, coughing and gasping usually brought on by allergies.
What're the warning signs of asthma? - Most people with asthma have warning signs before symptoms appear. There are many warning signs of an asthma episode.
How is asthma diagnosed? - The diagnosis of asthma is made on the basis of typical symptoms and signs. Positive allergy tests support a diagnosis of asthma.
What're the treatments for asthma? - Treatment of asthma is aimed at avoiding known allergens and respiratory irritants and controlling symptoms and airway inflammation through medication.
What quick relief (rescue) medications cure asthma? - Short-acting beta-agonists are the most commonly used asthma rescue medications. Anticholinergics are another class of asthma drugs.
Long-term asthma control medications - Combinations of steroids and other medications are effective for both treating and preventing asthma attacks in patients with moderate to severe asthma.
What're asthma inhalers? - Most asthma drugs are inhaled using special devices or nebulizers. Two common types include dry powder asthma inhalers and metered-dose asthma inhalers.
What're asthma nebulizers? - Asthma nebulizers can be used with all classes of inhaled medications but are most commonly used with short-acting beta2 agonists and ipratropium bromide.
How to control acute asthma attacks? - Acute asthma is an acute exacerbation of wheezing, unresponsive to usually effective therapy and necessitating care in an emergency room or hospital ward.
How to manage chronic asthma symptoms? - The aims of management are to recognize asthma, to abolish symptoms, to restore normal or best possible long term airway function.
What asthma relievers are available? - Asthma reliever is a drug that provides relief from asthma symptoms and is the most commonly used asthma medication.
What asthma preventers are available? - Asthma preventers are to be used twice a day regardless of whether your child has symptoms of asthma.
What's the treatment for childhood asthma? - The goals of asthma therapy are to prevent child from having chronic and troublesome symptoms, to maintain child's lung function.
What's the treatment for asthma in the elderly? - Diagnosis and treatment of asthma can be more complicated in people age 65 and older than in those who are younger.
What can be done to prevent asthma? - Avoiding known allergens and respiratory irritants can reduce asthma symptoms. People with asthma should minimize risk for respiratory tract infections.