What Is Asthma Attack?

What Is an “Asthma Attack”?
An asthma attack is a sudden worsening of asthma symptoms caused by the tightening of muscles around your airways (bronchospasm). During the asthma attack, the lining of the airways also becomes swollen or inflamed and thicker mucus — more than normal — is produced. All of these factors — bronchospasm, inflammation, and mucus production — cause symptoms of an asthma attack such as difficulty breathing, wheezing, coughing, shortness of breath, and difficulty performing normal daily activities. Other symptoms of an asthma attack include:

Severe wheezing when breathing both in and out
Coughing with asthma that won’t stop
Very rapid breathing
Chest pain or pressure
Tightened neck and chest muscles, called retractions
Difficulty talking
Feelings of anxiety or panic
Pale, sweaty face
Blue lips or fingernails
Or worsening symptoms despite use of your medications
Some people with asthma may go for extended periods without having an asthma attack or other symptoms, interrupted by periodic worsening of their symptoms, due to exposure to asthma triggers or perhaps from overdoing it during exercise-induced asthma.

Mild asthma attacks are generally more common. Usually, the airways open up within a few minutes to a few hours after treatment. Severe asthma attacks are less common but last longer and require immediate medical help. It is important to recognize and treat even mild symptoms of an asthma attack to help you prevent severe episodes and keep asthma under control.

What Happens If an Asthma Attack Goes Untreated?
Without immediate asthma medicine and asthma treatment, your breathing will become more labored, and wheezing may get louder. If you use a peak flow meter during an asthma attack, your personal best reading will probably be reduced.

As your lungs continue to tighten during the asthma attack, you will be unable to use the peak flow meter at all. Gradually, your lungs will tighten so much during the asthma attack that there is not enough air movement to produce wheezing. This is sometimes called the “silent chest,” and it is a dangerous sign. You may need to be taken to a hospital immediately with a severe asthma attack. Unfortunately, some people interpret the disappearance of wheezing during the asthma attack as a sign of improvement and fail to get prompt emergency care.

If you do not receive adequate treatment for an asthma attack, you will eventually be unable to speak and will develop a bluish coloring around your lips. This color change, known as “cyanosis,” means you have less and less oxygen in your blood. Without immediate aggressive treatment in an intensive care unit, you will lose consciousness and eventually die.

How Do I Recognize the Early Signs of An Asthma Attack?
Early warning signs are changes that happen just before or at the very beginning of an asthma attack. These changes start before the well-known symptoms of asthma and are the earliest signs that your asthma is worsening.

How Do I Recognize the Early Signs of An Asthma Attack? continued…
In general, these asthma attack symptoms are not severe enough to stop you from going about your daily activities. But by recognizing these signs, you can stop an asthma attack or prevent one from getting worse.

Early warning signs of an asthma attack include:

Frequent cough, especially at night
Reduced peak flow meter readings
Losing your breath easily or shortness of breath
Feeling very tired or weak when exercising
Wheezing or coughing after exercise or exercise-induced asthma
Feeling tired, easily upset, grouchy or moody
Decreases or changes in lung function as measured on a peak flow meter
Signs of a cold, or allergies (sneezing, runny nose, cough, nasal congestion, sore throat and headache)
Trouble sleeping with nighttime asthma
The severity of an asthma attack can escalate rapidly, so it’s important to treat these symptoms immediately once you recognize them.

What Do I Do If I Have An Asthma Attack?
If you or a loved one is experiencing an asthma attack and the symptoms do not improve after following the asthma action plan, contact your asthma doctor and follow the “Red Zone” or emergency instructions. Immediate medical attention is necessary.

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What Is an Asthma Attack or Flare Up
An asthma attack is a sudden worsening of your asthma symptoms caused by narrowing of your airways or bronchoconstriction as a result of inflammation, swelling, and mucus. Both you and your child need to:

•Understand The Asthma Care Plan
•Know Your Symptoms
•Know Your Peak Flow
•Know Your Medications
•Recognize Early Warning Signs
•Identify Indications For Emergency Care

Understand Your Asthma Care Plan To Prevent An Asthma Attack:
For anyone who has asthma, an asthma care plan is essential to prevent worsening of your symptoms and an asthma attack. The asthma care plan is your guide to determining how well your asthma is controlled and what actions need to be taken when asthma worsens or when you develop symptoms of an asthma attack. With your input, your doctor will develop your asthma care plan. Most plans have 3 components:

1.Stage of severity- identified by the peak expiratory flow rate
2.A list of symptoms to watch for
3.Specific actions to take based on peak flow or symptoms
Make sure you understand the plan and do not be afraid to ask questions. Make sure any other caregivers and his/ her school understand the asthma care plan as well.

Know Your Asthma and Asthma Attack Symptoms:
Everyone with asthma is different. Some people will have frequent attacks while others may go a long period between attacks. You need to monitor your asthma symptoms like chest tightness, wheezing, shortness of breath, and chronic cough. The action plan that you and your child’s healthcare provider have developed will list how to treat asthma symptoms.

Know Your Peak Flow:
A peak flow meter is the key to determining how your asthma is doing and preventing an asthma attack. It tells you how well you are breathing and its use is a key part of the asthma care plan.

If peak flow numbers are declining, your asthma is getting worse and you need to act quickly to prevent an asthma attack. You need to give medications based on the instructions in the asthma care plan to stop the symptoms from getting more severe and a full blown asthma attack.

Know Your Medications:
Understanding the purpose of each medication in the treatment of asthma is very important because some medications are designed for the acute relief of asthma symptoms and an asthma attack and some for the long term control of asthma. Taking a long-term beta agonist control medication during an acute asthma attack can actually lead to worsening of asthma.

The asthma care plan will outline which specific medications to take depending on peak flow and other symptoms.

Recognize Early Warning Signs Of Worsening Asthma & an Asthma Attack:
As the parent of a child with asthma or someone with asthma, it is very important that you recognize and treat the early warning signs of an asthma attack. Appropriate management early on in an asthma attack may prevent a trip to the ER, an admission to the hospital or worse. Generally, early warning signs of worsening asthma and an asthma attack include:

•A drop in peak expiratory flow rate
•Increased cough
•Wheezing
•Chest tightness
•Some difficulty performing normal daily activities
•Individual factors you notice over time that indicate worsening asthma or an asthma attack
You will likely be in the ‘yellow zone’ of the asthma care plan when developing these symptoms. Based on your asthma care plan, follow the instructions about taking extra doses of quick-relief medications and initiating other treatments like a course of oral corticosteroids. The asthma care plan will have instructions regarding how to proceed and when to call your doctor.

Most of the time when symptoms are identified and treated early, you will notice a prompt improvement in both peak flow and symptoms. However, you need to be prepared if your symptoms don’t improve.

Make sure you discuss your asthma care plan with your health care provider. If you or your child is frequently needing to step up asthma treatment because of symptoms or worsening peak flows, or frequent asthma attacks, this is a sign of poor control and adjustments to the plan may be needed.

Identify Indications For Emergency Care:
One of the most important skills as a patient or parent of a child with asthma is to know when you need no longer treat asthma at home, call your doctor, or just head to the emergency department. All of the following symptoms are indications that you or your child needs to seek a healthcare provider for emergency care immediately:

•Wheezing that occurs while breathing both in and out
•Coughing that has become continuous
•Difficulty breathing
•Tachypnea or breathing very fast
•Retractions where your skin is pulled in as you breath
•Shortness of breath
•Difficulty talking in complete sentences
•Becoming pale
•Becoming anxious
•Blue lips or fingernails called cyanosis
If you or your child has any of these symptoms, they are in the ‘red zone’ of the asthma care plan and you should begin following those instructions immediately, which should also include seeing a healthcare provider. Make sure that you keep your emergency numbers and details of who to contact in an emergency situation in an easily identifiable place like the refrigerator or a bulletin board near your phone. It is also a good idea to carry this information with you.

Adult recommendations do not significantly differ for handling an acute asthma flare.

When you or your child’s asthma is under control, you should be free of asthma symptoms and able to do most of normal activities. Prompt identification and action of an asthma attack and worsening asthma symptoms will prevent complications and frequent visits to the emergency department.

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What are the risk factors for an asthma attack?
Although anyone may have an asthma attack, it most commonly occurs in the following persons:

•children by the age of 5
•adults in their 30s
•adults older than 65
•people living in urban communities

Other factors include the following:

•family history of asthma
•personal medical history of allergies
Children most susceptible to asthma attacks include the following:

•children with a family history of asthma
•children who have allergies
•children who have exposure to secondhand tobacco smoke
What happens during an asthma attack or asthma exacerbation?
Persons with asthma have acute episodes when the air passages in their lungs become narrower, and breathing becomes more difficult. These problems are caused by an over-sensitivity of the lungs and airways.

•The lungs and airways overreact to certain triggers causing:
◦the lining of the airways to become inflamed and swollen.
◦tightening of the muscles that surround the airways.
◦an increased production of mucus.
•Breathing becomes harder and may hurt.
•There may be coughing.
•There may be a wheezing or whistling sound, which is typical of asthma. Wheezing occurs because of the rush of air which moves through the narrowed airways.

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1.1 What is an asthma attack?
An asthma attack, also known as an asthma episode or flare, is any shortness of breath which interrupts the asthmatic’s well-being and requires either medication or some other form of intervention for the asthmatic to breathe normally again.

1.1.1 What is wheezing?
Wheezing is the whistling or rattling sound that occurs when air flows through obstructed airways. At the start of an asthma attack, wheezing usually only occurs while exhaling, or breathing out, but as the attack progresses, wheezing may then be heard both while inhaling and exhaling. If after the attack progresses further, the asthmatic then stops wheezing, this may indicate that many bronchioles (small airways) have become completely blocked, which is a very serious condition.
1.1.2 Do all asthmatics wheeze?
No, not all asthmatics wheeze. Although wheezing is extremely common in asthmatics, in All About Asthma, Dr. Paul says, “It is important to note that not all asthmatic symptoms need be present for one to experience an asthma attack. For instance, not all asthmatics wheeze. And sometimes wheezing is so slight, it can only be heard with a stethoscope. With some asthmatics, coughing is the only symptom present.” Similarly, in Children with Asthma, Dr. Plaut states that children with chronic coughs “may have asthma even though no wheezing is present.” He diagnoses such children with asthma if their peak flow improves when given an inhaled bronchodilator.
1.1.3 What is “coughing asthma”?
In Children with Asthma, Dr. Plaut defines “coughing asthma” as “a form of asthma in which coughing is the only symptom and there is no abnormality in any lung function test.” This condition is also known as “cough variant asthma.” Coughing asthma often improves when standard asthma medications are taken.
1.1.4 Is asthma hereditary?
No, asthma itself is not hereditary, but there does seem to be a hereditary component to the tendency to develop asthma. In All About Asthma, Dr. Paul states that if neither parent has asthma, the chances of each of their children having asthma are less than 10%. When one parent has asthma, the chances rise to 25%, and when both parents have asthma, the chances climb to 50%. (Actually, there is considerable disagreement among my sources as to the exact numbers, but all agree that the chances climb dramatically if one or both parents have asthma.)
Similarly, if one or both parents have allergies, the chances of each of their children having allergies are 35% and 65%, respectively, compared to a less than 10% chance if neither parent has allergies.

However, Dr. Paul cautions that “children don’t inherit asthma itself, but the tendency to develop it.” Whether or not an individual develops asthma is also influenced by their exposure to various other factors such as infections, irritants, and allergens.