18.APR.2019 6 MIN READ | 6 MIN READ

The World Health Organisation estimates that 235 million people worldwide suffer from asthma. Dr Jim Teo explains how to recognise when your asthma attack becomes an emergency.

What is asthma?

Asthma is a recurring problem with your airways. The tubes that connect your lungs and respiratory system become inflamed and narrow, so air can no longer pass through easily. The inflammation also results in sticky mucus build-up within the bronchial tubes. This causes the wheezing and breathlessness that characterises asthma. General symptoms include:

  • Coughing
  • Wheezing
  • Chest pain
  • Chest tightness
  • Shortness of breath

Asthma affects everyone differently, so if you are diagnosed, it’s important to know your symptoms so you can manage the condition.

What causes asthma?

Causes of asthma
While the exact cause of asthma is unknown, there are risk factors that make asthma more common in some people. These risk factors are:

  • Genetics. Asthma is often inherited and if members of your family are sufferers you are more likely to develop asthma too.
  • Atopy. Having atopic dermatitis, eczema or similar skin conditions may make you more predisposed to asthma, probably because you are more sensitive to allergens in general.
  • Gender. In children, boys are more likely to suffer from asthma. In adults, women are more likely to be asthma sufferers.
  • Weight. If you are overweight, you may have an increased risk of developing asthma, or worsened symptoms if you are asthmatic.
  • Smoking. Research suggests that smokers are much more likely to develop respiratory illness. Asthma is also more difficult to control in smokers.

What are some common triggers?

Although there is no single cause of asthma, the most common triggers are:

  • Allergies. Most asthma sufferers are allergic to something. Some typical allergens include pollen, pet dander, mould and dust mites. If you are aware of what you are allergic to, you should try to avoid it.
  • Exercise. Although exercise is necessary for maintaining optimal health, strenuous exercise can sometimes trigger an asthma attack. Exercise-induced asthmatics should avoid strenuous aerobic workouts in favour of low intensity exercise that doesn’t lead to an attack. Using ventolin or salbutamol puffs before physical exercise can prevent asthma attack.
  • Acid reflux. If you have acid reflux and stomach acid reaches your throat or airways, it can lead to inflammation, irritation and asthma.
  • Sinusitis. Sinus infections cause inflammation and excessive mucus production, much like asthma. If you have both, they can occur together and worsen as the infection progresses.
  • Food allergies. In the same way that allergens such as pet hair can cause a reaction that triggers an asthma attack, your body’s allergic response to food such as shellfish, nuts or eggs can cause a flare-up.

It is vital that you avoid these triggers where possible if you know that you are susceptible to asthma. It is also very important to prevent the onset of symptoms by taking any medication your doctor has prescribed, particularly for conditions like acid reflux. Although asthma can’t be cured, you can manage it effectively if you are aware of your triggers.

What is an asthma attack?

What is an asthma attack?
An asthma attack is a flare-up of asthma symptoms. During an attack, your airways narrow dramatically and you can no longer breathe effectively. The severity of an asthma attack can range from mild to severe, but they are often sudden and can be scary. It can cause death if not treated promptly.

If you have asthma, keep an eye out for the early warning signs of an attack. These include a persistent cough, heavy breathing after exercise, feeling stressed and tired, and waking up breathless or coughing in the early morning. These early signs may give you the opportunity to treat the attack and prevent it from becoming serious or life-threatening.

When is an asthma attack an emergency?

If your asthma attack is severe, it is very important to go to the Accident & Emergency (A&E) department. Here are some symptoms to look out for:

  • Severe wheezing
  • Pain in your chest
  • Rapid breathing
  • Relentless coughing
  • Blue or pale skin, lips, or nails
  • Sweating
  • Anxiety
  • A peak flow reading of below 80%, if you have a peak flow meter
  • Present medication especially ventolin puffs not easing symptoms effectively

If you experience any of these symptoms, you should call an ambulance, say that you are having an asthma attack and request for an ambulance with oxygen. An asthma attack can be fatal as your airways may narrow to such an extent that your body is starved of oxygen.

On the way to the A&E, you should try to remain calm. Panicking will exacerbate your symptoms. If you have a bronchodilator inhaler (ventolin), which is an inhaler that opens up and relaxes your airways, you should use it. Your doctor may have given you an asthma action plan so you know what to do in an emergency. If so, follow the medication guidelines your doctor has given you on the way to the hospital.

In a respiratory emergency, you are likely to be prioritised at the hospital. If you are waiting for a doctor, remain upright and continue to take puffs of your inhaler every few minutes. Avoid lying down as it can restrict your airways and airflow even further. Alert the hospital staff at the counter and let them know that you are having an attack.

Treatment for an attack

Treatment of an asthma attack
The treatment you will be given in the event of a severe asthma attack depends on your individual symptoms. The most common remedies include:

  • Oral corticosteroids, which are medications that reduce inflammation in your airways to help air to move freely again.
  • Beta agonists like ventolin puffs, which are the same type of medication that is found in a rescue inhaler. You may be given a nebuliser, which is a mask that fits over your mouth and nose and helps you to deeply inhale the medication.
  • Oxygen and breathing tubes, which may be necessary if your attack is particularly severe, to get enough oxygen into your body while other medications are administered.

Long term, your doctor will come up with a plan to keep your asthma under control, which will usually involve inhalers specifically for the prevention and management of your symptoms.

Living with asthma

Asthma can be a scary condition, especially in children, but millions of people live with asthma worldwide and most have a very normal life. Diagnosis is the first step, so if you experience any of the general symptoms of asthma, even if you’ve never had an attack, you should always see your doctor. They will be able to test your lung function and check for other indicators of the condition. If you do have asthma, they will give you appropriate medication to keep attacks at bay.

If you are diagnosed with asthma:

  • Use your prescribed medication as directed
  • Avoid your known triggers or allergies wherever possible
  • Have an asthma action plan and ensure your family and friends know what to do
  • Stay generally well with a healthy diet and appropriate exercise, being mindful of exercise-induced asthma
  • Avoid smoking
  • Remain proactive in managing your symptoms

If in doubt, visit the A&E during an asthma attack to receive proper treatment.

 

Article reviewed by Dr Jim Teo, respiratory specialist at Parkway East Hospital

Reference

Ambardekar, N. (2018, Jul 9) Asthma Symptoms. Retrieved 3/3/19 from https://www.webmd.com/asthma/guide/asthma-symptoms#3

Asthma Attack, Mayo Clinic. Retrieved 3/3/19 from https://www.mayoclinic.org/diseases-conditions/asthma-attack/diagnosis-treatment/drc-20354274

Asthma Emergency, Asthma Australia. Retrieved 3/3/19 from https://www.asthmaaustralia.org.au/national/about-asthma/asthma-emergency

Bhargava, H.D. (2018, Oct 2) Asthma Causes and Triggers. Retrieved 3/3/19 from https://www.webmd.com/asthma/asthma-triggers#4

Blahd, W. (2017, May 10) Asthma Attack Symptoms and Warning Signs. Retrieved 3/3/19 from https://www.webmd.com/asthma/guide/asthma-attack-symptoms

Brennan, D. (2019, Jan 29) Asthma Action Plans. Retrieved 3/3/19 from https://www.webmd.com/asthma/guide/make-an-asthma-action-plan-child#2

Chronic Respiratory Diseases, World Health Organisation. Retrieved 3/3/19 from https://www.who.int/respiratory/asthma/en/

DerSarkissian, C. (2018, Feb 28) Asthma Risk Factors. Retrieved 3/3/19 from https://www.webmd.com/asthma/asthma-risk-factors#3

DerSarkissian, C. (2017, Aug 6) An Overview of Asthma Drugs. Retrieved 3/3/19 from https://www.webmd.com/asthma/asthma-treatments#2

18.APR.2019
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Jim Teo Yeow Kwan
Respiratory Physician
Parkway East Hospital

Dr Jim Teo Yeow Kwan is a respiratory physician and intensivist practising at Gleneagles Hospital and Parkway East Hospital, Singapore.