Asthma is a common disease of the upper airways that affects children and adults on a large scale. People with asthma have inflammation of the airways responsible for getting air from the mouth and nose to the lungs. This can result in either gradual or sudden signs and symptoms of respiratory distress that, if not responding to prescription therapy, may require emergency medical services, or EMS, intervention.
What is Asthma?
Asthma is a chain reaction of events that begins with a predisposition to asthma, whether genetic or environmental, that causes the airways to become sensitive to irritation. This irritation causes marked swelling and tightening of these airways which, in turn, results in narrowed airways and an increased production of mucus. Thus begins a domino effect of further constricting and narrowing of the airways and ongoing mucus production. Though the causes of an asthma attack may be difficult to determine, dust, dander, smoke, exercise and even changes in humidity, temperature and altitude can provoke one. The National Institutes of Health reports that asthma is one of the most common respiratory diseases affecting more than 20 million people in the United States, almost one-third of whom are children.
When to Call EMS
Most people who have been diagnosed with asthma are given specific instructions on how to avoid asthma attacks. They are also prescribed medications such as steroids and metered-dose inhalers, or MDIs, or nebulizers to use either at predetermined intervals, or in some cases, only during emergency attacks. It is important not to delay calling 911 as soon as the signs and symptoms seem to be worse than usual or fail to readily respond to home treatments. Often, this is patient-specific but the general rule of thumb is if in doubt, call 911 because any delays during an acute asthma attack can have devastating outcomes.
Initial EMS Response to an Asthma Attack
Though protocols and procedures may vary slightly, most EMS organizations will respond to asthma attack swiftly and with similar interventions. Upon first encounter with the patient, EMS will assess the current status of the airway, breathing and circulatory status. Commonly, the patient's response to questions about medical history and the current complaint, along with a listen to the patient's lung sounds, will confirm an asthma attack. As also recommended by the Mayo Clinic, EMS can apply oxygen and, depending on allergies and prescribed medications, will administer long-acting beta agonists and anticholinergic medications via a nebulizer. A nebulizer utilizes air or oxygen to disperse a medication in the form of an inhalable mist which allows the medication to be used more quickly and effectively, often producing some relief within seconds or minutes. Depending on the severity, intravenous steroidal solutions may be injected to aid in decreasing the inflammation and constriction of the airways. This is often most effective over several hours from the time of initial administration and is helpful in preventing recurrent attacks later.
Invasive Interventions
In rare instances, more invasive interventions may be required by EMS due to severe or prolonged asthma attacks which may place the patient in danger of life-threatening complications. Depending on the severity, intravenous steroidal solutions may be injected to aid in decreasing the inflammation and constriction of the airways. This is often most effective over several hours from the time of initial administration and is helpful in preventing recurrent attacks later. Intravenous or intramuscular injections of powerful medications such as epinephrine or terbutaline can often decrease and even reverse the inflammation and mucus production. These are similar to some of the inhaled medications but have a higher potency and are more readily absorbed and made available to the body.
If the above interventions are not effective and the patient is still struggling to breathe, endotracheal intubation may be a last resort intervention to save the patient's life. This procedure involves sedating the patient in an effort to insert a breathing tube into the trachea, thereby ensuring that the upper most airway can remain open. This might be required during severe asthma attacks or in patients who are either very young, elderly or who have significant preexisting conditions. Though the risks associated with this procedure are increased, it can be the only way to protect the asthma patient's airway, which is critical to life.
Prevention is Key
The Mayo Clinic recommends several tips for preventing acute asthma attacks. This may prevent the need for an EMS response. Having a documented plan to deal with asthma and asthma attacks is crucial. Knowing what triggers commonly prompt an attack and then avoiding those triggers is also important. Daily vigilance in monitoring, recognizing and responding to potential asthma attacks while always following the established program set forth by a physician is a necessity.
