Asthma is an obstructive lung disease that is episodic and reversible to a significant degree, according to "Current Diagnosis & Treatment Emergency Medicine." Between asthma attacks, individuals may have normal lung functioning. An exacerbation is an increase in the severity of symptoms that causes airflow obstruction to the lungs.
Signs and Symptoms
Patients who are having an asthma exacerbation will complain of shortness of breath and a cough. Some patients may also describe a feeling of chest tightness. When the airways are narrowing during the attack, it is difficult for air to move in or out of the lungs. This causes a wheezing or whistling sound in the airways. Most asthmatic patients are familiar with their disease and know when they are having an attack. Allergens and irritants are the primary triggers for an asthma exacerbation. Examples of allergens and irritants include cigarette smoke, molds and animal dander. Acute exacerbations are also caused from infections or exercise.
Oxygen Delivery
Patients with an asthma exacerbation require supplemental oxygen. Depending on the severity of the attack, different amounts of oxygen will be needed. Some patients need oxygen supplied by a mask to keep their oxygen level in the appropriate range. For severe exacerbations, it may be necessary for the patient to have a breathing tube connected to a mechanical breathing machine placed through the mouth and into the trachea.
Bronchodilator Medication
Bronchodilators are medications used to treat asthma attacks. These medications are administered by an inhaler or a nebulizer. A nebulizer creates a mist that patients inhale as they breathe. Bronchodilators cause relaxation of the smooth muscles in the lungs. When the smooth muscles relax, the airways dilate, or enlarge, which results in improved oxygen exchange in the lungs. A frequently used bronchodilator medication is Albuterol.
Anticholinergic Medications
Anticholinergic medications are also used during an exacerbation. These medications help to decrease spasms that cause narrowing of the airways. Anticholinergics also help to decrease the amount of mucous that is produced in the airways. These medications are not very effective by themselves and are usually administered in combination with a bronchodilator.
Steroids
Steroids are beneficial in the treatment of asthma attacks. Steroids decrease swelling of airways, decrease the amount of mucous produced and enhance the effect of the bronchodilators. "Current Diagnosis & Treatment Emergency Medicine" states that steroids are crucial in reducing the rate of relapse in moderate to severe exacerbations.
Significance
According to the American Lung Association, asthma is in the top 10 most prevalent medical conditions, and it accounts for an estimated 14.5 million lost workdays for adults and 12.8 million lost schooldays for children.
References
- "Current Diagnosis & Treatment Emergency Medicine"; eds. C. Keith Stone, Roger L. Humphries; 2008
- "Advanced Emergency Nursing Journal"; Emergency Management of Asthma Exacerbations: David House, Elda Ramirez; May 2008
- American Lung Association: Trends in Asthma Morbidity and Mortality; Oct 2007
