Over 18 million Americans suffer from asthma, a chronic condition responsible for almost 2 million visits to the emergency room yearly. Asthma affects children and adults, causing excess mucus and swelling of the airways, affecting airflow. Inflammation and sensitivity of the airways can worsen from certain triggers. In an acute asthma attack, symptoms are exacerbated and people develop increasing shortness of breath, cough, wheezing and tightness in the chest. Many asthma exacerbations can be prevented with daily controller medications and lifestyle changes, but sometimes triggers can cause the asthma to flare up.
Symptoms of Acute Exacerbation
Symptoms of asthma exacerbation may include feeling restless, coughing, wheezing and chest tightness. Asthma attack severity can be classified as mild, moderate, severe or life-threatening. Things a doctor may consider to determine how bad an exacerbation is and how it will be treated include: how much the respiratory rate is increased; speed of heart rate; ability to take deep breaths and inflate the lungs; blood oxygen levels; whether the patient is using extra muscles to breathe; whether the patient can talk in full sentences
A person with a mild asthma exacerbation may just feel short of breath and mildly restless, but may not have any significant change in oxygen level. On the other hand, in a life-threatening exacerbation, a person may be agitated, unable to speak, using abdominal muscles to breathe and have a blue tinge to his lips from poor oxygen levels in the blood.
Acute asthma exacerbation is often caused by a particular trigger. Common triggers include allergens, exercise and poor air quality. Respiratory viruses, especially rhinovirus, cause the majority of asthma exacerbations in both children and adults. Changes in weather such as extreme heat or cold may also cause spasm of the airways. Medications not related to asthma treatment may still have the effect of triggering an asthma attack. Aspirin, anti-inflammatory pain medications, and blood pressure medications known as beta-blockers and ace inhibitors may all interfere with asthma control. Stopping or changing an asthma control medication can also lead to asthma becoming unstable and spiraling into an attack. Being male, having a strong family history of severe asthma, and having eczema or allergies may translate to greater risk of exacerbations.
Treatment for Acute Asthma Exacerbations
Treatments vary depending on severity of the attack. Bronchodilators -- medications most often administered by an inhaler or a nebulizer -- help relax and dilate the airways. When an attack starts, home treatment with rescue bronchodilators is important to try to stop exacerbation. If rescue medications do not relieve shortness of breath, cough and wheezing, treatment in a healthcare setting like an urgent-care facility, physician’s office or emergency room should be pursued.
Care in the emergency department may include the use of multiple medications, such as repeated treatments with bronchodilators; oxygen, if blood levels are low; and steroid medications to help decrease inflammation of the airways and stop progression of the attack. When steroids are given in a timely fashion, they can help prevent relapses and the need for hospitalization. Magnesium sulfate is a naturally occurring mineral in the body, and when given intravenously it has been found to help stop severe asthma attacks.
If you have asthma and are suffering from shortness of breath and wheezing despite taking your control and rescue medications, seek immediate medical attention. Consequences of an untreated asthma attack could be dire, including confusion, poor organ function, collapse of the respiratory system and even death. Call 911 if you are suffering from an asthma attack that is severe or you see someone with asthma who is struggling to breathe, is in distress, or turning pale or blue.
- Centers for Disease Control and Prevention: Fast Stats, Asthma
- Clinical and Experimental Allergy: Acute Exacerbations of Asthma: Epidemiology, Biology and the Exacerbation-Prone Phenotype
- Thoracic: Managing Asthma Exacerbations in the Emergency Department Summary of the National Asthma Education and Prevention Program Expert Panel Report 3 Guidelines for the Management of Asthma Exacerbations
- World Allergy Organization: Acute Asthma
- American Family Physicians: Management of Acute Asthma Exacerbations