Asthma is a chronic condition of inflammation in your lungs' airways. It manifests itself with recurring attacks of shortness of breath, wheezing and cough. Allergies, smoke, upper airway infections or colds, and exercise are some of the most common triggers of asthma attacks. Medicines are available to treat acute asthma symptoms and to prevent exacerbations. Sometimes medicines don't work initially, so it is important to recognize symptoms of worsening asthma.
Respiratory Distress
Usually, patients with an asthma exacerbation have some respiratory distress, with rapid breathing and cough. When symptoms worsen, patients with worsening asthma have marked retractions, which is rapid breathing and tugging in of the abdominal and chest muscles in an effort to bring in more oxygen. You can recognize retractions by carefully looking at an asthmatic's chest and seeing if her ribs poke out when breathing. Some patients, particularly children, also have paradoxical breathing as a sign of worsening asthma. Paradoxical breathing is when the chest wall moves in during inspiration and out during expiration, instead of the other way around.
Diminished Breath Sounds
A very serious sign of worsening asthma is a decrease in the respiratory sounds. In asthma, chronic inflammation constricts the airways. The patient continues to move air through these narrowed airways, creating the typical high-pitched noise of asthma called wheezing. When asthma worsens, airway constriction becomes severe and there is not enough movement of air in the chest to cause wheezing. This can be misconstrued as improvement in the patient's respiratory status, when in fact it is a significant worsening of the patient's condition.
Altered Mental Status
Another sign of worsening asthma is when the patient starts exhibiting mental status changes. These include confusion, irritability, agitation, drowsiness and stupor. As the condition worsens, patients exhibit altered perception and hallucinations. They eventually can lose consciousness. Decreased oxygen delivery to the brain is the main factor when the mental status changes in patients with asthma.
Cyanosis
Cyanosis is a bluish tinge of the skin. It is caused by decreased oxygen delivery to the body from the heart. In patients with worsening asthma, inflammation and airway swelling and constriction compromise oxygen delivery. This means that the blood pumped by the heart circulates with less oxygen than usual. This low-oxygen blood turns the tissues a bluish color, notably in the skin around the mouth and in the fingertips.
