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Managing Asthma

Asthma Attack Management

If you have never had an asthma attack, imagine breathing through a straw, trying to breath underwater, or trying to breath with someone sitting on your chest. If you have had an asthma attack then you know firsthand what it feels like and how terrifying it can be.

How asthma affects your breathing?

Ever heard the saying, “as easy as breathing”? For most of us breathing is automatic. We hardly think about it while performing regular activities like driving, walking, talking, eating or playing with the dog.

Airways: Nose, nasal cavities, mouth, larynx (voice box), trachea (windpipe), bronchial tubes and branches1

During the process of breathing, air comes in through the nose and mouth, travels down your trachea (windpipe), dividing into branch-like bronchial tubes or bronchi into your lungs.
If your airways become narrow and inflamed, which happens when you have asthma, it becomes more difficult for air to move in and out of your lungs. 2, 3, 4 This makes it harder to breathe, and in some cases difficult to function properly.

What happens during an asthma attack?

Classic asthma symptoms may include coughing, wheezing, a tight chest, and breathlessness.5 Symptoms may occur every day or every now and then.6a
Treating the airway inflammation that leads to asthma symptoms on a daily basis helps to keep asthma under control and prevent asthma attacks.6b

Wheezing: A high-pitched whistling, squeaky, or purring sound when you breathe7a

If the muscles around your airways tighten, your asthma symptoms can flare-up and get worse to the extent that it may become extremely difficult to breath or speak, like you are suffocating. If this happens, you are likely having an asthma attack.

Warning signs and symptoms

Signs and symptoms may include:

  • Severe wheezing
  • Persistent coughing
  • Faster breathing
  • Rapid heartbeat
  • Rattling sound in the chest
  • Persistent chest pressure
  • Tight neck muscles
  • Ribs that stick out because the air between them pulls in (called retractions)8, 9a

Sometimes, the signs and symptoms are less obvious. Likewise, they can happen suddenly or gradually, so it can be difficult to know for sure if you are developing, or having an asthma attack.

Becoming aware of all possible signs and symptoms (mild or severe), and monitoring them can help to prevent an asthma attack altogether, or prevent a mild asthma attack from becoming more serious.

Milder signs and symptoms may include:

  • Feeling persistently tired for no obvious reason – if you get tired easily or more regularly
  • If you detect signs of allergies or a cold (such as a runny nose, a scratchy throat, or a blocked nose)

What triggers an asthma attack?

Things that bring about or make your asthma worse are called triggers and may include:

  • Allergens such as pollen (trees, weeds, grass), house dust mites (tiny bugs invisible to the naked eye), pet dander (microscopic flecks of shed skin), and mould
  • Infections such colds, flu, or pneumonia
  • Pollens such as trees, grass and weeds
  • Tobacco smoke – if you are a smoker, quit
  • Airborne irritants (such as smog, chemical fumes, car exhaust fumes)
  • Food allergies (such as nuts or fish) some of which can be life-threatening
  • Cold or dry air
  • Heat and humidity
  • Other underlying health conditions or diseases such as gastroesophageal reflux (GORD) – when your stomach contents move back up into your food pipe
  • Intense emotions or stress
  • Strenuous exercise or physical strain7b, 10, 11

While strenuous exercise can trigger asthma, exercise does not cause asthma. If managed properly, asthma need not stop you from being active and physically fit.

What to do if you have an asthma attack?

Asthma attacks vary from mild to severe, and in some cases may be life-threatening, requiring emergency medical treatment.

Take the following steps:

  • Keep calm and try not to panic
  • Sit in an upright position (do not lie down) – this helps to open your airways, making it easier for air to move through your lungs
  • Breathe as slowly and deeply as possible, breating in through your nose and out through pursed lips (make a tight O shape) – try to make the exhale (out-breath) longer than your inhale (in-breath)
  • Take your prescribed medication
  • Check your breathing with a peak flow metre (if your doctor has advised you to do so
  • If your rescue inhaler does not provide relief within 15-20 minutes, or if your symptoms worsen, head to your local clinic or hospital emergency room12, 13, 9b

Controller inhaler vs rescue inhaler
An everyday (controller) inhaler contains long-acting medicine. A rescue (reliever) inhaler contains fast-acting medicine to help quickly relax and open your airways to relieve asthma attack symptoms. Controller inhalers do not give immediate relief.

Ways to reduce your asthma attack risk?

Controlling your asthma is the best way to prevent or reduce your risk of an asthma attack. Visit your doctor regularly, get your medication strategy right, and take your medication as prescribed. Know (and where possible) control your triggers by avoiding or eliminating them. Lead an active life, getting regular exercise and pay attention to your asthma signs and symptoms.

In consultation with your doctor, have an asthma attack emergency plan and share it with friends and family. Asthma can change over time so, talk to your doctor if you have any questions or concerns about symptom changes, your medication type, dosage and frequency. 14 Do not stop taking your medication without consulting your doctor, even if your asthma appears to have improved.


Two of the main reasons for poor asthma control

Incorrect use of inhalers and not adhering to treatment are two of the main reasons for poor asthma control. This can lead to more serious health issues including asthma attack.

In some asthma patients, such as older people and children, incorrect use may be the result of coordination problems. For example, an asthma patient may struggle to take a deep breath to inhale medication properly or there might be a time delay between dose activation and taking an in-breath.

Please note: This is educational information only and should not be used for diagnosis. For more information on asthma attack management, consult your healthcare professional.


Medical References

⦁ National Heart, Lung and Blood Institute. How the Lungs Work. Available at: https://www.nhlbi.nih.gov/health-topics/how-lungs-work. Accessed 22 July 201.
⦁ Asthma and Allergy Foundation of America. Asthma. Available at: https://www.aafa.org/asthma.aspx. Accessed 22 July 2019.
⦁ Mayo Clinic. Asthma. Available at: https://www.mayoclinic.org/diseases-conditions/asthma/symptoms-causes/syc-20369653. Accessed 22 July 2019.
⦁ American Lung Association. What Is Asthma? Available at: https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/asthma/learn-about-asthma/what-is-asthma.html. Accessed 22 July 2019.
⦁ Asthma and Allergy Foundation of America. What are the Symptoms of Asthma? Available at: https://www.aafa.org/asthma-symptoms/. Accessed 22 July 2019.
⦁ National Heart, Lung, and Blood Institute. Asthma. Available at: https://www.nhlbi.nih.gov/health-topics/asthma. Accessed 22 July 2019.
⦁ Seattle Children’s Hospital Research Foundation. Asthma Attack. Available at: https://www.seattlechildrens.org/conditions/a-z/asthma-attack/. Accessed 22 July 2019.
⦁ Children’s Hospital of Wisconsin. Signs and symptoms of an asthma attack. Available at: https://chw.org/medical-care/asthma/signs-and-symptoms. Accessed 22 July 2019.
⦁ National Health Service. Asthma Attacks. Available at: https://www.nhs.uk/conditions/asthma/asthma-attack/. Accessed 22 July 2019.
⦁ Cleveland Clinic. Understanding Asthma Triggers: Possible Causes. Available at: https://my.clevelandclinic.org/health/symptoms/10374-understanding-asthma-triggers/possible-causes. Accessed 22 July 2019.
⦁ Healthychildren.org. Asthma Triggers and What to do About Them. Available at: https://www.healthychildren.org/English/health-issues/conditions/allergies-asthma/Pages/Asthma-Triggers-and-What-to-do-About-Them.aspx. Accessed 22 July 2019.
⦁ Cleveland Clinic. Bronchodilators and Asthma. Available at: https://my.clevelandclinic.org/health/treatments/17575-bronchodilators–asthma. Accessed 22 July 2019.
⦁ Asthma UK. Asthma Attacks. Available at: https://www.asthma.org.uk/advice/asthma-attacks/. Accessed 22 July 2019.
⦁ Mayo Clinic. Asthma Attack. Available at: https://www.mayoclinic.org/diseases-conditions/asthma/symptoms-causes/syc-20369653. Accessed 22 July 2019.
⦁ Healthline. What Is and Asthma Attack? Available at: https://www.healthline.com/health/asthma/asthma-attack. Accessed 22 July 2019.

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