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Asthma Attacks/Exacerbations

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Asthma exacerbations or attacks are an increase in asthma symptoms that if not controlled can lead to respiratory distress. An exacerbation can build up gradually over days or there may be a sudden and sharp deterioration within a couple of hours. The causative factors and recovery time for both are different. Generally a slow decline is because of inadequate control of chronic asthma, poor compliance to medications or due to respiratory infections. This type is based on increase in inflammation and displays a slow recovery. A sudden asthma attack is brought on by exposure to triggers or even emotional stress. This leads to bronchospasm which brings on a sudden difficulty in breathing, but also responds quickly to appropriate medication.

What happens in an asthma attack

An asthma exacerbation can be recognized by the following symptoms:

It is important to note that persons with an acute attack may not necessarily appear very distressed. In the case of severe bronchospasm, there may be little air flow so that wheezing may disappear. This is also described as the silent chest and indicates dire emergency. The development of blue nails or lips is again an indication of very severe attack and impending respiratory failure.

However, timely recognition of a mild exacerbation and the use of appropriate medication can help to prevent further deterioration. Asthma patients should always work out a personalized treatment plan with their doctor. Most importantly, they should learn to recognize the early signs of an exacerbation and be aware of which medicines to use in case of increase in symptoms. All symptoms may not manifest in the same pattern in all sufferers and timely recognition along with immediate appropriate home treatment saves further distress.  

Early signs of asthma attack or exacerbations

  • Increase in coughing
  • Tiring easily, feeling irritable
  • Losing breath easily or feeling winded
  • Feeling weak or coughing on exercise
  • Symptoms of cold and allergy such as running nose, sneezing, sore throat and so on
  • Difficulty in sleeping
  • Drop in personal best PEF

In some situations the use of rescue medicine may not be able to provide sufficient relief. If one uses a peak flow meter, readings that are less than one’s personal best are an indication of worsening asthma. In such situations, it is best to seek immediate medical help. The following is a guide for severity of asthma according to peak expiratory flow rate.

Peak Expiratory Flow Rate Guide :

  • 70% or greater - mild
  • 40-69% - moderate
  • 25-39% - severe
  • >25% - at risk for respiratory failure

Treatment plan for asthma attack or exacerbations

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Normally a home treatment plan for a mild exacerbation begins with a dose of albuterol/salbutamol every 20 minutes. A corticosteroid in tablet form may also be prescribed by your doctor in case of an attack. It is important to strictly follow the written plan given to you by your doctor. If you do not get relief after 3 doses or there is worsening of symptoms, it is better to immediately seek medical help.

Emergency treatment for asthma attack or exacerbations

If you do not have a treatment plan or your symptoms do not improve, do not delay especially if it is a quick onset attack. This can quickly assume life-threatening proportions. Treatment at emergency departments also begins with a dose of a short acting beta agonist like albuterol and a brief physical assessment. This will be accompanied by oral corticosteroids. If relief is not observed, ipratropium administered through a nebulizer can help achieve bronchodilation. Oxygen may need to be administered for a moderate to severe exacerbation to maintain blood oxygen levels. If deterioration persists and there is danger of respiratory arrest then intubation may become necessary. However, the attending doctor may prefer to use magnesium sulfate or heliox before attempting intubation, as this can be difficult to perform in a person with severe asthma.

Written by: healthplus24.com team

Date last updated: June 08, 2015

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