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At The Onset Of An Acute Asthma Attack

How Is Asthma Diagnosed

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Your health care provider may use many tools to diagnose asthma:

  • Physical exam
  • Medical history
  • Lung function tests, including spirometry, to test how well your lungs work
  • Tests to measure how your airways react to specific exposures. During this test, you inhale different concentrations of allergens or medicines that may tighten the muscles in your airways. Spirometry is done before and after the test.
  • Peak expiratory flow tests to measure how fast you can blow air out using maximum effort
  • Fractional exhaled nitric oxide tests to measure levels of nitric oxide in your breath when you breathe out. High levels of nitric oxide may mean that your lungs are inflamed.
  • Allergy skin or blood tests, if you have a history of allergies. These tests check which allergens cause a reaction from your immune system.

What Are The Symptoms Of Asthma

The symptoms of asthma include:

  • Chest tightness
  • Shortness of breath
  • Wheezing, which causes a whistling sound when you breathe out

These symptoms can range from mild to severe. You may have them every day or only once in a while.

When you are having an asthma attack, your symptoms get much worse. The attacks may come on gradually or suddenly. Sometimes they can be life-threatening. They are more common in people who have severe asthma. If you are having asthma attacks, you may need a change in your treatment.

Risk Factors Of Acute Asthma

In addition to the triggers that can cause an asthma attack, there are a few risk factors that can increase the chances of an attack occurring.

  • Changes in medication Reduction or cessation of certain medications or the use of certain medications in common may increase the possibility of an attack

  • Non-adherence to medication In addition to changes in medication, patients who do not adhere to the medication prescribed to them are at increased risk of exacerbation

  • Smoking The damaging effects of smoking on the lungs also makes smokers more likely to have an asthma attack

  • Coughing at night The risk of an acute asthma attack goes up in relation to the number of nights in a row you experience a troublesome cough

  • Obesity People with a BMI greater than 30 are more likely to have asthma

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What Is Acute Asthma

Asthma itself is a chronic condition, so its important to avoid triggers that might bring on an asthma attack. These include allergens and untreated infections.

If you have asthma, you must be careful to follow your treatment plan. If your asthma is well controlled, you can usually live a relatively normal life. However, a trigger exposure can cause an acute asthma flare,¹ which is otherwise known as an asthma attack. During an asthma attack, the bronchial passages that allow air in and out of the lungs swell up and become narrow.

What Are The Most Common Triggers Of Asthma Attacks

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Common asthma attack triggers include:

  • Coming into contact with allergens, such as pollen, animal fur, mould or dust
  • Eating certain foods
  • Environmental factors, such as pollution, poor air quality or cold air
  • Taking non-steroidal anti-inflammatory medications, such as ibuprofen
  • Taking medication such as beta blockers
  • Stress or extreme emotion

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What Are The Symptoms Of A Severe Asthma Attack

Asthma is known as a progressive disease, meaning that it starts out with mild symptoms but can become severe over time. It is caused by inflammation or swelling of the airways, making it difficult for air to pass through.

The symptoms of severe asthma can vary from person to person, but the following signs could indicate a severe asthma attack:

  • Coughing, especially in the morning and at night
  • Tightness in the chest
  • Feeling confused or agitated
  • Symptoms that do not improve with medication

Asthma attacks are typically treated by quick-relief medications that a person will breathe in through a device called a rescue inhaler. If asthma symptoms do not improve with the use of this or other medications, it could be a sign that asthma is severe.

Your Body May Present With Early Symptoms

Response from Theresa Cannizzarro, Respiratory Therapist

There are several warning signs that can occur before an asthma attack happens. A very common one is that you will notice your peak flow numbers start to drop, often times days before you start experiencing symptoms. Noticing under your chin is itchy is another unusual, yet common warning sign of an impending asthma attack. Itchy throat, excessive tiredness, and moodiness can also occur a couple days to a couple hours before your asthma starts acting up.

It’s important to start paying close attention to your body for any of these symptoms you may experience. I recommend to my patients to keep an asthma diary/journal and write down every day how you are feeling as well as peak flows, and symptoms. You’ll start to notice a pattern and be able to better predict if/when your asthma will start acting up.

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Acute Exacerbation Of Asthma

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What happens during an acute exacerbation of asthma?

Asthma is a chronic lung disease. It causes inflammation and narrowing of your airways. This can affect your airflow.

The symptoms of asthma come and go. When symptoms flare up and get progressively worse, it can be called:

  • an exacerbation
  • an episode
  • a flare-up

Your airways become swollen during an acute exacerbation. Your muscles contract and your bronchial tubes narrow. Breathing normally becomes more and more difficult.

Even if youve had exacerbations before and know what to do, its still a good idea to contact your doctor. An acute exacerbation of asthma is serious and can even become life-threatening. Thats why its important to recognize the symptoms early and to take appropriate action.

Its important to develop an asthma plan for how to treat your symptoms. Work with your doctor to come up with a method for what to do when your symptoms flare up.

Home Management Of Asthma Exacerbations

An asthma attack

An asthma exacerbation that causes minimal problems for the mother may have severe sequelae for the fetus. Patients should be instructed on rescue management and should be educated to recognize signs and symptoms of early asthma exacerbations such as coughing, chest tightness, dyspnea, or wheezing or by a 20% decrease in their PEFR. This is important so that prompt home rescue treatment may be instituted to avoid maternal and fetal hypoxia. In general, patients should use inhaled albuterol, 2 to 4 puffs every 20 minutes for up to 1 hour . The response is considered good if symptoms are resolved or if they become subjectively mild, normal activities can be resumed, and the PEFR is more than 80% of the personal best. For asthma exacerbations that can be managed at home, a course of oral prednisone is recommended, 40 to 60mg per day in a single dose or in two divided doses for 3 to 10 days.64 The patient should seek further medical attention if the response is incomplete or if fetal activity is decreased.

Leonard B. Bacharier, Robert C. Strunk, in, 2010

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Early Phase Asthma Attack

This is the immediate response to an antigen, and causes allergy and/ or asthma symptoms in a matter of seconds or minutes. This response reaches its peak within 15-30 minutes and resolves within 1-2 hours.1 What happens here is dust mite IgE recognize, bind with, and release cytokines that communicate with

Mast cells. These are white blood cells that are randomly scattered along connective tissue of your skin, the conjunctiva of your eyes, and your respiratory tract. They were discovered in 1953, and are a special type of leukocyte called a granulocyte.2

Granulocyte. These are leukocytes that contain granules. Stimulation by cytokines causes them to degranulate.

Degranulate. This means they release their contents into the bloodstream. Among their contents are the mediators of inflammation.

Common Symptoms To Look Out For

Response from Lyn Harper, MPA, BSRT, RRT

Yes, there can be many warning signs of an asthma attack. They may come on suddenly or over a period of days. Here are a few things to watch for:

  • A reduction in your peak flow reading. This gives you very early notification that youâre headed for a flare-up.
  • Sudden shortness of breath

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Patients At Risk For Severe Asthma Exacerbations

Careful consideration should be carried out in patients with risk factors for severe asthma exacerbations. Patients with exacerbations that led to endotracheal intubation, previous admissions to the ICU, a history of multiple hospitalizations in the past year or multiple emergency department visits in the past month, the need of chronic oral corticosteroids use, poor access to health care, and frequent use of rescue inhalers are considered to have increased risk of severe asthma exacerbations and death. Patients with asthma and with these characteristics should be evaluated promptly and treated expeditiously. In addition, a minority of patients with asthma may experience a significant decline in lung function without a change in symptoms. These under-perceivers are at higher risk for near-fatal exacerbations. This article focuses on the approach to manage exacerbations of asthma.

Symptoms After An Asthma Attack

Asthma Attack in Children: Causes, Early Warning Signs, and Treatment ...

How you feel after an asthma attack will depend on how severe the attack was and what triggered it.

If the attack was triggered by an irritant, such as cold weather, pollutants or allergens such as pollen, animal fur or dust, you should recover relatively quickly.

If your asthma attack was caused by an infection, such an upper airway infection, then it might take longer for you to recover. You may have symptoms such as fatigue and exhaustion after your asthma attack.

Do follow any recovery guidance given to you by a doctor or medical professional. Rest, drink plenty of fluids, take your medication and attend any necessary follow-up appointments.

If you havent seen your doctor or asthma nurse for a routine appointment recently, book one as soon as possible.

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Unproved Alternate Therapy In Status Asthmaticus

Although the application of noninvasive ventilation has proved to be safe and effective in COPD, the use of NIV in severe asthma is not clearly defined. A systematic review found 5 studies with > 200 subjects with severe asthma randomized to NIV or placebo. Two of the studies found no difference in the number of subjects who required intubation and mechanical ventilation , whereas one study demonstrated fewer admissions in the NIV group. NIV should not be attempted in patients who are agitated or uncooperative, and patients should be monitored closely if NIV is attempted. Although retrospective studies are encouraging about the potential benefits of NIV, in our experience, many patients with acute, severe asthma are unable to tolerate NIV.,

Although intravenous aminophylline is not likely to result in any additional bronchodilation when compared with standard care with inhaled bronchodilators and corticosteroids, some patients with near-fatal asthma may gain benefit with intravenous aminophylline. The usual loading dose of 5 mg/kg is given intravenously over 20 min and then infused at a rate of 0.50.7 mg/kg/h. Such patients are rare, and the potential adverse effects are not uncommon . Blood levels should be checked daily for all patients receiving aminophylline infusions.

How Often Should You Take Peak Flow Measurements

Peak flow readings can be taken on a regular basis or only at certain times. Regular monitoring may be useful when you are first diagnosed with asthma to determine your normal peak flow rates. Regular monitoring is also important when your asthma is unstable, or for those who do not notice symptoms when their asthma starts getting out of control. If your peak flow rate has dropped below your normal, you can act quickly to get control before it becomes serious.

Triggers are the things that can cause your asthma symptoms. Each person has their own set of asthma triggers. Over time you can figure out what your asthma triggers are and take steps to reduce your exposure.

There are two types of asthma triggers:

  • Allergens

Here are some tips that can help you stay active:

  • Do not start exercising if you have any asthma symptoms
  • Warm up by starting at a slower paceincrease the pace slowly
  • If you need to take a reliever inhaler before exercising, it should be taken about 10-15 minutes before the activity
  • If you develop asthma symptoms while exercising, stop immediatelyuse your reliever inhaler and do not start again unless your symptoms are completely gone.
  • Consider exercising indoors when outdoor conditions may trigger your asthma
  • When exercising in cold weather, cover your nose and mouth with a scarf or cold weather mask
  • If symptoms continue, your asthma may not be under controlwork with your health-care provider to improve your asthma management

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What Is Chronic Asthma

Chronic asthma is a condition where acute asthma gets worse with time and asthma treatments do not respond well to it. The symptoms are more intense than regular asthmatic symptoms and last for a longer period of time.

People who are dealing with chronic asthma find it difficult to control and it has a major impact on their daily lives as well. Due to the asthmatic attack, they are not in a state to engage with people socially and continue with their regular activities.

Asthma Can Be Managed

Acute Severe Asthma – Initial Assessment

Sticking to your treatment plan can help prevent your asthma symptoms from worsening. If you are taking multiple treatments but still experiencing symptoms, you might need more help managing your condition. Your doctor may recommend a combination of prescription medications, complementary therapies, and lifestyle changes. These options can help you manage the condition more effectively.

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Viral Exposure In Children

Evidence suggests that rhinovirus illness during infancy is a significant risk factor for the development of wheezing in preschool children and a frequent trigger of wheezing illnesses in children with asthma. Human rhinovirus C is a newly identified genotype of HRV found in patients with respiratory tract infections. A study of children with acute asthma who presented to the emergency department found HRVC present in the majority of patients. The presence of HRVC was also associated with more severe asthma.

Approximately 80-85% of childhood asthma episodes are associated with prior viral exposure. Prior childhood pneumonia due to infection by respiratory syncytial virus, Mycoplasma pneumoniae, and/or Chlamydia species was found in more than 50% of a small sample of children aged 7-9 years who later had asthma. Treatment with antibiotics appropriate for these organisms improves the clinical signs and symptoms of asthma.

Assessment Of The Severity Of Asthma Attack

The severity of the asthma attack must be rapidly evaluated by the following clinical criteria. Not all signs are necessarily present.

Assessment of severity in children over 2 years and adults

Able to talk in sentences

Respiratory rate

Cannot complete sentences in one breathorToo breathless to talk or feed

Altered level of consciousness


Bradycardia in children or arrhythmia/hypotension in adults

SpO2 < 92%

Treatment and follow-up depend on the severity of the attack and the patients response:

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Signs And Symptoms Of Flare Up

Mild to Moderate


What can you do to prevent this happening again?

If you have had an asthma attack or ended up in a hospital or an emergency department, it means that your asthma is not under your control.

When youve had an asthma flare-up you need to see your doctor within 3 days to review your asthma and update your Asthma Action Plan to discuss:

  • What is your current level of asthma control how do we improve it?
  • How well are your asthma medicines working can we improve their use?
  • What triggered your asthma attack can you avoid the trigger, or how to respond better to the trigger next time to avoid an asthma attack?
  • Are there any other factors that might be affecting your asthma control how do we reduce their impact on your asthma?

For more support about managing asthma, talk to us. 1800 ASTHMA is a no-charge service open Monday-Friday, 9am-5pm. You can get in touch with us through phone, or by booking in a call-back.

To help get back on track after your visit to the emergency department or hospital after an asthma attack visit our after hospital page.

Complications Of Acute Asthma

Dealing with asthma attacks

If asthma is well controlled, it will usually have minimal impact on your lifestyle. However, an asthma attack can interfere with work, school, sleep, and recreational activities. Having poorly controlled asthma makes this worse.

In extreme circumstances, a severe asthma attack can result in death. Thankfully, the number of deaths due to asthma is declining. In 2016, asthma was an underlying cause of death in only 10 people per million. The chances of an asthma attack resulting in death increase with age.

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Canadian Paediatric Society Acute Care Committee

Members: Carolyn Beck MD,Kevin Chan MD , Laurel Chauvin-Kimoff MD , Kimberly Dow MD , Karen Gripp MD, Kristina Krmptoic MD, Marie-Pier Lirette MD , Kyle C McKenzie MD , Evelyne D. Trottier MDLiaisons: Laurel Chauvin-Kimoff MD, CPS Paediatric Emergency Medicine Section Sidd Thakore MD, CPS Hospital Paediatrics Section

How Can I Tell What Causes And Triggers My Asthma

Figuring out what was going on around you when you had an attack is the first step to identifying your triggers.

Your doctor may also do blood testing or ask you to use a device called a peak flow meter. It measures how much air you exhale and how quickly it comes out. It can alert you to changes in your breathing and the onset of asthma symptoms.

Ask your asthma doctor if using a peak flow meter would help you narrow down the causes of your asthma.

It can be tough to identify them all, and they can change. For example, you might not have been bothered by tree pollen when you were a child, only to have a problem with it as an adult.

Even when you know your triggers, you might have a hard time avoiding them in certain situations. For example, you may notice that your workplace is cleaned with a cleaning product that bothers your lungs.

Thatâs why itâs so important to work closely with the doctor who treats your asthma. They can help you think of strategies to avoid triggers, or at least cut down on the amount of time you spend near them. They can also make sure you have the right medication when an asthma attack does strike.

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