Signs And Symptoms Of Asthma Exacerbation

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Nursing interventions with rationales for Asthma Anxiety

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What Types Of Asthma Are There

Healthcare providers identify asthma as intermittent or persistent . Persistent asthma can be mild, moderate or severe. Healthcare providers base asthma severity on how often you have attacks. They also consider how well you can do things during an attack.

Asthma can be:

• Allergic: Some peoples can cause an asthma attack. Molds, pollens and other allergens can cause an attack.
• Non-allergic: Outside factors can cause asthma to flare up. Exercise, stress, illness and weather may cause a flare.

How To Avoid Asthma Triggers

If you know what your asthma triggers are, then where possible, its beneficial to try to avoid them.

If theres a particular allergen culprit you know of, then keeping your home clean and dust-free can help. For example, you could consider swapping carpets for wooden floors to reduce the amount of dust build-up or hiring a cleaner so youre not personally exposed to dust when cleaning.

It can be more difficult to avoid asthma triggers completely when youre at work, especially if your asthma is occupational and linked to your working environment. In an ideal world, you could simply change jobs to something more suitable for your health, but in reality this isnt always feasible.

Let your employer or the HR department know about your asthma. You should be able to discuss the options available for optimising your work environment to be more suitable to your needs.

Keeping on top of your asthma management plan, working alongside your doctor or asthma nurse and making sure you take your inhalers or other asthma medications should help to control your symptoms. Making practical lifestyle choices is important too, like eating healthily, exercising and not smoking.

It can also be beneficial to learn an asthma breathing technique. There are various breathing techniques that can help asthma and knowing how to breathe properly could help if something unexpectedly triggers an attack.

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When To See A Healthcare Provider

If you haven’t yet been diagnosed with asthma, see your healthcare provider if you have frequent wheezing or coughing that lasts for more than a few days.

If you are diagnosed with asthma, you will then work on keeping your condition under control and monitoring your condition to see if it is getting worse rather than better. When asthma is not well controlled, you can likely expect to experience one or more of the following:

• You become more aware of your wheezing.
• You develop a cough that won’t go away.
• You cough more at night or in cold weather.
• You cough or wheeze with physical activity.
• You get less relief from quick-relief medications.
• You have more trouble falling asleep or getting a good night’s rest.
• You get tired more easily than usual.
• Your allergy symptoms worsen.
• You are less able to identify when an attack is about to begin.
• You have a downturn in your peak expiratory flow rate .

If you have any of these symptoms, see your healthcare provider to determine whether there have been significant changes in your respiratory health. Spirometry and other tests may be used to evaluate the extent of these changes and what, if any, changes to your treatment plan need to be made.

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.

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Treatment Of Acute Asthma Exacerbation

The goal of asthma exacerbation treatment is to relieve symptoms and return patients to their best lung function. Treatment includes

• Inhaled bronchodilators

• Usually systemic corticosteroids

Details of the treatment of acute asthma exacerbations Treatment of Acute Asthma Exacerbations The goal of asthma exacerbation treatment is to relieve symptoms and return patients to their best lung function. Treatment includes Inhaled bronchodilators … read more , including of severe attacks requiring hospitalization Hospitalization The goal of asthma exacerbation treatment is to relieve symptoms and return patients to their best lung function. Treatment includes Inhaled bronchodilators … read more , are discussed elsewhere.

Prehospital Management Of Asthma Exacerbations

The Expert Panel recommends that emergency medical services providersadminister supplemental oxygen and SABA to patients who have signs or symptomsof an asthma exacerbation .

Prehospital administration of SABA reduces airflow obstruction and relieves symptoms. Ideally, all EMS providers wouldreceive a standing order to allow them to provide albuterol to their patients whohave asthma exacerbations. Such an order would be consistent with their legallyauthorized scope of practice and local medical direction . In such settings, EMS providers should haveavailable a nebulizer and/or an inhaler plus spacer/holding chamber for SABAadministration .If these are not available, subcutaneous epinephrine or terbutaline should be givenfor severe exacerbations .

DOSAGES OF DRUGS FOR ASTHMA EXACERBATIONS Notes:

When initiating bronchodilatory use, EMS personnel should not delay transport of thepatient to the appropriate medical facility. The treatment, however, may be repeatedwhile transporting the patient. Prolonged transport times maynecessitate multiple inhaled SABA treatments before arrival at the medical facility. Patients shouldreceive a maximum of three inhaled SABA treatments in the first hour, and then oneper hour thereafter . After each treatment, EMS personnel should reassess andrecord the patient’s vital signs and lung sounds.

MANAGEMENT OF ASTHMA EXACERBATIONS: EMERGENCY DEPARTMENT ANDHOSPITAL-BASED CARE

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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.

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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Is There Anything I Can Do To Prevent An Attack

Theres no way to completely prevent severe asthma attacks if you have asthma. However, there are several things you can do to greatly reduce your risk of having one.

The most important step is sticking with the treatment plan recommended by your doctor. Even if your symptoms seem to be improving and you arent having any attacks, dont stop any treatments until your doctor tells you to do so.

Other preventive measures you can take include:

• Using a peak flow monitor. This is a portable device that measures how much air comes out of your lungs when you quickly exhale. Keep track of your readings to see if you notice any patterns. Buy a peak flow monitor here.
• Monitoring your triggers. Try to keep a running list of certain situations or activities that often accompany your attacks. This can help you avoid them in the future.
• Carrying an extra inhaler. Always keep an extra inhaler with you for emergencies. If youre traveling, bring some extra medication with you.
• Talking to friends and family. Tell those close to you how to recognize the signs of a severe asthma attack and why they should take you to a hospital if they notice them. People who dont have asthma might not realize how serious your condition is.

Acute Asthma Prognosis And Treatment

Most recent update: July 2021Originally Posted: September 2004

Division of Allergy and Immunology,University of South Florida Morsani College of MedicineJames A. Haley Veterans’ HospitalTampa, FL 33612

Professor of Medicine, Pediatrics and Public HealthDirector, Division of Allergy and ImmunologyJoy McCann Culverhouse Chair in Allergy and ImmunologyUniversity of South Florida Morsani College of MedicineJames A. Haley Veterans’ HospitalEmail: rlockey@health.usf.edu

Michael A. Kaliner, MD FAAAAIMedical Director, Institute for Asthma and AllergyChevy Chase and Wheaton, MarylandProfessor of Medicine, George Washington University School of MedicineWashington, DC

Professor of Medicine, Pediatrics and Public HealthDirector of the Division of Allergy and ImmunologyJoy McCann Culverhouse Chair of Allergy and ImmunologyUniversity of South Florida College of Medicine and the James A. Haley Veterans’ HospitalTampa, FL

Abstract

Key words: Asthma flare Acute asthma Asthma attack Wheezing Acute asthma diagnosis Acute asthma management

Abbreviations

EPR-3 – The Expert Panel Report 3EPR-4 The Expert Panel Report 4FeNO Fractional Exhaled Nitric OxideOCS – Oral corticosteroidsCOPD – Chronic obstructive pulmonary diseasePEF – Peak expiratory flowSABA – Short acting beta agonistAE Adverse eventsFVC- Forced vital capacity

Introduction

1. Recognition of patients who are at a greater risk for near-fatal or fatal asthma.

Physical Examination

Differential Diagnosis of Acute Asthma

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Why Is My Asthma Worse At Night

Asthma that gets worse at night is sometimes called nighttime asthma or nocturnal asthma. There are no definite reasons that this happens, but there are some educated guesses. These include:

• The way you sleep: Sleeping on your back can result in mucus dripping into your throat or acid reflux coming back up from your stomach. Also, sleeping on your back puts pressure on your chest and lungs, which makes breathing more difficult. However, lying face down or on your side can put pressure on your lungs.
• Triggers in your bedroom and triggers that happen in the evening: You may find your blankets, sheets and pillows have dust mites, mold or pet hair on them. If youve been outside in the early evening, you may have brought pollen in with you.
• Medication side effects: Some drugs that treat asthma, such as steroids and montelukast, can affect your sleep.
• Air thats too hot or too cold: Hot air can cause airways to narrow when you breathe in. Cold air is an asthma trigger for some people.
• Lung function changes: Lung function lessens at night as a natural process.
• Asthma is poorly controlled during the day: Symptoms that arent controlled during the day wont be better at night. Its important to work with your provider to make sure your asthma symptoms are controlled both day and night. Treating nighttime symptoms is very important. Serious asthma attacks, and sometimes deaths, can happen at night.

Hows An Acute Exacerbation Of Asthma Diagnosed

If youve had an acute exacerbation before, youll probably recognize the symptoms. Your doctor will be able to make a quick diagnosis.

If its your first acute exacerbation, your doctor will need to know your medical history, particularly your history of asthma. To make a proper diagnosis, your doctor will likely perform a physical exam and a test of your lung function.

There are several tests that may be used to see how well your lungs are working:

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What Are Common Asthma Attack Triggers

You can have an asthma attack if you come in contact with substances that irritate you. Healthcare providers call these substances triggers. Knowing what triggers your asthma makes it easier to avoid asthma attacks.

For some people, a trigger can bring on an attack right away. For other people, or at other times, an attack may start hours or days later.

Triggers can be different for each person. But some common triggers include:

What Happens If An Asthma Attack Goes Untreated

Without immediate asthma medicine and asthma treatment, your breathing may become more labored, and wheezing may get louder. If you use a peak flow meter during an asthma attack, your reading will probably be less than your personal best.

As your lungs continue to tighten during the asthma attack, you may be unable to use the peak flow meter at all. Gradually, your lungs may tighten so much during the asthma attack that there is not enough air movement to produce wheezing. This is sometimes called the “silent chest,” and it is a dangerous sign. You need to be taken to a hospital immediately with a severe asthma attack. Call 911 for help. Unfortunately, some people interpret the disappearance of wheezing during the asthma attack as a sign of improvement and fail to get prompt emergency care.

If you do not receive adequate treatment for an asthma attack, you may eventually be unable to speak and can develop a bluish coloring around your lips. This color change, known as “cyanosis,” means you have less and less oxygen in your blood. Without immediate aggressive treatment in an emergency room or intensive care unit, you may lose consciousness and eventually die.

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Who Strategy For Prevention And Control Of Asthma

Asthma is included in the WHO Global Action Plan for the Prevention and Control of NCDs and the United Nations 2030 Agenda for Sustainable Development.

WHO is taking action to extend diagnosis of and treatment for asthma in a number of ways.

The WHO Package of Essential Noncommunicable Disease Interventions was developed to help improve NCD management in primary health care in low-resource settings. PEN includes protocols for the assessment, diagnosis, and management of chronic respiratory diseases , and modules on healthy lifestyle counselling, including tobacco cessation, and self-care.

Reducing tobacco smoke exposure is important for both primary prevention of asthma and disease management. The Framework Convention on Tobacco Control is enabling progress in this area as are WHO initiatives such as MPOWER and mTobacco Cessation.

Side Effects Of Steroid Tablets

Oral steroids carry a risk if they are taken for more than three months or if they are taken frequently . Side effects can include:

• muscle weakness

With the exception of increased appetite, which is very commonly experienced by people taking oral steroids, most of these unwanted effects are uncommon.

However, it is a good idea to keep an eye out for them regularly, especially side effects that are not immediately obvious, such as high blood pressure, thinning of the bones, diabetes and glaucoma.

You will need regular appointments to check for these.

Read further information:

• Asthma UK: side effects of asthma medicines

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How To Prevent An Asthma Attack

Preventing an asthma attack is easier to do if you know what triggers your asthma.

Avoidance of the triggers can help prevent an asthma attack in many cases, says David Stempel, MD, Senior VP of Clinical and Medical Affairs at Propeller Health. Asthma attacks can be further mitigated by taking preventative medications such as inhaled corticosteroids and in some cases using a short-acting bronchodilator, like albuterol, 15 minutes prior to exposure to a trigger like exercise.

How Do Healthcare Providers Diagnose Asthma

Your healthcare provider will review your medical history, including information about your parents and siblings. Your provider will also ask you about your symptoms. Your provider will need to know any history of allergies, eczema and other lung diseases.

Your provider may order spirometry. This test measures airflow through your lungs and is used to diagnose and monitor your progress with treatment. Your healthcare provider may order a chest X-ray, blood test or skin test.

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Monitoring Response To Treatment

Guidelines recommend office use of spirometry to measure airflow limitation and assess impairment and risk. Spirometry should be repeated at least every 1 to 2 years in patients with asthma to monitor disease progression, and a step-up in therapy might be required if lung function declines or becomes impaired with evidence of increased airflow obstruction . Outside the office, home peak expiratory flow monitoring, in conjunction with patient symptom diaries and the use of an asthma action plan, is especially useful for charting disease progression and response to treatment in patients with moderate to severe persistent asthma. When asthma is quiescent, one PEF measurement in the morning suffices. Should PEF measurements fall to < 80% of the patients personal best, then twice/day monitoring to assess circadian variation is useful. Circadian variation of > 20% indicates airway instability and the need to re-evaluate the therapeutic regimen.

Can Asthma Be Prevented

Asthma cant be prevented entirely, but there are some practical ways to reduce the risk of an asthma attack and live well with asthma.

• Get vaccinated for influenza: flu and other respiratory viruses are common triggers for asthma.
• Manage any allergies: asthma and allergies are closely linked, so treating allergic rhinitis and avoiding or managing any allergy triggers will help with your asthma.
• Live smoke-free: quit smoking if you smoke, and avoid any second-hand smoke .
• Eat well: a balanced diet helps you to maintain a healthy weight. Being overweight or obese makes asthma harder to manage.
• Care for yourself: mental health and asthma are linked, so let a trusted friend or your doctor know if you have been feeling sad or anxious, or dont enjoy things as much as before.
• See your doctor regularly: asthma needs to be regularly assessed and managed, and your medication needs may change over time. Ensure your asthma action plan is up to date by checking in with your doctor regularly.

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