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What Do Hospitals Do For Asthma Attacks

How To Recover From A Severe Asthma Attack

Asthma

Some tips to recover from a severe asthma attack include:

  • Rest: Having a severe asthma attack can be scary and stressful. The stress response can result in fatigue. It takes time and rest for your body to recover.
  • Book a follow-up appointment: This is an opportunity to ensure that your asthma action plan is as up-to-date and effective as possible. Your healthcare provider can review the conditions that led to your asthma attack and adjust your medications or make suggestions that can help you to avoid future attacks.
  • Take medications as prescribed: Poor adherence to medications has been identified as a trigger for asthma attacks and a factor that leads to a more difficult recovery. If you have questions or concerns about your medications, talk to your healthcare provider or pharmacist.
  • Do not overexert yourself: You may find yourself becoming tired after even a small amount of exercise or movement. This is common after a severe asthma attack. Give it time and listen to your body.

What Should I Know About Covid

If you have asthma that is moderate-to-severe, or if your asthma symptoms arent well controlled, youre at greater risk of having to be hospitalized if you get COVID-19. Therefore, you should wear a mask if you go to indoor spaces with other people, get vaccinated and avoid exposure to people who have the virus.

A note from Cleveland Clinic

Many people live fulfilling lives with asthma. Some professional athletes with asthma have set records in their sports. Your healthcare provider can help you find the best way to manage your asthma. Talk to your healthcare provider about how to control your symptoms.

Last reviewed by a Cleveland Clinic medical professional on 01/19/2022.

References

What Happens During An Asthma Flare

During a flare-up, you might have:

  • trouble breathing
  • a whistling sound when you breathe
  • a cough

Flare-ups happen when the in the lungs get more irritated and swollen than usual. Your lungs might make a sticky mucus, which clogs the airways. The muscles around the airways will also tighten up, making them really narrow. This clogging and narrowing make it tough to pull air in and push air out.

Some flare-ups are mild, but others are serious. If the flare-up is severe, a person might:

  • struggle to breathe or have fast breathing even when sitting still
  • not be able to speak more than a few words at a time without pausing
  • have retractions while breathing in

Flare-ups can happen suddenly. They also can build up over time, especially if you havent been taking your asthma medicine.

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Tips To Avoid Asthma Attacks

Although not all causes of asthma are known, there are certain risk factors that can lead to a respiratory crisis. The most important triggers are:

  • Pollution, tobacco smoke and dust mites.
  • Respiratory infections from colds and flu.
  • Allergies to animals, dust mites, grasses and spices, including dyes and preservatives.
  • Prescription drugs, pharmaceuticals and chemicals.
  • Exhaustive physical exercise, especially in dry and cold environments.
  • Other physical exertions that may stress the lungs, such as hysterical laughter or shrieking.
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Understanding An Asthma Attack

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Difficulty breathing is usually the first sign of an asthma attack. This is caused by inflammation in the airways that then stimulates a tightening of the surrounding muscles. When this occurs, a person can experience coughing spells, wheezing, a tightening of the chest, or an inability to move air out of the chest.

Many people mistakenly think asthma attacks always go hand-in-hand with wheezing, but this is not always the case, says Ernesto Ruiz-Huidobro, MD, an allergist at Allergy and Asthma Healthcare in Lake St. Louis, Missouri. To wheeze, you have to move air, so if they are really obstructed, they may not be moving air.”

Other symptoms may include a blue or gray tinge to the fingers or lips, difficulty speaking, or difficulty doing simple chores or other activities, according to the American Academy of Family Physicians .

“Asthma is extremely variable,” Dr. Ruiz-Huidobro says. And theres no average time for an asthma attack to last. While some are mild and can be managed at home, others require treatment at a hospital.

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Assessment Sheets And Treatment Protocols

One approach which has been used to facilitate clinical practice in accordance with guidelines is the implementation of assessment sheets and treatment protocols. When used in the emergency department, they have been shown to identify rapidly individuals at risk of an adverse outcome, ensure a high standard of management, facilitate the appropriate referral to respiratory wards and medical ICU and improve outcomes such as length of stay and number of subsequent return visits. Treatment protocols are traditionally limited to algorithm-based flow charts, but the addition of an assessment sheet facilitates their implementation. This is particularly the case with severe asthma in which management is determined by asthma severity and in which doctors seem to have major difficulties in following this approach.

A guideline-based asthma assessment and associated treatment algorithm is shown in figs 1 and 2. The assessment sheet is designed to encourage a quick focused history to identify baseline and acute risk, an objective assessment of asthma severity, and repeat clinical examination and measures of FEV1. The response to treatment can thus be assessed and a decision made on whether the patient requires admission or can be discharged. In this case, a structured approach is provided to address issues relating to long-term care and advice on when the patient should present again if their asthma deteriorates further.

    Figure 2

    What To Expect At The Hospital

    When you get to the hospital, the doctors will make sure that your symptoms are due to asthma, how severe it is, and whether you have any other conditions that could be involved, such as pneumonia.

    Your treatment in the hospital may include continuous use of an asthma nebulizer, and also supplemental oxygen and steroid medicine to stop the attack.

    The doctor may also give you a dose of magnesium sulfate, which youâd get by IV, to help the muscles around your airways relax. These arenât medicines that would be a normal part of asthma care — doctors just use them for emergencies.

    If medicines donât help, you may need a mechanical ventilator in an intensive care unit to help you breathe. Your doctors will insert a breathing tube into your nose or mouth to do this. These breathing aids are temporary. Your doctor will remove them once the attack ends and your lungs have recovered enough to breathe without the machineâs help.

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    What Can I Expect At The Hospital

    The doctor or nurse will check your oxygen level and give you more oxygen. He or she may check your peak flow and do a blood test. You may have to take other medicines, such as nebulizer treatments or steroids. The medicines may be given through an IV. You also may need to stay overnight in the hospital, depending on how bad your attack was and your response to treatment.

    Patient History And Waveform Capnography Help Identify Asthma Attacks

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    Asthma attacks can mimic other respiratory conditions. Wheezing from the lower airways can be difficult to distinguish from sounds caused by upper airway inflammation. Anxiety can trigger an asthma attack, but it can also cause hyperventilation with no bronchospasm. The sound of air passing, sometimes referred to as cardiac wheezes, through fluid-filled alveoli from pulmonary edema, can be made worse if misdiagnosed and treated as an asthma attack.

    Not all asthma attacks cause wheezing. Cough may be the only sign of an asthma attack, especially in exercise-induced and nocturnal attacks . Breath sounds may be diminished or absent in severe asthma attacks, which an ominous sign of decreased air movement through the lower airways.

    Waveform capnography is a valuable tool to differentiate an asthma attack from other causes of respiratory distress. The waveform represents air movement throughout the respiratory cycle, and is normally rectangular shaped. Bronchoconstriction causes air to be released unevenly from the alveoli, which makes the capnography waveform appear rounded, similar to a shark fin .

    The length of the waveform also represents the exhalation phase, which is prolonged during an asthma attack. The more severe the bronchoconstriction, the more pronounced the shark fin and length of the waveform. This can be seen even if the patient has diminished breath sounds and is not wheezing.

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    Is Your Childs Asthma Controlled

    Proper asthma control is key to staying healthy with asthma and preventing possibly life-threatening asthma attacks. Everyone with asthma should be able to achieve good asthma control. If your child is having trouble staying symptom-free or have any of the signs of poor asthma control listed below, we highly recommend speaking with your healthcare provider as soon as possible.

    Signs of Poor Asthma Control:

    • Frequent breathing difficulties, including coughing or wheezing most days
    • Asthma impacting sleep if asthma wakes your child up at night, their asthma isnt controlled
    • Inability to exercise without experiencing breathing difficulties
    • Relying on the reliever inhaler more than 3 times per week
    • Severe breathing difficulty or inability to wear a mask or face covering
    • Recent asthma attack or hospitalization

    When To Seek Medical Help

    You should seek medical help for an asthma attack if you experience any of the following:

    • You have had symptoms of a mild asthma attack for more than 24 hours, especially if you are using asthma medications.
    • You have a fever for more than three days.
    • You have a fever that disappears, only to return more than 24 hours later.

    After recovery from a severe asthma attack at home or after hospitalization, it’s recommended that you book an appointment with your healthcare provider to make sure your asthma action plan is adequate and you are not at risk for another attack.

    You should call 911 or go to the emergency room if any of the following occurs:

    • Your breathing difficulty, including wheezing, continues to worsen despite using a rescue inhaler.
    • You cannot talk normally due to shortness of breath, and it does not immediately begin to subside with a rescue inhaler.
    • You have bluish skin on your lips, face, fingertips, or around the eyes from cyanosis.
    • You cannot stop coughing.
    • You are using rescue medications more frequently than once every four hours.
    • You have a fever over 104 degrees.
    • You are experiencing moderate or severe symptoms and you do not have a rescue inhaler.

    If you experience worrisome symptoms that are not on this list, consult a healthcare provider as soon as possible.

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    Continue Using Rescue Medication As Instructed

    If your symptoms are severe, use your rescue medication while you wait for help. Follow the instructions that your doctor or pharmacist provided for using your rescue medication in an emergency. The maximum dosage will vary based on the medication.

    Do not hesitate to call for emergency help if youre experiencing asthma symptoms. An asthma attack can worsen quickly, especially in children.

    If youre admitted to a hospital emergency room with an allergic asthma attack, the most common treatments may include:

    • short-acting beta-agonists, the same medications used in a rescue inhaler and often given via a nebulizer
    • other types of bronchodilators to widen the bronchi
    • oral, inhaled, or injected corticosteroids to reduce inflammation in the lungs and airways
    • intubation to help pump oxygen into the lungs in severe cases

    Even after your symptoms stabilize, your doctor may want to observe you for several hours to ensure there isnt a subsequent asthma attack.

    Recovery from a severe allergic asthma attack can take anywhere from a few hours to several days. It depends on the severity of the attack. If there was damage to the lungs, ongoing treatment may be needed.

    Allergic asthma attacks are triggered by exposure to allergens. The symptoms can sometimes be confused with anaphylaxis, a systemic and other potentially life threatening condition.

    Anaphylaxis is a severe allergic reaction to allergens such as:

    • certain medications
    • foods like peanuts, eggs, or shellfish
    • ibuprofen
    • aspirin

    What Should I Do If I See Someone Having An Asthma Attack

    Deaths From Asthma
    • Sit them up straight dont let them lie down. Try to keep calm.
    • Get the person to take one puff of their reliever inhaler every 30-60 seconds, up to a maximum of 10 puffs.
    • If they feel worse at any point while using the inhaler or if they dont feel better after 10 puffs, call 999 for an ambulance.
    • If the ambulance is taking longer than 15 minutes repeat step 2.
    • If the sufferers heart stops beating, then you need to administer CPR until the ambulance arrives.

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    Personal Asthma Action Plan

    As part of your initial assessment, you should be encouraged to draw up a personal asthma action plan with your GP or asthma nurse.

    If youve been admitted to hospital because of an asthma attack, you should be offered an action plan before you go home.

    The action plan should include information about your asthma medicines, and will help you recognise when your symptoms are getting worse and what steps to take. You should also be given information about what to do if you have an asthma attack.

    Your personal asthma action plan should be reviewed with your GP or asthma nurse at least once a year, or more frequently if your symptoms are severe.

    As part of your asthma plan, you may be given a peak flow meter. This will give you another way of monitoring your asthma, rather than relying only on symptoms, so you can recognise deterioration earlier and take appropriate steps.

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    Treatment Goals: Open Constricted Airways Dry Secretions And Reduce Inflammation

    Nebulized albuterol, connected to oxygen at 6-8 LPM, is the first EMS treatment for asthma. Albuterol stimulates beta-2 receptor sites to causes rapid bronchodilation. Ipratropium bromide can be mixed with albuterol in a nebulizer, which causes bronchodilation and inhibits mucus secretion by inhibiting the vagal response. Both can be administered until the patients symptoms improve .

    Corticosteroids decrease inflammation from an asthma attack. Methylprednisolone can be administered intravenously or intramuscularly, and prednisone can be administered orally. The onset for both medications is four to six hours, so they should be administered along with bronchodilators and deferred if urgent airway management is needed . Despite the long onset of action, one study found in-hospital delays of steroid administration to asthma patients, and a lower hospital admission rate among patients who received methylprednisolone from EMS .

    CPAP is a treatment option for moderate to severe asthma attacks. CPAP increases the pressure that the patient exhales against, which pushes open lower airways and improves gas exchange . Nebulized bronchodilators should be administered through CPAP, which provides an air-tight seal to help direct medication into the lower airways.

    Magnesium sulfate may help patients with severe asthma attacks in addition to nebulized bronchodilators and CPAP. It works by relaxing smooth bronchial muscles, and is administered as an IV infusion over 20 minutes .

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    What Should I Do If I Have A Severe Asthma Attack

    A severe asthma attack needs immediate medical care. The first step is your rescue inhaler. A rescue inhaler uses fast-acting medicines to open up your airways. Its different than your normal maintenance inhaler, which you use every day. You should only use the rescue inhaler in an emergency.

    If your rescue inhaler doesnt help or you dont have it with you, go to the emergency department if you have:

    • Anxiety or panic.

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    How To Prevent Asthma Attacks

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    To prevent asthma flare-ups from happening in the first place, make sure your child takes the prescribed controller medicine as directed. This is the medicine that controls the inflammation and tightness of the airways.

    “Most children with an asthma diagnosis, especially those with moderate to severe asthma, take their controller medicine every day, sometimes twice a day,” says Dr. Afolabi.

    If your child has allergies, take steps to help your child avoid exposure:

    • Relocate dogs and cats

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    Contact Doctor During Office Hours

    • Dont have written asthma action plan from your doctor
    • Use an inhaler, but dont have a spacer
    • Miss more than 1 day of school per month for asthma
    • Asthma limits exercise or sports
    • Asthma attacks wake child up from sleep
    • Use more than 1 inhaler per month
    • No asthma check-up in more than 1 year
    • You have other questions or concerns

    Prepare Your Child For September Asthma Peak

    The 2021-2022 back to school season will be difficult for both students and teachers living with asthma. As schools operate during COVID-19, there are additional aspects of asthma management to consider.

    Asthma Canada has gathered recommendations to help our community prepare for the back to school season and September Asthma Peak to protect those living with asthma.

    Schedule an asthma check-up with your health care provider before return-to-school, even if its just a virtual appointment to review your childs inhaler technique. Develop or update a written Asthma Action Plan with your health care provider, and make sure to provide a copy to your childs school.

    Speak with your childs school about their asthma policies including inhaler use and make sure policies are in place to create a trigger-free environment for learning, exercise and play.

    Ensure that your child has their reliever medication on hand or accessible at all times. Read more about Ryans Law.

    Make sure you child is taking their asthma medications as prescribed and dont stop unless advised by their healthcare provider to do so.

    Refill or renew your childs asthma medication prescriptions. We recommend having a 30-day supply of medication on hand.

    Demonstrate correct hand washing technique and explain the importance of frequent hand washing always, but especially during the pandemic.

    Teach your children healthy ways to cope with stress and anxiety. Strong emotions and anxiety can trigger an asthma attack.

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