Recognising and Responding to Acute Asthma

Asthma is clinically defined as the combination of variable respiratory symptoms such as wheezing, shortness of breath, cough and chest tightness, and significant variation in lung function.

Asthma is a chronic disease that can be controlled but not cured.

In the event of an asthma attack, certain stimuli cause the smooth muscles of the bronchi to contract, causing the passage to narrow. The tissue lining of the airway swells as a result of inflammation and secretes mucus (Ortega and Genese 2019a). This narrowing of the airways is usually reversible.

A minor asthma attack can be treated at home with proper medications. A severe asthma attack requires medical intervention and has the potential to be a life-threatening emergency.

The most effective way of preventing an asthma attack is recognising and treating the early signs of an asthma flare-up. In order to do this, it is necessary to have in place and follow an asthma treatment plan that has been made in collaboration with a doctor (Mayo Clinic 2019).

This plan (detailed below) will detail steps to follow in the event that a person’s asthma worsens and what to do in the event of an asthma attack.

Asthma in Numbers

Roughly 1 in 9 Australians have asthma (2.7 million).

The prevalence of asthma is twice as high among First Nations people than it is for non-First Nations people, this gap is even wider in the older adult group.

Asthma is more common in people residing in lower socio-economic areas and more prevalent in regional and remote areas as opposed to major cities.

Fewer than 1 in 5 people over the age of 15 have a written asthma treatment plan (lowest for people aged 25-44) even though it is recommended that every person who has asthma has a written plan.

(ABS 2018; AIHW 2018; Asthma Australia n.d.)

Common Asthma Triggers

• Upper respiratory infections;
• Colds;
• Allergens;
• Cigarette smoke;
• Cold, dry air; and
• Exercise.

(Pietrangelo 2018)

Symptoms of Acute Asthma

Common symptoms of acute asthma include:

• Shortness of breath;
• Chest tightness or pain;
• Coughing;
• Wheezing;
• Low peak expiratory flow readings; and
• Asthma symptoms that do not respond to an inhaler.

(Mayo Clinic 2019)

Most asthma attacks occur in the early hours of the morning. This is generally the time when the effect of protective drugs has worn off and the body is least able to prevent the airway from narrowing (Ortega and Genese 2019a).

The symptoms of an asthma attack can vary from person to person, making it necessary for a person with asthma to work with their medical officer to identify their unique signs and symptoms (Mayo Clinic 2019).

Asthma Diagnosis

There is no single reliable test to form an asthma diagnosis. Commonly, a diagnosis of asthma is made based on:

• History;
• Physical examination;
• Consideration of other diagnoses;
• Documenting variable airflow limitation.

(National Asthma Council 2019)

The exact causes of asthma are unknown; it is likely asthma is the result of a combination of complex interactions between genes, environmental conditions and nutrition (Ortega and Genese 2019a).

Asthma Severity

Asthma ranges in severity. It is necessary for a person with asthma to know their asthma rating.

• Intermittent: Symptoms will be present two days per week or less and do not interfere with everyday life.
• Mild persistent: Symptoms will be present more frequently than two days a week and may slightly limit activities.
• Moderate persistent: Symptoms will be present daily and may limit some activities.
• Severe persistent: Symptoms will be present throughout the day and interfere excessively with daily life.

(Ortega and Genese 2019a)

Acute Asthma Diagnosis

Lung (pulmonary) tests are taken to evaluate how well a person’s lungs are functioning. Poor lung function indicates that asthma is not currently well-controlled (Mayo Clinic 2019).

Lung function tests include:

• Peak flow: This test measures how quickly a person can breathe out, known as peak expiratory flow (PEF). A peak flow test is performed by blowing into a mouthpiece as hard and as fast as possible in one breath.
• Spirometry: During spirometry, a person takes deep breaths and forcefully exhales into a hose connected to a machine called a spirometer. A typical spirometry measurement is forced expiratory volume, measuring how fast a person can breathe out in one second.
• Nitric oxide measurement: This measures the amount of nitric oxide gas a person has in their breath when they exhale. High nitric oxide readings indicate that a person’s bronchial tubes are inflamed.
• Pulse oximetry: A test that measures the amount of oxygen in their blood; this is measured through the fingernails.

(Mayo Clinic 2019)

When to Seek Emergency Medical Treatment

It is recommended that a person experiencing the following symptoms seek immediate medical attention:

• Severe breathlessness or wheezing, especially in the early morning or night;
• An inability or difficulty to speak because of shortness of breath;
• Having to strain chest muscles to breathe;
• Low peak flow readings; and
• No improvement after using a quick-acting (rescue) inhaler.

(Mayo Clinic 2019)

Asthma Action Plans

An individualised written asthma action plan is necessary for people who have asthma. It will be made in accordance with their treatment regimen, the severity of their asthma, culture, language, and their ability to self-manage.

A plan should involve the following:

• The person’s usual asthma and allergy medicines.
• Clear instructions on how to change medications.
• When and where to get medical care, including during an emergency.
• The name of the person preparing the plan.
• The date the plan was made.

(National Asthma Council 2019)

Asthma Treatment

Medicines used to treat asthma allow people to live normal lives. In many cases, the medicines used to treat an asthma attack can be used (in lower doses) to limit the occurrence of attacks.

The main medications used in asthma are:

• Relievers (short-acting ϐ2 agonists)
• Preventers:
• Non-steroidal preventers;
• Long-acting ϐ2 agonists (LABAs);
• Inhaled corticosteroids; and
• Biological agents.

(Gowan 2019; Ortega and Genese 2019b)

Asthma Prevention

It is strongly advised that people who have asthma learn their triggers and do their best to avoid these.

Other prevention tips include:

• Having an adequate supply of medications and to always follow instructions for these.
• Informing a doctor when medications are less effective or aren’t working.
• Paying attention to symptoms in the event of cold or flu.
• Seeking medical help immediately if an acute exacerbation is a possibility.

(Pietrangelo 2018)

Additional Resources

• National Asthma Council, Managing Asthma in Adults, https://www.asthmahandbook.org.au/management/adults
• Thunderstorm Asthma, https://www.ausmed.com.au/cpd/lecture/thunderstorm-asthma
• Asthma: Unlocking Inhaler Technique, https://www.nps.org.au/cpd/activities/unlocking-asthma-inhaler-technique?utm_source=Ausmed&utm_medium=Referral&utm_campaign=Recommended+Resources

References

• Asthma Australia n.d., Asthma Statistics and Facts, Asthma Australia, viewed 21 January 2020, https://asthma.org.au/about-asthma/understanding-asthma/statistics/
• Australian Bureau of Statistics 2018; National Health Survey: First Results 2017-18, ABS Cat no. 4364.0.55.001, Canberra: ABS
• Australian Institute of Health and Welfare (AIHW) 2018, Asthma Snapshot, Canberra: AIHW
• Gowan, J 2019, ‘All About COPD’, Ausmed, viewed 21 January 2020, https://www.ausmed.com.au/cpd/lecture/all-about-copd
• Mayo Clinic 2019, Asthma Attack, Mayo Clinic, viewed 20 January 2020, https://www.mayoclinic.org/diseases-conditions/asthma-attack/symptoms-causes/syc-20354268
• National Asthma Council 2019a, ‘Preparing Written Asthma Action Plans for Adults’, Australian Asthma Handbook, viewed 20 January 2020, https://www.asthmahandbook.org.au/management/adults/self-management/action-plans
• National Asthma Council 2019b, ‘Diagnosing Asthma in Adults’, Australian Asthma Handbook, https://www.asthmahandbook.org.au/diagnosis/adults
• Ortega, V and Genese, F 2019a, ‘Asthma’, MSD Manual, viewed 16 January 2020, https://www.msdmanuals.com/en-au/home/lung-and-airway-disorders/asthma/asthma
• Ortega V and Genese, F 2019b, ‘Drugs for Preventing and Treating Asthma’, MSD Manual, viewed 20 January 2020, https://www.msdmanuals.com/en-au/home/lung-and-airway-disorders/asthma/drugs-for-preventing-and-treating-asthma
• Pietrangelo, A 2018, ‘Acute Exacerbation of Asthma’, Healthline, viewed 16 January 2020, https://www.healthline.com/health/asthma/acute-asthma-exacerbation