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Asthma is a chronic inflammatory disorder in which the respiratory tract is hyper-responsive to certain stimuli, which can result in constriction of the airways, bronchospasms, wheezing and shortness of breath. Usually, asthma develops in early childhood and is associated with a family history of asthma or other allergic diseases. Asthma patients are generally able to live normal lives with the use of daily inhaled medicines; however, sometimes, exacerbations or attacks of asthma can occur.

Although some symptoms of breathlessness upon exertion are normal in asthmatic patients, sometimes, acute attacks can occur where there is a severe tightening of the airways. Asthma attacks are medical emergencies that need quick first aid and transport of the patient to the nearest hospital.

  1. Recognising an asthma attack
  2. What to do in case of an asthma attack
  3. Complications of asthma attacks

Asthma attacks can appear as:

  • Difficulty breathing
  • Gasping and severe shortness of breath
  • Wheezing and coughing
  • A sensation of tightness of the chest, it may feel like a band is tightening around it
  • A rapid heartbeat and palpitations
  • Difficulty speaking, shown through short sentences and whispering. In mild attacks, the patient is able to speak in short sentences but in severe attacks, only phrases or words may be uttered.
  • Loud wheezes are heard in severe asthma attacks
  • Emotional distress, panic and anxiety
  • Grey-blue tinge to the lips, earlobes and nail beds can be present due to developing hypoxia and falling SpO2 levels
  • Exhaustion, in the case of a severe attack
  • Drowsiness and loss of consciousness is possible in severe attacks 
  • The disappearance of loud wheezing and a silent chest is indicative of life-threatening asthma

An asthma attack can occur anywhere and at anytime. First aid can be life-saving, especially when the time taken to reach the nearest hospital is long. The four steps to follow to give first aid during an asthma attack (4x4x4 method) are as follows:

  • Calm the patient down and make them sit upright to assist the opening of the airway.
  • Assist the patient to use their inhaler to take puffs of their medicine (Salbutamol, a short-acting beta-agonist). Take the time to attach a spacer device, if available, to the inhaler as this will deliver the medicine more effectively. Shake the inhaler, put one puff into a spacer at a time and get the person to take four breaths of each puff through the spacer. If a spacer is not available, simply shake the inhaler and give the patient four puffs directly.
  • Wait for four minutes following four breaths or puffs of salbutamol inhaler. If the patient does not improve, repeat step 2.
  • If the patient does not improve or deteriorates, call for an ambulance or alternate transport to the hospital while continuing to give 4 puffs of the inhaler to the patient every four minutes till medical assistance is available.
  • Continue to assess the patient as they are transported to the hospital. Keep a count of the breaths they’re taking per minute if possible.
  • Try to keep the patient awake and alert.
  • Sometimes anaphylaxis can appear similar to asthma attacks. If one cannot be differentiated from the other, asthma first aid should be continued as no significant complications can arise from inhaled salbutamol use in such a case. However, if the patient has known allergies and has an EpiPen (adrenaline or epinephrine auto-injector), it should be used as well immediately.

(Read more: Ayurvedic Treatment, Medicines, Remedies, Herbs for Asthma)

So to surmise the key steps of asthma attack first aid (4x4x4 method) - calm and sit the patient upright, give them 4 puffs of their regular salbutamol (short-acting beta agonist) inhaler (with or without a spacer), allow them to take 4 breaths, wait for 4 minutes and reassess. If there is no improvement, continue to give 4 puffs of salbutamol inhaler every 4 minutes whilst making way to the hospital.

(Read more: Asthma in children)

At the hospital, the patient is assessed quickly and, if oxygen concentrations are below normal, high concentration oxygen is started with a mask. Treatment with short-acting beta-agonists (eg. salbutamol) is continued, either with an inhaler or nebuliser. Other inhaled medicines may be needed. If the asthma attack still remains uncontrolled, intravenous, inhaled and/or oral corticosteroids need to be initiated. Other reserve drugs like aminophylline and magnesium sulphate may be resorted to. Failure to respond to medicine necessitates the use of endotracheal intubation and mechanical ventilation. If the respiratory arrest occurs, immediate intubation becomes necessary.

Status asthmaticus, or asthma attacks, can lead to many complications of varying severity. Examples include:

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