Dealing with Worsening Asthma

Asthma is a variable condition, which means that symptoms are different between people, and symptoms in the same person are different during different points in time (i.e., over the course of a year). One of the goals of asthma treatment is to minimize this variability, and therefore have the best possible control of symptoms.

Your level of asthma control is dependent on the number of asthma symptoms that you experience regularly. Signs of uncontrolled asthma include:

• Daytime asthma symptoms more than twice/week
• Waking up at night from asthma
• Using your reliever medication more than twice/week
• Physical activity limitations due to asthma

There are 3 levels of asthma control:

• controlled - a person with controlled asthma does not experience any uncontrolled asthma symptoms in a given month.
• partly controlled - if you’ve noticed 1-2 signs of uncontrolled asthma over the past month, it means that your asthma is partly controlled.
• uncontrolled – your asthma is considered uncontrolled if you experience 3 or more signs of uncontrolled asthma in a month.
• But even if your asthma is controlled, you can still experience asthma attacks (exacerbations). Your risk may be increased if you have other risk factors, such as certain medical conditions or poor inhaler technique.

Asthma attacks are episodes of progressive increases in one or more of the following symptoms:

• shortness of breath
• cough
• wheezing
• chest tightness

During an asthma attack, poor lung function can also be reliably measured by peak expiratory flow rates or by other lung measurements at a doctor's office or laboratory. A decrease in your peak expiratory flow rate can signal an upcoming asthma attack even days before you experience any symptoms.

Asthma attacks can vary from mild to severe. Treatment for the attack will depend on the severity.

If you are being treated at an emergency department, you will be measured and monitored for the following:

• peak expiratory flow rates (only in people who are older than 5 years of age)
• pulse rate (how fast your heart is beating)
• respiratory rate (how fast you are breathing)
• pulse oximetry (how much oxygen is in the blood)

All material copyright MediResource Inc. 1996 – 2024. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Dealing-with-Worsening-Asthma

For some people, research has shown that a number of factors, sometimes known as "triggers," can lead to asthma attacks (exacerbations). These triggers can include:

• environmental allergens (e.g., dust mites, pets with fur, cockroaches, molds, pollen)
• infections caused by viruses
• pollutants (e.g., cigarette smoke, carbon monoxide, outdoor air pollution)
• food and medication additives (e.g., sulfites)
• medications (e.g., acetylsalicylic acid - Aspirin®, nonsteroidal anti-inflammatory medications, and beta-blockers)

A person who effectively avoids a trigger may have better control of their asthma, and they will have less need for rescue medication. As a result, they may also be able to successfully prevent an asthma attack.

Here are some tips on how to reduce your exposure to triggers:

• make changes in your indoor environment to minimize your exposure to allergens and pollutants known to cause symptoms
• consider getting a flu shot every year
• stop smoking
• limit your exposure to secondhand smoke
• reduce or eliminate your exposure to occupational irritants known to cause symptoms
• avoid additives, medications, and foods known to cause symptoms

Avoiding triggers is not the only answer, though. Since people with asthma may react to many triggers in their daily lives, it is not practical to completely avoid all factors. This is why the treatment plan is so important. People who have good asthma control are often less sensitive to triggers.

Ideally, people with asthma should be motivated to learn more about their condition, and should work with their health care team to write down a specific asthma action plan that is targeted towards their individual needs. Another part of the puzzle involves being adherent to asthma medications, in order to get the most benefit possible. Being adherent means using the medication exactly as your doctor prescribed it. Ask your health educator, doctor, nurse, or pharmacist about ways to simplify your treatment plan in order to make it easier for you to take your medications exactly as prescribed or intended.

Hopefully, all of these things will ultimately result in improved asthma control and fewer asthma attacks.

All material copyright MediResource Inc. 1996 – 2024. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Dealing-with-Worsening-Asthma

The severity of an asthma attack (exacerbation) will determine the course of treatment. Mild or moderate asthma attacks are generally treatable outside the hospital setting while severe attacks are usually treated in a hospital, where closer monitoring is possible.

Mild or moderate asthma attacks have the following features:

• peak expiratory flow rate of > 50% predicted or personal best
• elevated heart rate (between 100 to 120 beats per minute)
• ability to speak in phrases while sitting up, without agitation

On the other hand, those with severe asthma attacks may experience:

• peak expiratory flow rate to 50% or less of predicted or personal best
• elevated heart rate (above 120 beats per minute)
• only able to speak in words while hunched forward and agitated

The goals of managing asthma attacks are to:

• relieve any obstructions in airflow, as measured by a return to 60-80% (or higher) of predicted or personal best peak expiratory flow rate
• restore blood oxygen levels to normal
• prevent future attacks

The usual treatment for mild asthma attacks is repeated doses of a fast-acting bronchodilator, also called "reliever" medication. Ask your doctor how many puffs you should take, how often, and for how long. For example, a person might be instructed to take 2 to 4 puffs every 20 minutes for the first hour of a mild asthma attack, followed by 2 to 4 puffs every 3 to 4 hours. Make sure that you write your doctor's instructions down on your action plan, so that you know what to do in case of a mild asthma attack.

If a person’s peak expiratory flow rates falls under 60% of their personal best or does not improve after 48 hours after following their asthma action plan, they should speak to their doctor. In addition, people who have had a mild asthma attack should clarify with their health educator, doctor, nurse, or pharmacist that they are using their asthma medications (both controller and reliever) properly. Note that some people have their reliever and their controller medication together in a single inhaler. If this is the case for you, make sure you know how to use the inhaler correctly.

All material copyright MediResource Inc. 1996 – 2024. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Dealing-with-Worsening-Asthma

Some people are at higher risk of life-threatening asthma attacks and need closer supervision in the hospital. They should seek urgent care early in the course of their attacks. These individuals include those who:

• are currently not taking inhaled steroid medications
• are currently taking, or recently stopped, oral steroid medications
• have a history of psychiatric or psychosocial conditions
• have certain medical conditions such as diabetes or arrythmias
• have a history of near-fatal asthma needing emergency breathing assistance in the hospital (intubation and mechanical ventilation)
• have a history of not taking asthma medications or following their asthma action plan as prescribed
• have been hospitalized or had an emergency care visit for asthma in the past year
• highly use fast-acting inhaled bronchodilators, especially those who use more than one salbutamol inhaler (or equivalent) per month
• have both food allergies and asthma

Regardless of risk level, any person who thinks they may be having a severe asthma attack should see or contact their doctor immediately. They should also consider going to the nearest clinic or hospital that provides emergency care for people with acute asthma.

The usual treatments for severe asthma attacks are repeated doses of fast-acting bronchodilators, other inhalers or medications for asthma, steroid injections or pills given early in the treatment course, and oxygen.

During and immediately after an asthma attack, it may take some time for you to respond to the treatments. Your health care team will monitor you closely for improvements in lung function (peak expiratory flow rates or other lung function measurements). Once your lung function has stabilized, your doctor will decide whether to admit you to the hospital for more follow-up or discharge you to go home.

Individuals can be safely discharged after their peak expiratory flow rates stabilize or return to their previous personal best. Upon discharge, people who have had a severe asthma attack will likely also be given a prescription for an oral steroid medication, as well as an inhaled steroid if one was not being used previously. They will be educated about use of their inhalers, peak flow meters, and action plans. They will also be asked to see their regular doctor or asthma specialist for further follow-up.

All material copyright MediResource Inc. 1996 – 2024. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Dealing-with-Worsening-Asthma