A 13-year-old Western Cape girl died en route to hospital after an asthma attack last week.
Asthma is not a condition that should be taken lightly. If not properly managed, it costs lives. What triggers asthma attacks and when should you be rushed to the trauma unit of the hospital?
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What are the triggers?
Although doctors are still not certain how a person develops asthma, they do know that the lungs can overreact to things (referred to as triggers) which can start an asthma attack. This is why one of the best ways to prevent an attack is to understand what the triggers are.
These include:
Colds. Usually viral ones can exacerbate the asthma symptoms.
Allergies. House dust-mites, grass/tree pollens, skin flakes from animals.
Pollution. Cigarette smoke, car exhaust fumes and certain chemical gases.
Sport/ exercise. In cold weather especially, but this can be controlled through medication.
Emotion.These include excitement, fear, anger, laughter.
Drugs.Aspirin and some anti-inflammatory medication could lead to an asthma attack.
Types of attacks vary
Dr Mike Levin, a paediatrician, treasurer of the National Asthma Education Programme and member of the Allergy Society of South Africa, said that there are a number of different questions which determine how long a patient has before it’s too late.
“Basically, if you are using your reliever and you have an acute attack, use the reliever for two puffs. If it’s very bad or that didn’t work, use five to 10 puffs in a row. If this still doesn’t work, you need to get to hospital – but remember to take your pump with you and keep giving yourself five to 10 puffs along the way.”
He said, “It’s not about how long you’ve got, it’s about how bad the attack is and how the patient is responding to the treatment.”
The American Lung Association (ALA) describes asthma attacks as severe, moderate or mild.
Severe attacks lead to breathlessness, trouble with talking, neck muscles becoming tight during breathing, lips and fingernails turning grey or blue and skin becoming tight around the ribs.
In the case of a severe asthma attack, they recommend that asthma medication should be taken as prescribed. Emergency assistance should then be called for immediately.
In more moderate and mild attacks, which are in fact the more common type; there is a tightness in the chest, coughing up of mucus, a feeling of restlessness and often trouble sleeping, with a wheezing or whistling sound when breathing.
The ALA stated that in the case of a moderate/ mild attack, again asthma medicine prescribed for an attack should be taken, as this should open up the airways in the lungs in minutes. If it doesn’t work, the doctor should be called.
Watching for the second wave
According to the ALA, in some cases when the attack appears to have eased up, a second wave, which is more dangerous, can hit.
This happens when the airways continue to swell and this can last for days or even weeks. It can also happen even if there are no asthma symptoms and can even trigger more attacks as the lungs become more sensitive to other irritants.
The second wave often sees patients admitted to hospital and given medicine to reduce the swelling in the air tubes and relax the tightened muscles.
Controlling asthma
The Global Initiative for Asthma (GINA) claimed that more than 300 million people are affected by asthma worldwide and added that the primary goal of asthma care is to “achieve and maintain control of the clinical manifestations of the disease for prolonged periods”.
“When asthma is controlled, patients can prevent most attacks, avoid troublesome symptoms day and night, and keep physically active.”
They suggest four types of therapy to reach these goals. These include:
Developing patient/doctor partnership
Identifying and reducing exposure to risk factors
Assessing, treating and monitoring the asthma, and
Management of asthma exacerbations (such as being around people who smoke).
However, although there are treatments available for asthma, they point out that there are a few things one should not do to treat asthma:
Sedatives should be strictly avoided
Mucolytic drugs (which breakdown substances containing mucous) can worsen the cough
Physical therapy/physiotherapy on the chest may increase the discomfort
Hydration with volumes of fluid for adults and older children
Antibiotics do not treat attacks but are sometimes prescribed if the patient also has pneumonia or a bacterial infection
Epinephrine/adrenaline medication.
Back to basics
However, whatever the trigger or treatment, it is important that a plan is in place in case of an emergency in which the family, friends, teacher or colleagues of the asthma sufferer know what to do and who to call.
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