Asthma – Status Asthmaticus

Asthma is a chronic respiratory disorder in which a person experiences difficulty in breathing, accompanied by wheezing and a “tight” chest. Additional symptoms can be a dry cough and vomiting (usually in children). An asthma attack may start suddenly; the fear and worry that this causes can prolong the attack.

Question: What causes asthma attacks?

Asthma attacks are caused by a narrowing of the small bronchial tubes in the lungs. The most common kind of asthma (allergic bronchial asthma) is caused by an allergic reaction. Many pollens, molds, dusts (especially dust containing the house mite), and animal hair and dander can cause allergic-type asthma attacks.

Asthmatic symptoms are sometimes associated with hay fever. Infection in the respiratory system, exposure to cold, exercise, fatigue, irritating fumes, and certain emotional and psychological states can all trigger an asthma attack. These conditions may also serve as secondary factors that increase the severity or frequency of attacks. Asthma from these causes may occur in people who have no history of allergic reactions, as well as in those who do.

Question: How does asthma interfere with breathing?

Air passes through the lungs via tubes (called bronchi) and smaller vessels (bronchioles). With asthma, the smaller bronchi and bronchioles become swollen and clogged with mucus, and the muscles surrounding the bronchioles contract so that the air that should pass through is unable to do so. The body reacts to the lack of oxygen, and the patient forces more and more air into the lungs. But, because of the blockages, there is difficulty in exhaling it. The wheezing noise is caused by air being forcibly exhaled through the narrowed bronchi.

Question: How long does an asthma attack last?

An attack of asthma may last for a few minutes, but most go on for several hours. A severe, prolonged attack (a form of asthma known as status asthmaticus) may last for a number of hours or even days. A person with status asthmaticus requires hospitalization.

Question: What immediate help can be given to a person suffering from asthma?

With more severe attacks it is important that the patient sit up-right, either in a chair or in bed, propped up by pillows. A table in front of the patient is useful; this can be grasped and the arm muscles used to assist breathing. A patient is rarely hungry, but should be encouraged to drink large amounts of liquids. Bronchial dilator inhalants from aerosol cans may be helpful in relaxing the muscles of the bronchioles. These are available by prescription and must be used according to a physician’s direction. Severe episodes of asthma require immediate medical attention.

Question: How does a physician treat asthma between attacks?

The goal is to prevent an attack by keeping the bronchi and bronchioles from becoming narrowed. Theophylline, or such adrenergic drugs as epinephrine and isoproterenol, can relieve bronchospasms and, thus, help to prevent bronchial obstruction. (These drugs can also be used during an asthma attack.) Corticosteroids may be useful for short-term relief in severe cases. A new type of inhalant drug, cromolyn sodium (disodium cromoglycate or DSCG), has also proven successful in preventing asthmatic attacks in some persons. The proper drug or combination of drugs will depend upon the prescribing physician as well as the course of the disorder.

Question: What is the treatment for severe asthma (status asthmaticus)?

An attack of status asthmaticus requires hospitalization and urgent treatment. Some drug treatments are best administered as a mist through a breathing apparatus. Strong bronchodilators can relieve the attack by relaxing the spasms in the bronchioles. In this situation the patient may be attached to a mechanical respirator to aid breathing.

Question: Apart from taking the appropriate drugs, what other precautions can be taken to prevent an asthma attack?

Several simple measures can reduce the risk of attack. The appropriate medication should be taken prior to events known to trigger an episode-before exercise, for example. A person with allergic asthma should sleep in a room without carpets or rugs. Blankets and pillows of synthetic fiber reduce the risk of house dust and mites. In dry climates, a humidifier can be used to increase the moisture content of the air in the room.

For patients in whom asthma is caused by respiratory infection, breathing exercises may be of value. A respiratory therapist can teach the patient the most appropriate ones. These exercises are not only a psychological help in preventing an attack, but when a minor respiratory infection does occur, the lungs should function more efficiently. An asthmatic patient should seek medical advice promptly when suffering from a respiratory infection.

Question: Are there any complications involved with chronic asthma?

Because so much air is held in the lungs during an asthma attack, the air sacs (alveoli) can become so stretched that the cell walls may tear. This damage causes a gradual loss of elasticity in the lungs and can lead to the condition known as emphysema. If the patient coughs too much, the surface of a lung may burst, causing the air to escape into the cavity that encloses the lung (pleural cavity). This condition is known as a pneumothorax.

Other complications can arise from the mucous secretions that do not drain properly during an asthma attack. This can lead to bronchitis and sometimes bronchial pneumonia. Frequent attacks may result in chronic bronchitis.

Question: What other disorders might be confused with asthma?

A disorder mistakenly known as cardiac asthma has symptoms similar to asthma (gasping for breath, a “tight” chest), but is actually a type of heart disease. Immediate medical attention is required.

Question: Can asthma be cured completely?

Asthma cannot be cured. The possibility of future attacks can, however, be minimized by drugs and other preventives, but if a person is disposed to asthma, there is always a chance that an attack will occur.

Question: Is asthma common in children?

Asthma is fairly common in childhood, usually first occurring between the ages of three and eight. Most attacks are an allergic reaction to airborne pollen, certain foods, animal hair, and some other substances. The majority of children with asthma are from families with a history of the illness. Before puberty, asthma occurs more often among boys than girls; after puberty, the incidence is fairly equal between the sexes. Medical treatment includes teaching a child and his or her parents how to detect symptoms of an attack and how to use prescribed medications. Emotional stress can often trigger an asthma attack; children with emotional problems may thus require some form of psychological support.