Asthma Crises (Asthma Attacks)

Definition and Causes

The asthma crisis can be defined as a sudden worsening of the symptoms of asthma, which arise quite intensely, causing severe breathing difficulties.

Asthmatic crises are related to the contraction of the muscles that form the wall of the bronchi and the consequent reduction of the space where the air circulates (bronchoconstriction); moreover, the inside of the bronchi swells and inflames, producing a thick mucus which constitutes further obstacle to the free circulation of air.

All these factors - bronchospasm, inflammation and mucous hypersecretion, responsible for the classic symptoms of the asthmatic crisis such as dyspnoea, cough, shortness of breath, and difficulty in carrying out normal daily activities - are triggered by allergenic and irritating stimuli (dust, animals, smoke, pollen ), from viral infections (flu, cold) or from intense physical exertion.

Severe and Mild Crises

An asthma crisis can be minor, with symptoms that improve with doctor-prescribed home treatment, or severe.

Mild asthma attacks are generally more common. Usually, the airways regain patency within a few minutes or in any case within a few hours after treatment.

Severe asthma attacks are less common but last longer, cause more severe symptoms, and require immediate medical attention. A severe asthma attack that does not improve with home treatment can become a life-threatening health emergency.

Recognizing the symptoms is therefore essential; however, it is important to recognize and treat even the mildest symptoms of an asthma attack, in order to prevent severe episodes and keep asthma under control.

Severe exacerbations can also occur in people with a previous history of mild asthma, but are more likely in people with moderate or severe asthma.

Symptoms

The symptoms of the asthmatic crisis can vary from person to person and the patient must learn to recognize the degree of severity in order to be able to manage them and contact, when necessary, the doctor or - in the worst cases - health care.

The most common symptoms of the asthmatic crisis include increased heart rate (tachycardia), cough, wheezing when breathing, shortness of breath, feeling of weight on the chest, wheezing, awakening in the middle of the night. The shoulders and chin are raised in an attempt to breathe better.

When to call the doctor

An asthmatic crisis can be considered serious, therefore deserving medical attention, when it is associated with symptoms such as difficulty speaking, severe dyspnea or rapid and rapid breathing, especially at night or early in the morning, gray or bluish discoloration of the lips and nails, cyanosis and paleness, intense agitation, over-distension of the nostrils during breathing, neck and side muscles evident on inhalation, severe tachycardia, difficulty walking, lack of relief despite adoption of the seizure treatment prescribed by the doctor, low peak of expiratory flow (PEF) which falls within the red zone of the cursor flow meter.

Causes

There are numerous possible factors that trigger or worsen the asthma crisis, which vary from person to person based on individual sensitivity:

allergens (mites, pollen, animal hair or feathers, food, mold, professional factors from agricultural and industrial processing),
viral agents (common respiratory infections, such as colds or flu),
physical effort.

Asthma attacks can be favored or worsened by environmental irritants, such as cold and humid air, smoke, smog and exhaust gases, sudden and intense sporting activity.

How to intervene

During an asthmatic crisis it is first necessary to remain calm, trying as much as possible to relax and breathe slowly and deeply. The agitation and fear can in fact precipitate the situation. The ideal position to face the asthmatic crisis is sitting, with the back slightly tilted forward and the elbows resting on a rigid surface, in order to take advantage of the work of the respiratory muscles auxiliaries, such as the small pectoral. However, the adoption of a lying position should be avoided.

At the same time it is necessary to promptly take the therapy prescribed by the doctor, carefully following not only the doses, but also the inhalation methods suggested by the doctor and the package leaflet.

Inhaled short-acting beta2-agonists are the first choice treatment in case of acute asthma. Salbutamol or albuterol (eg VENTOLIN ®) is the reference drug:

Pre-dosed sray (with spacer): 2-4 (200-400 mcg) sprays, up to 10 sprays in the most severe forms, repeated if necessary every 20-30 minutes for the first hour, then every 1-4 hours as needed.
The dosage must be personalized by the doctor, adapting it to the individual patient. The dose to be delivered must be individualized according to the severity of the attack: frequent in case of severe attack, more spaced doses in mild forms.
In an emergency, salbutamol is also used through a nebulizer in a hospital setting, and is also available as a solution for injection. It is also combined with other drugs, such as oral or intravenous corticosteroids, Ipratropium bromide.

The use of short-acting beta2-agonists overlaps with that of basic or background drugs, which used regularly control the onset of asthma symptoms.

Prevention

The asthmatic subject should pay particular attention to all those environmental risk factors that trigger and worsen asthma symptoms.

Against dust mites (one of the main causes of asthma), it is advisable to ventilate the house (especially the bedroom) daily by exposing sheets, pillows, blankets and mattress to the sun, to periodically wash the bed linen complete with pillow covers and mattress protector at 60 ° (below this temperature the mites do not die), and to avoid the presence of carpets and rugs (it is impossible to keep them free of allergens) and all objects that collect dust.

The daily ventilation of the home environment, the reduction of humidity (do not use humidifiers, eliminate water infiltrations) and the removal of possible sources of mold (regularly wash shower curtains, rugs, bathroom fixtures and tiles with bleach, limit the number of ornamental plants) helps prevent asthma attacks related to mold allergies.

Knowing the pollination period of the plant to which the subject is allergic, allows both to prepare in time through an adequate symptomatic treatment, and to avoid walks outdoors in areas of particular concentration of pollen or to keep the windows closed in the early hours of the day. morning and evening, times when the greatest concentrations of pollen coincide.

Finally, those allergic to particular animals should naturally avoid coming into contact with them. It should be noted how growing up with dogs and cats from the first months of life can constitute a protective factor against the onset of allergic sensitization to these animals; however, when the sensitization has already developed contact with dogs and cats constitutes a factor of risk for the aggravation of asthma.

In "occupational asthma," removal from the "agent responsible for" asthma leads in a high percentage of cases to improvement and sometimes to "healing".

When it is not possible to avoid or at least control the possible factors involved in the onset of the asthmatic crisis, the best way to prevent it is to follow a suitable basic therapy (anti-inflammatory and long-acting bronchodilators), also known as background therapy. .

This therapy should never be abandoned or suspended prematurely, even when the symptoms subside; although in some cases a certain reversibility of the disease has been documented (cure or rather the absence of long-term symptoms even when therapy is suspended), asthma is considered a chronic disease and must be treated as such. therapy, a patient can improve to the point that his asthma passes to a stage of lower severity, until it becomes asymptomatic. The asthmatic exacerbations, with consequent crises, are however around the corner and that is why basic therapy is not suitable. suspended, and possibly enhanced in periods of greater exposure to the allergen.

Therapeutic schemes are extremely variable in relation to the severity and etiology of asthma, as well as the frequency of asthma attacks. In our article on drugs for the treatment of bronchial asthma, the classes of drugs most used in asthma therapy, and some examples of pharmacological specialties, are reported.

Influenza vaccination and weight loss in case of obesity can be useful for the prevention of exacerbations. Naturally, viral infections such as flu and colds (the most frequent cause of asthma attacks), are also prevented through "thorough hand hygiene with soap and water before eating or bringing your hands to your eyes or mouth. you practice sports in cold environments, it is important to cover your mouth with scarves or masks, especially in the initial phase of physical warm-up.