Asthma attacks are linked to the contraction of the muscles that form the wall of the bronchi and the consequent reduction of the space where air circulates (bronchoconstriction); furthermore, the inside of the bronchi swells and becomes inflamed, producing thick mucus which constitutes a further obstacle to the free circulation of air.
All these factors – bronchospasm , inflammation and mucosal hypersecretion, responsible for the classic symptoms of asthmatic crisis such as dyspnoea , cough, shortness of breath , and difficulty 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 attack can be minor, with symptoms that improve with home treatment prescribed by your doctor, 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 for the asthmatic .
Recognizing the symptoms is therefore fundamental; However, it is important to recognize and treat even the mildest symptoms of an asthma attack, in order to prevent serious episodes and keep asthma under control.
Severe exacerbations can also appear in people with a previous history of mild asthma, but are more likely in people with moderate or severe asthma.
The symptoms of the asthmatic crisis can vary from person to person and the patient must learn to recognize the degree of severity so as to be able to manage them and contact, when necessary, the doctor or – in the worst cases – the medical emergency services.
Among the most common symptoms of asthma attacks are increased heart rate ( tachycardia ), cough , wheezing when breathing , shortness of breath , the sensation of having a weight on the chest, shortness of breath , waking up 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 of medical attention, when it is associated with symptoms such as difficulty speaking, severe dyspnea or shortness of breath and rapid breathing, especially at night or early in the morning , gray or bluish discoloration of lips and nails , cyanosis and paleness , intense agitation, hyperdistention of the nostrils during breathing, neck and side muscles evident during inspiration, severe tachycardia, difficulty walking , lack of relief despite taking the seizure treatment prescribed by the doctor, low peak blood pressure expiratory flow (PEF)which falls within the red zone of the cursor flow meter.
There are numerous possible factors that trigger or worsen the asthma crisis, which vary from subject to subject based on individual sensitivity:
- allergens ( mites , pollen, animal hair or feathers , foods , molds , professional factors from agricultural and industrial processing),
- viral agents (common respiratory system 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 fumes, sudden and intense sporting activity.
How To Intervene
During an asthma attack it is first of all necessary to remain calm, trying as much as possible to relax and breathe slowly and deeply. Agitation and fear can in fact precipitate the situation. The ideal position to deal with an asthma attack is sitting, with the back slightly inclined forward and the elbows resting on a rigid surface, in order to exploit the work of the auxiliary respiratory muscles, such as the pectoralis minor . However, adopting 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 information leaflet .
Short-acting inhaled beta2 -agonists are the first-line treatment for acute asthma. Salbutamol or albuterol (e.g. 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 in 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 based on the severity of the attack: frequent in the case of a severe attack, more spaced doses in mild forms.
- In case of emergency, in hospital settings salbutamol is also used through a nebulizer, and is also available as an injectable solution. 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 medications, which used regularly keep the onset of asthma symptoms under control .
The asthmatic subject should pay particular attention to all those environmental risk factors that trigger and worsen asthmatic symptoms.
Against dust mites (one of the main causes of asthma), it is advisable to ventilate the home (especially the bedroom) daily by exposing sheets, pillows, blankets and mattresses to the sun , and to periodically wash the bed linen complete with pillow covers and mattress cover 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.
Daily ventilation of the home environment, reduction of humidity (do not use humidifiers, eliminate water infiltrations) and 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 linked to mold allergies .
Knowing the pollination period of the plant to which the subject is allergic allows both to prepare in time through adequate symptomatic treatment and to avoid walking outdoors in areas with a particular concentration of pollen or to keep the windows closed in the early hours of the day. morning and evening, times in which the greatest concentrations of pollen coincide.
Finally, those allergic to particular animals should naturally avoid coming into contact with them. Note how growing up with dogs and cats from the first months of life can constitute a protective factor towards the onset of allergic sensitization to these animals; however, when sensitization has already developed, contact with dogs and cats constitutes a risk factor for worsening asthma.
In occupational asthma , distancing from the agent responsible for the asthma leads in a high percentage of cases to improvement and sometimes to “cure”.
When it is not possible to avoid or at least control the possible factors implicated in the onset of the asthmatic crisis, the best way to prevent it is to follow a suitable basic therapy ( anti-inflammatories and long-acting bronchodilators ), also known as bottom .
This therapy should never be abandoned or suspended early , even when the symptoms regress; although in some cases a certain reversibility of the disease has been documented (recovery or rather absence of long-term symptoms even when therapy is suspended), asthma is considered a chronic pathology and must be treated as such. Following the correct setting of therapy, a patient can improve to the point that his asthma progresses to a lower stage of severity, until it becomes asymptomatic. However, asthma exacerbations, with consequent crises, are just around the corner and this is why the basic therapy should not be suspended, and possibly strengthened during 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. Our article on drugs for the treatment of bronchial asthma shows the classes of drugs most used in asthma therapy, and some examples of pharmacological specialties.
Flu vaccination and weight loss in the case of obesity can be useful for preventing flare-ups. Naturally, viral infections such as flu and colds (the most frequent cause of asthma attacks) can also be prevented through careful hand hygiene with soap and water before eating or touching your eyes or mouth. Finally, if you practice sports in cold environments, it is important to cover your mouth with scarves or masks , especially in the initial physical warm-up phase