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Asthma: dangerous asthma

What are the symptoms and signs?

Failure to recognise the development of a severe asthma attack has cost the lives of many people. Most people cope with their asthma nicely, but doctors are concerned about the fact that some die when it could be prevented.

Asthma has to be treated with great care. The more you know about it, the better you can recognise danger.

Who are likely to be at high risk?

• People who have experienced one or more of the following are more likely to have a severe attack:
• a previous severe asthma attack
• previous hospital admission, especially if to intensive care
• hospital attendance in the past 12 months
• long-term oral steroid treatment
• carelessness with taking medication
• night-time attacks, especially with severe chest tightness
• recent emotional problems
• Remember that severe attacks can start suddenly (even in mild asthmatics) and catch you by surprise.

Why is peak expiratory flow measurement important?

People who have moderate to severe asthma should obtain a peak expiratory flow (PEF) meter and measure their PEF. It tells you how well your lungs are working by measuring the amount of air moving through the airways.

It is very simple to use. Anyone older than 7 years can test PEF accurately. You should measure your PEF in the morning and at night before inhaling your bronchodilator, and then 10 minutes after. Do this 3 times for each test.

Warning signs using PEF are:

• falling of your PEF and poor control
• readings less than 70 per cent of your normal best
• readings less than 100 L/min
• more morning dipping than normal
• erratic readings
• less response to your bronchodilator than normal

What are the early warning signs of severe asthma or an asthma attack?

• symptoms persisting or getting worse despite adequate medication
• increased coughing and chest tightness
• poor response to 2 inhalations
• benefit from inhalations not lasting 2 hours
• increasing medication requirements
• sleep being disturbed by coughing, wheezing or breathlessness
• chest tightness on waking in the morning
• low peak expiratory flow readings
• Contact your doctor if these problems are present.

What are the really dangerous signs?

• Any of the following problems tell us that asthma is 'out of control':
• marked breathlessness, especially at rest
• sleep being greatly disturbed by asthma
• asthma getting worse quickly rather than slowly, despite medication
• feeling frightened
• difficulty in speaking: unable to say more than a few words
• exhaustion
• drowsiness or not with it feeling
• chest becoming 'silent' with a quiet wheeze, yet breathing still laboured
• blue or blue-grey colour
• chest wall drawing in
• respiratory rate greater than 25 (adults) or 50 (children)

Action plan

• If any of these are present, immediately:
• Call an ambulance and say 'severe asthma attack' (best option).
• or
• Call your doctor.
• or
• If you are having trouble finding medical help, get someone to drive you to the nearest hospital.
• Keep using your bronchodilator inhaler continuously if you are distressed.
  
  

Copyright 1995: John Murtagh, Professor of General Practice
Monash University, Melbourne, Australia