ASTHMA ATTACK

Main Symptoms

Use this guideline only if a physician has previously diagnosed you as having asthma, asthmatic bronchitis, or reactive airway disease.
Asthma symptoms include recurring episodes of wheezing, cough, chest tightness, and difficulty breathing.
Wheezing is a high-pitched or whistling sound heard when you breathe out.

General Information

Asthma Triggers - Different things can cause an asthma attack. These things are called asthma triggers.
- Allergens (pollen, house dust, mold, animal dander)
- Sudden changes in the weather (generally cold weather)
- Irritants (cigarette smoke, dirt, pollution)
- Infections (cold or flu)
- Exercise
Peak Flow Meters: Peak flow meters measure how fast an adult can move air out of the lungs. Every adult asthmatic should have a peak flow meter. These measurements are very useful for grading the severity of an asthma attack.
- Mild attack: PEFR 80-100% of baseline (personal best) (green zone)
- Moderate attack: PEFR 50-80% (yellow zone)
- Severe attack: PEFR less than 50% (red zone)
- In general, medications should be increased when the PEFR is less than 80% of baseline and an adult should be seen immediately in an office or emergency department if the PEFR is less than 50%.

WHEN TO CALL YOUR DOCTOR FOR ASTHMA ATTACK

Call 911 Now (you may need an ambulance) If:

Severe difficulty breathing (e.g. struggling for each breath, unable to speak, or speaking in single words)
Bluish lips, tongue or face
Wheezing started suddenly after medicine, an allergic food or bee sting
Passed out (fainted)

Call Your Doctor Now (night or day) If:

You feel weak or very sick
Feel like you did when hospitalized before with asthma
Difficulty breathing not gone within 20 minutes after neb or inhaler
Peak flow rate less than 50% of baseline level (personal best)
Peak flow rate 50-80% of baseline level after using neb or inhaler
Wheezing (heard across the room) not gone within 20 minutes after using neb or inhaler
Continuous (nonstop) coughing that prevents work or sleep and does not improve after using neb or inhaler
Asthma medicine (neb or inhaler) is needed more frequently than every 4 hours
Fever of 103 F (39.4 C) or higher
Fever of 100.5 F (38.1 C) or higher and you:
- Are over 60 years of age:
- Have diabetes mellitus or a weakened immune system (e.g. HIV positive, cancer chemotherapy, chronic steroid treatment, splenectomy)
- Are bedridden (e.g. nursing home patient, stroke, chronic illness, recovering from surgery)
Severe wheezing or coughing and you don't have neb or inhaler available (e.g. ran-out, lost)

Call Your Doctor Within 24 Hours (between 9am and 4pm) If:

You think you need to be seen
Lots of yellow or green nasal discharge now with a fever
Nasal discharge present longer than 10 days
Sinus pressure or pain (around cheekbone or eye)
Fever present longer than 3 days
You have any of the following asthma risk factors:
- Prior tube in your windpipe for asthma
- Hospitalized this past year for asthma
- Need for frequent steroid (e.g. prednisone) bursts
- Recently tapered or stopped using steroids

Call Your Doctor During Weekday Office Hours If:

You have other questions or concerns
Missing more than 1 day of work or school per month for asthma
Asthma limits exercise or sports
Asthma attacks frequently awaken from sleep
Uses more than 1 inhaler/month
Mild wheezing persists longer than 5 days
No asthma check-up in over 1 year

Self Care at Home If:

Mild asthma attack and you don't think you need to be seen

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HOME CARE ADVICE FOR MILD ASTHMA ATTACK

Quick-Relief Asthma Medicine:
- Start your quick-relief medicine (e.g. albuterol inhaler or nebulizer) at the first sign of any coughing or shortness of breath (don't wait for wheezing). Use inhaler (2 puffs each time) or nebulizer q 4 hours. Continue the quick-relief medicine until you have not wheezed or coughed for 48 hours.
- The best "cough medicine" for an adult with asthma is always the asthma medicine. (Note: Don't use cough suppressants, but cough drops may help a tickly cough.)
Long-Term-Control Asthma Medicine: If you are using a controller medicine (e.g. inhaled steroids or cromolyn), continue to take it as directed.
Fluids: Try to drink normal amount of clear fluids (e.g. water). (Reason: adequate hydration makes it easier to cough up the sticky lung mucus.)
Humidifier: If the air is dry, use a cool mist humidifier to prevent drying of the upper airway.
Hay Fever: For nose allergy symptoms, it's OK to take antihistamines. (Reasons: poor control of allergic rhinitis makes asthma worse, whereas antihistamines don't make asthma worse).
Remove Allergens: Take a shower to remove pollens, animal dander, or other allergens from the body and hair.
Avoid Triggers: Avoid known triggers of asthma attacks (e.g. tobacco smoke, cats, other pets, feather pillows, exercise)
Work with Your Doctor: There is no cure for asthma but you can take charge and learn to control it. The best way to take charge of asthma is to work with your doctor (over many months) to find the right controller (preventive) medicine so your asthma is under control. If you keep having asthma attacks, then the asthma is not under control. People can die from asthma if they do not take it seriously and work with a doctor to control it.
Expected Course: If treatment is started early, most asthma attacks are quickly brought under control. All wheezing should be gone by 5 days.
Call Your Doctor If:
- Inhaled asthma medicine (nebulizer or inhaler) is needed more often than every 4 hours
- Wheezing has not completely cleared after 5 days
- You become worse or develop any of the "Call Your Doctor" symptoms.

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Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Reviewed 8/2004

Revised 8/2003

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