Definition and Causes
The asthmatic crisis can be defined as a sudden worsening of asthma symptoms, which arise quite intensely causing major breathing difficulties.
All these factors - bronchospasm, inflammation and mucous hypersecretion, responsible for the classic symptoms of asthmatic crisis such as dyspnea, cough, shortness of breath, and difficulty in performing normal daily activities - are triggered by allergenic and irritating stimuli (dust, animals, smoke, pollen ), from viral infections (influences, colds) or from an intense physical effort.
Severe and mild crisis
An asthmatic crisis can be minor, with symptoms that improve with the home treatment prescribed by the doctor, or serious.
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, lead to more severe symptoms and require immediate medical assistance. A severe asthma attack that does not improve with home treatment can become a health emergency that endangers the life of the asthmatic.
Recognizing the symptoms is therefore fundamental; it is however important to recognize and treat even the mildest symptoms of an asthma attack, so as to prevent serious episodes and keep the asthma under control.
Severe exacerbations may also occur in individuals with a previous history of mild asthma, but are more likely in individuals 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 and contact, when necessary, the doctor or - in the worst cases - health care.
Among the most common symptoms of the asthmatic crisis are heart rate (tachycardia), coughing, wheezing during breathing, shortness of breath, feeling of weight on the chest, wheezing, 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 worthy of medical help, when it is associated with symptoms such as difficulty speaking, severe dyspnea or rapid breathing, especially at night or early in the morning, gray or bluish colouration of lips and nails, cyanosis and pallor, intense agitation, hyper-distention of the nostrils during breathing, neck and rib muscles evident during inspiration, severe tachycardia, difficulty walking, lack of relief despite the adoption of the doctor's prescribed anti-crisis treatment, low peak expiratory flow (PEF) which falls within the red area of the flow meter.
Causes
There are numerous possible factors that trigger or worsen the asthma crisis, varying from subject to subject based on individual sensitivity:
- allergens (mites, pollen, animal hair or feathers, food, mold, professional agricultural and industrial processing factors),
- viral agents (common infections of the respiratory system, such as a cold or the flu),
- physical effort.
Asthma attacks can be favored or worsened by environmental irritation factors, such as cold and damp air, smoke, smog and exhaust gases, sudden and intense sporting activity.
How to intervene
During an asthmatic crisis it is necessary first of all to remain calm, trying as much as possible to relax and breathe slowly and deeply. Agitation and fright 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 plane, so as to exploit the work of the auxiliary respiratory muscles, such as the small pectoralis. Instead, the adoption of a lying position should be avoided.
At the same time it is necessary to take promptly the therapy prescribed by the doctor, carefully following not only the doses, but also the inhalation methods suggested by the doctor and the leaflet.
Short-acting beta2-agonists inhaled are the first-line treatment for acute asthma. Salbutamol or albuterol (eg VENTOLIN ®) is the reference drug:
- Sray pre-dosed (with spacer): 2-4 (200-400 mcg) spray, 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 customized by the doctor, adapting it to the individual patient. The dose to be dispensed 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 in a hospital environment through a nebulizer, 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 when used regularly keep the onset of asthma symptoms under control.
Prevention
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 house daily (especially the bedroom) by exposing sheets, pillows, blankets and mattress to the sun, to periodically wash the bed linen complete with pillow covers and 60 ° mattress cover (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 the objects that collect dust.
The daily ventilation of the domestic environment, the reduction of humidity (do not use humidifiers, eliminate water infiltration) and the removal of possible sources of mold (regularly wash shower curtains, floor mats, sanitary ware and tiles with bleach, limit the number of ornamental plants) helps prevent asthmatic crises related to mold allergies.
Knowing the period of pollination of the plant to which the subject is allergic, allows both to prepare in time through an adequate symptomatological treatment, and to avoid walks outdoors in areas of particular concentration of pollen or to keep the windows closed in the first hours of morning and evening, times when the highest concentrations of pollen coincide.
Finally, those allergic to particular animals should naturally avoid coming into contact with them. Note how growing with dogs and cats from the first months of life can be a protective factor towards the onset of allergic sensitization to these animals; however, when sensitization has already developed, contact with dogs and cats is a risk factor for the aggravation of asthma.
In occupational asthma, the removal from the agent responsible for asthma leads to a high percentage of cases of improvement and sometimes "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 gift of basic therapy (long-acting anti-inflammatory and bronchodilator), also known as therapy of bottom .
This therapy should never be abandoned or suspended beforehand, even when the symptoms subside; although in some cases a certain reversibility of the disease has been documented (healing or better absence of long-term symptoms even when the therapy is suspended), asthma is considered a chronic pathology and should be treated as such. Following the correct setting of the therapy, a patient can improve to the point that his asthma passes to a lower stage of gravity, until it becomes asymptomatic. The asthmatic exacerbations, with consequent crises, are however around the corner and this is why the basic therapy should not be suspended, and possibly enhanced during periods of greater exposure to the allergen.
Therapeutic patterns are extremely variable in relation to the severity and aetiology of asthma, as well as to the frequency of asthma attacks. In our article on medicines for the treatment of bronchial asthma the classes of drugs most used in therapy against asthma are reported, and some examples of pharmacological specialties.
Influenza vaccination and weight loss in cases of obesity may be useful for the prevention of exacerbations. Of course, viral infections such as flu and cold (the most frequent cause of asthma attacks) are also prevented by careful hand hygiene with soap and water before eating or bringing the hands to the eyes or mouth. Finally, in the case of sports in cold environments, it is important to cover the mouth with scarves or masks, especially in the initial phase of physical warming.
