Asthma is a chronic obstructive disease that causes breathing problems. It is characterized by diverse and recurring symptoms, reversible airway obstruction and bronchospasm. During an attack, the airway muscles in the lungs tighten, narrowing the airways and making breathing difficult. It is characterized by an inappropriately strong immune response and chronic inflammation of the tracheobronchial tree.

The name asthma comes from the Greek word ἅσθμα, ásthma, which means “breath” or “difficulty breathing”. It is believed to be caused by a combination of genetic and environmental factors. Diagnosis is usually made based on symptoms, response to treatment and spirometry.

The risks associated with asthma can be divided into three main groups:

1. Allergic asthma:
   • House dust (like the mite Dermatophagoides pteronyssinus).
   • Pet hair, feathers.
   • Mildew.
   • Grass, weed and tree pollen.
2. Non-allergic asthma:
   • Cigarette smoke.
   • Chemical agents and inhalant irritants.
   • Perfumes and fragrances.
   • Air pollutants.
   • Certain medicines.
3. Occupational asthma:
   • Dust in the workplace.
   • Resin.
   • Chemical agents in the workplace.
   • Insecticides.
   • Evaporations.
   • Other substances present in the workplace.

Recognizing an asthma attack:

• Shortness of breath.
• Clear and loud wheezing when breathing.
• Speaking in short sentences or in a whisper.
• Restlessness and anxiety.
• Cessation of hypoxia (cyanosis, exhaustion after an attack).
• Cough.
• Roaring in the respiratory tract.
• Use of accessory respiratory muscles.
• Attacks usually occur suddenly, after exposure to allergens or risk factors. In rare cases, attacks may occur several hours later. An attack may be preceded by irritation of the nose or throat. Asthma usually gets worse between 2 and 4 am.

Clinical characteristics:

• The frequency and severity of symptoms can vary.
• Occasional attacks can be mild and short-lived.
• Triad of symptoms: dyspnea (difficulty breathing, wheezing, especially during exhalation, dilation of nostrils during inhalation, especially in children), cough (chronic or recurrent, worse at night or early morning, disrupts sleep) and wheezing.
• Associated conditions (eczema, rhinitis, seasonal allergic rhinitis).
• At the beginning of the attack, pressure in the chest, non-productive cough.
• Breathing becomes loud and rough.
• Humming is heard during both phases.
• Tachypnea, tachycardia, mild systolic hypertension.
• Activation of auxiliary respiratory muscles.
• The attack often ends with a cough that eliminates thick and viscous secretions.

Laboratory tests and diagnostic procedures:

• Blood gas analysis and pH.
• Spirometry (measurement of vital capacity, forced vital capacity and forced expiratory volume in the first second, FEV1).
• The course of the disease and the effectiveness of asthma treatment can be monitored by measuring peak expiratory flow rate (PEFR) at home or FEV1 in the laboratory.
• The peak expiratory flow meter measures the peak expiratory flow rate (PEF), which is the fastest rate of airflow through the airways during forced expiration after a maximal inspiration.
• Chest X-ray.
• Specific tests (allergens).
• Non-specific bronchoprovocation tests (histamine).
• IgE and eosinophils in peripheral blood.

Asthma attacks can be prevented:

• Selection of appropriate drugs and individual dosage.
• An approach to the long-term management of asthma.
• Treatment of acute asthma attacks.
• Recognizing and avoiding factors that aggravate asthma.
• Adjustment and monitoring of therapy based on the severity of disease symptoms.

What to do during an asthma attack:

• Calm and soothe the affected person.
• Place her in the most comfortable position (sitting). Usually, patients sit with their body leaning forward.
• Mild attacks may subside quickly. If symptoms persist, advise another breath from the inhaler.
• In case of severe attacks when the inhaler does not help, call emergency medical services at number 194.
• Monitor vital signs (consciousness, breathing, pulse) until emergency medical services arrive.

Medicines:

• Medicines for long-term prevention that prevent worsening of symptoms and progression of the disease and prevent acute asthma attacks. Medications for long-term control include inhaled and oral medications: corticosteroids, long-acting beta-2 agonists, extended-release theophylline, chromones, and leukotriene modifiers.
• Quick-relief medications that quickly widen the airways, relaxing the muscles around them that tighten during an attack. For rapid relief of acute symptoms and asthma attacks, bronchodilators such as short-acting beta-2 agonists, anticholinergics, short-acting theophylline and adrenergics are used for severe asthma attacks or status asthmaticus.

Asthma is a chronic disease characterized by obstruction of the lower airways. This obstruction is caused by increased sensitivity of the tracheobronchial tree. Asthma is caused by chronic inflammation of the bronchi. The muscles around the bronchi become irritated and tighten due to inflammation, leading to symptoms. Additionally, due to inflammation, the mucous glands produce an excessive amount of sputum which further blocks the airways.

The best strategy for managing acute asthma exacerbations is early recognition and intervention before an asthma attack becomes severe and potentially life-threatening.

Symptoms of an acute exacerbation of asthma include: shortness of breath, cough, chest tightness, fatigue during exertion, exhaustion, wheezing and prolonged exhalation. Asthma is often worse at night or early in the morning. In severe asthma attacks, patients may use accessory muscles for breathing, exhibit paradoxical breathing, and may have sweating. Difficulty breathing leads to hypoxia and hypercapnia. Hypoxia is characterized by tachypnea, cyanosis, restlessness, fear, tachycardia and hypertension. Hypercapnia is manifested by confusion, fatigue, flushing, cloudiness, hypoventilation or apnea. The threat of respiratory arrest is characterized by altered mental status, lethargy, “chest silence”, acidosis, severe hypoxia and hypercapnia.

If the patient has his first “asthma attack”, then the differential diagnosis should always consider whether the cause may be inhalation of foreign bodies.

A rare complication of asthma can be pneumothorax and this should be ruled out during examination.

Obstruction and hoarseness are caused by three factors in the bronchial tree:

1. Increased production of bronchial mucus.
2. Edema of the bronchial mucosa.
3. Spasm and contraction of bronchial muscles.

Emergencies: In adults, asthma can often be complicated and associated with bronchitis, especially in smokers. This can further complicate treatment, both regularly and in emergency situations. Most asthmatics regularly use inhalers as a means of “prevention” and to “ease” their condition.

The emergency medical team usually encounters asthma in one of two forms (Table 1).

Table 1. Two forms of asthma

Life-threatening form of asthma Acutely severe form of asthma ● Exhaustion ● Confusion ● Coma ● Quiet breathing ● Cyanosis ● Poor respiratory effort ● Bradycardia ● Hypotension ● Peak airflow <33% of predicted best value ● SpO2 <92% ● It is not possible to say a sentence in one breath ● Breathing >25 times per minute (for adults)● Heart rate >110 beats per minute ● Peak airflow 33 %-50% of predicted best value

Treatment:

• Ensure the safety of the incident site and apply personal protective measures.
• Notify T1 if necessary.
• Evaluate ABCDE.

Assess for life-threatening features. If any of these features are present, start managing ABC.

Treatment of acute exacerbation of asthma is based on the following:

1. Identifying the cause of asthma exacerbation – inhaled allergens (pollen, mold), drugs (beta blockers, NSAIDs), respiratory infections, inhaled irritants (chemical fumes, tobacco smoke), and if possible, remove the cause.
2. Oxygen titration to achieve target saturation> 92% (in pregnant women> 95%).
3. Frequent assessment of the patient’s condition

ABSTRACT:

• Early recognition and therapy are key in the management of acute exacerbations of asthma in adults.
• Oxygen therapy should be titrated to achieve a target saturation of 92% (95% in pregnant women).