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Asthma Attack

Is this your symptom?

You are having an asthma attack
Use this care guide only if a doctor has told you that you have asthma

Symptoms of Asthma

Symptoms of an asthma attack are wheezing, a cough, tight chest, and trouble breathing.
Wheezing is the classic symptom. Wheezing is a high-pitched whistling or purring sound. You can hear it best when you are breathing out.
The diagnosis of asthma requires attacks of wheezing or trouble breathing that recur. This may start in childhood or later in life.

Causes (Triggers) of Asthma Attacks

Infections that affect breathing(like colds or the flu). You often can't avoid these. Know that they might cause you to wheeze and use your inhalers, as instructed.
Pollens(trees, grass and weeds). Keep windows closed and stay indoors when pollen counts are high.
Animals(dogs, cats or rabbits). If they are a trigger for you, avoid contact with them, if you can. Do not allow them into your bedroom. Bathe them regularly.
Tobacco smoke. Avoid smoking. Quit, if you are a smoker. Avoid second-hand smoke, too. If anyone in the family smokes, ask them to quit or ask them to smoke outdoors (away from you).
Irritants(such as smog, car exhaust, barns, dirty basement). Avoid areas where there may be dust or fumes. Keep an eye on weather reports of the air quality. Stay indoors if the air quality is poor. Storms and bad weather can also trigger attacks.
Food Allergy (serious). Asthma attacks caused by a food allergy can be life-threatening (anaphylaxis). Common triggers are nuts or fish. Avoid foods that you know will trigger your asthma.
House Dust Mites.
- Use allergen-proof mattress and pillow covers to make a barrier between dust mites and yourself.
- Don't use down-filled bedding: pillows, quilts, or comforters.
- Wash your bedding weekly and dry it completely.
- Vacuum carpets, area rugs, and floors weekly using a vacuum with a HEPA filter.
- Keep relative humidity levels in the home low, around 30- 50%.
Pests(mice, cockroaches) are often found where food is eaten and crumbs are left behind. To control pests in your home:
- Clean dishes, crumbs, and spills right away.
- Keep trash outdoors or in a sealed container.
- Store food in airtight containers.
- Vacuum or sweep areas that might attract pests every 2-3 days.
- Keep counters, sinks, tables, and floors clean.
Exercise can trigger an asthma attack.
Mold.
- Mold grows in damp areas such as bathrooms and kitchens. Clean these areas weekly. Remove mold as soon as it starts to appear.
- Keep rooms well ventilated or use a dehumidifier to remove moisture from the air.
- Fix any leaks that are causing dampness. Replace any materials that have become badly affected by mold, such as carpets or rugs.

Asthma Attack Scale

Mild - Green Zone (doing well). No asthma symptoms. You can talk normally. Normal work, activities and sleep. Peak Flow Rate 80-100% of normal rate.
Mild - Yellow Zone. No breathing problems. May have a mild cough or wheezing off and on that does not last. Peak Flow Rate higher than 80% of normal rate.
Moderate - Yellow Zone (getting worse). Some breathing problems. Speaks in short phrases. Wheezing can be heard. Mild retractions are present (ribs pull in with each breath). Chest might feel tight. Frequent cough. Peak Flow Rate 50-80% of normal rate.
Severe - Red Zone (medical alert). Lots of breathing problems. Speaks in single words. Wheezing may be loud. Rarely, wheezing is absent due to poor air movement. Retractions may be severe. Peak Flow Rate less than 50% of normal rate.
911 asthma symptoms. Struggling to breathe. Can't speak. Drowsy or confused. Plus other Severe asthma symptoms (above).
Some people with asthma can get worse (go from mild to severe) very quickly. If this has happened to you before, get care right away if you start to wheeze.

Peak Flow Meter:

A peak flow meter measures Peak Flow Rates (PFR). It tells us how well a person can move air out of the lungs.

When to Call for Asthma Attack

When to Call for Asthma Attack
Call 911 Now Start to wheeze suddenly after a bee sting, taking medicine, or eating an allergic food Severe trouble breathing (struggling for each breath, can barely speak) or stopped breathing Passed out (fainted) Confused or very drowsy Lips or face are bluish when not coughing You think you have a life-threatening emergency Call Doctor or Seek Care Now Pulse oxygen level less than 90% during asthma attack PEFR is 50-80% of normal rate after using nebulizer or inhaler (Yellow Zone) Wheezing not gone 20 minutes after using nebulizer or inhaler Breathing is much faster than normal; you may be getting exhausted Nonstop coughing is not better after using nebulizer or inhaler Severe chest pain Need to use asthma medicine (neb or inhaler) more often than every 4 hours Fever or chills; feeling hot or shivery You feel weak or very sick You think you need to be seen, and the problem is urgent	Contact Doctor Within 24 Hours Mild wheezing or coughing on and off for 3 days or longer Sinus pain (not just congestion) around the cheekbones or eyes Fever lasts more than 3 days Fever returns after being gone for more than 24 hours You think you need to be seen, but the problem is not urgent Contact Doctor During Office Hours Don't have written asthma action plan from your doctor Use an inhaler more often than you usually would Missed more than 1 day of work per month for asthma Asthma limits exercise, sports or other activities Asthma attacks wake you up from sleep No asthma check-up in more than 1 year You have other questions or concerns	Self Care at Home Mild wheezing or coughing on and off with no problems breathing. Present for less than 3 days. Mild asthma attack

Call 911 Now

Start to wheeze suddenly after a bee sting, taking medicine, or eating an allergic food
Severe trouble breathing (struggling for each breath, can barely speak) or stopped breathing
Passed out (fainted)
Confused or very drowsy
Lips or face are bluish when not coughing
You think you have a life-threatening emergency

Call Doctor or Seek Care Now

Pulse oxygen level less than 90% during asthma attack
PEFR is 50-80% of normal rate after using nebulizer or inhaler (Yellow Zone)
Wheezing not gone 20 minutes after using nebulizer or inhaler
Breathing is much faster than normal; you may be getting exhausted
Nonstop coughing is not better after using nebulizer or inhaler
Severe chest pain
Need to use asthma medicine (neb or inhaler) more often than every 4 hours
Fever or chills; feeling hot or shivery
You feel weak or very sick
You think you need to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

Mild wheezing or coughing on and off for 3 days or longer
Sinus pain (not just congestion) around the cheekbones or eyes
Fever lasts more than 3 days
Fever returns after being gone for more than 24 hours
You think you need to be seen, but the problem is not urgent

Contact Doctor During Office Hours

Don't have written asthma action plan from your doctor
Use an inhaler more often than you usually would
Missed more than 1 day of work per month for asthma
Asthma limits exercise, sports or other activities
Asthma attacks wake you up from sleep
No asthma check-up in more than 1 year
You have other questions or concerns

Self Care at Home

Mild wheezing or coughing on and off with no problems breathing. Present for less than 3 days.
Mild asthma attack

Care Advice

What You Should Know About Asthma:

Around 8% of adults have asthma.
During an attack, the airways narrow.
Without fast treatment, it can be life-threatening. People die from asthma each year.
Asthma can flare up at any time. Different things can trigger an asthma attack in different people. See below for advice to prevent these triggers from causing an attack.
When you are away from your home, always take your asthma medicines with you.
The sooner you start treatment, the faster you will reverse the attack and feel better.
Here is some care advice that should help.

Asthma Quick-Relief Medicine:

Quick-relief (rescue) medicine is albuterol or what your doctor recommends.
Start it at the first sign of any wheezing, shortness of breath or hard coughing.
Use as instructed. Use an inhaler, inhaler with a spacer (2 puffs each time), nebulizer (neb) machine or other device.
Repeat it every 4 hours if you have asthma symptoms. But if you are not getting better, or your symptoms are getting worse, seek care.
Coughing. The best "cough med" for someone with asthma is most often the asthma medicine. It is often the wheeze that causes the person to cough. Caution: cough suppressants are not advised, but cough drops or warm fluids may help soothe a tickly throat.
Caution: if the inhaler hasn't been used in more than 7 days, prime it. Test spray it twice into the air before using it for treatment. Also, do this if it is new.
Use the medicine until you have not wheezed or coughed for 48 hours.
Inhaler technique. Some people find it hard to use an inhaler and get the full dose of their medicine. Ask your doctor or nurse to watch you using your inhaler and give you advice on how to use it better, if needed.
Spacer. A spacer is a plastic tube or holding chamber. It attaches to the inhaler at one end and you breathe through at the other (mouth) end. The spacer holds the asthma med sprayed into it while you take several breaths to breath it in. It will help you get twice the amount of medicine into your lungs.

Asthma Controller Medicine:

You may have been told to use a controller drug. An example is an inhaled steroid.
It's for preventing attacks and must be used daily.
During asthma attacks, keep using this medicine as ordered by your doctor or listed in your Asthma Action Plan.

Allergy Medicine for Hay Fever:

For signs of nasal allergies (hay fever), it's okay to take allergy medicine. Reason: poor control of nasal allergies makes asthma worse.

Fluids - Drink More:

Try to drink lots of fluids.
Goal: stay well-hydrated.
Reason: when you are breathing fast, you can start to get dehydrated. Fluids will loosen up any phlegm in the lungs. Then it's easier to cough up.

Humidifier:

If the air in your home is dry, use a humidifier. Reason: dry air makes coughs worse.

Avoid Tobacco Smoke:

Tobacco smoke makes asthma much worse.
Don't let anyone smoke around you.

Avoid or Remove Triggers:

Shower to remove pollens or other allergens from your body and hair.
Avoid known causes of asthma attacks (such as smoke or cats).
During attacks, reduce exercise or sports if it makes your asthma worse.
Exercise can be a trigger for some people.

What to Expect:

If treatment is started early, most asthma attacks are quickly brought under control.
All wheezing should be gone by 5 days.

Inhaler With a Spacer: How to Use

Step 1. Shake the inhaler well. Then attach it to the spacer (holding chamber).
Step 2. Breathe out completely and empty the lungs.
Step 3. Close the lips and teeth around the spacer mouthpiece.
Step 4. Press down on the inhaler. This will put one puff of the medicine in the spacer.
Step 5. Breathe in slowly until the lungs are full.
Step 6. Hold a deep breath for 10 seconds. Allow the medicine to work deep in the lungs.
If your doctor has ordered 2 or more puffs, wait 1 minute. Then repeat steps 1-6.

Inhaler: How to Use Without a Spacer

Step 1. Shake the inhaler well.
Step 2. Breathe out completely and empty the lungs.
Step 3. Close the lips and teeth around the inhaler mouthpiece.
Step 4. Press down on the inhaler to release a puff. Do this just as you start to breathe in.
Step 5. Breathe in slowly until the lungs are full.
Step 6. Hold a deep breath for 10 seconds. Allow the medicine to work deep in the lungs.
If your doctor has ordered 2 or more puffs, wait 1 minute. Then repeat steps 1-6.
Important: ask your doctor for a spacer if you don't have one. It will help send more medicine into the lungs.
Adults who don't like a spacer can be prescribed an albuterol dry powder device.

Home Nebulizer: How to Use:

A nebulizer machine changes a liquid medicine (med) into a fine mist. The fine mist can carry the med deep into the lungs. This is called a nebulizer (neb) treatment.
Step 1. Prepare the medicine. First, wash your hands with soap and water. For pre-mixed single dose vials, just add one vial to the neb holding cup. For multi-dose vials, you need to do the mixing. First, add the correct amount of normal saline to the neb cup. Then carefully measure and add the correct amount of medicine to the saline.
Step 2. Connect the nebulizer to the air compressor tubing. The air compressor is run by electricity. Portable ones run on a battery. Compressors make the jet of air that turns the medicine into a fine mist.
Step 3. Turn on the air compressor. It will start making the fine mist that you need.
Step 4. Place the mouthpiece between your teeth and seal with the lips. Breathe slowly and deeply. Hold a deep breath for 10 seconds once a minute.
Step 5. Continue the treatment until the med is gone. If the med sticks to the side of the cup, shake it a little. An average neb treatment takes 10 minutes.
Step 6. After each treatment, take the nebulizer apart. Rinse and clean it as directed. Reason: it can't produce mist if it gets clogged.
Caution: closely follow your doctor's instructions. Use the exact amount of med your doctor ordered. If you feel you need a neb treatment more often than every 4 hours, see your doctor for advice.

Call Your Doctor If:

Trouble breathing occurs
Asthma quick-relief medicine (neb or inhaler) is needed more than every 4 hours
Wheezing gets worse
Mild wheezing lasts more than 3 days
You think you need to be seen
Your symptoms get worse

Remember! Contact your doctor if you or your child develop any "Contact Your Doctor" symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

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