Acute Asthma: Causes, Symptoms, Diagnosis, And Treatment

Asthma is a condition that results in the swelling and narrowing of the airways in the lungs. When you have an asthma attack, you will have difficulty breathing, chest tightness, and coughing. 

Asthma can be an acute condition or a chronic one. This post will discuss the former, telling you everything you need to know about what causes acute asthma, how it is diagnosed, and what you and your doctor can do about it. 

What is acute asthma? 

Asthma itself is a chronic condition, so it’s important to avoid triggers that might bring on an asthma attack. These include allergens and untreated infections. 

If you have asthma, you must be careful to follow your treatment plan. If your asthma is well controlled, you can usually live a relatively normal life. However, a trigger exposure can cause an acute asthma flare,¹ which is otherwise known as an asthma attack. During an asthma attack, the bronchial passages that allow air in and out of the lungs swell up and become narrow.

How common is acute asthma?

Chronic asthma is fairly common, with over 300 million people² around the world being impacted by the condition. Any of those people are susceptible to an acute asthma attack if they come into contact with the potential triggers. 

In the United States, there are around 12 million asthma attacks³ each year. Roughly 3 million of them require hospitalization. Thankfully, such attacks are avoidable with the proper treatment and education from your doctor.

Symptoms of acute asthma

The symptoms of acute asthma vary depending on the severity of the attack. Some of the things to look out for are listed below. These symptoms will either appear during an attack or worsen if they already exist. 

• Wheezing

• Chest tightness

• Cough

• Shortness of breath

• The sensation of air hunger

• Difficulty sleeping

• Severe fatigue

• Faster breathing

• Increased heart rate

• Unexplained sweating

• Decreased alertness

• Difficulty completing sentences

• Inability to lie flat

Risk factors of acute asthma

In addition to the triggers that can cause an asthma attack, there are a few risk factors⁴ that can increase the chances of an attack occurring.

• Changes in medication — Reduction or cessation of certain medications or the use of certain medications in common may increase the possibility of an attack

• Non-adherence to medication — In addition to changes in medication, patients who do not adhere to the medication prescribed to them are at increased risk of exacerbation

• Smoking — The damaging effects of smoking on the lungs also makes smokers more likely to have an asthma attack

• Coughing at night — The risk of an acute asthma attack goes up in relation to the number of nights in a row you experience a troublesome cough

• Obesity — People with a BMI greater than 30 are more likely to have asthma⁵

Causes of acute asthma

An acute asthma attack can be caused by several triggers. With experience and the help of your doctor, you’ll be able to identify the triggers that are most likely to affect you. Common triggers include:

• Respiratory tract infections — This includes lower tract infections such as pneumonia, bronchitis, and tuberculosis as well as upper tract infections like pharyngitis, laryngitis, sinusitis, flu, and cold

• Allergens — These include pollen, dander, or other allergens that affect the respiratory system, including household pests, such as dust mites, mice, and cockroaches 

• Exposure to pollution — Strong inhaled pollutants such as chemical fumes, strong odors, and smoke can trigger an attack

Diagnosis

There are several conditions that can cause the symptoms of asthma. Some of the other conditions⁶ your doctor may check for include COPD, vocal cord dysfunction, bronchitis, tracheal obstruction, pulmonary edema, and pneumonia, among others. 

There are a number of tests that can be performed that will help the doctor narrow down the diagnosis. These tests are described below:

Spirometry 

This test involves breathing into a tube connected to a machine called a spirometer. The device measures how much air you can inhale and exhale, as well as how quickly you exhale. At the time of the test, the person administering it will give you detailed instructions.

Peak flow 

A peak flow test may be used instead of a spirometer. This test is simpler than spirometry, and measures only the amount of air you can exhale.

Trigger tests 

Also called provocation tests, this batch of procedures will test how sensitive your lungs are to various asthma triggers. It can help determine which triggers you need to avoid in a controlled and medically monitored manner. 

Pulse oximetry 

This device attaches to your finger and uses a light to measure the concentration of oxygen in your blood along with your pulse. Because asthma causes breathing difficulties, this information can be useful to ensure that your body is getting enough oxygen.

Chest X-ray 

Some of the conditions that may trigger your asthma symptoms can be detected using a chest X-ray. Your doctor may want to perform this procedure to rule those out and ensure that the proper treatment is given.

Fractional exhaled nitric oxide tests (FeNO) 

Nitric oxide is a byproduct of inflammation. By breathing into a device that measures the amount of this gas in your breath, your doctor can determine the amount of inflammation in your respiratory system. 

Management and treatment of acute asthma

While chronic asthma has no cure, it can be controlled. With proper management and treatment, the occurrence of acute asthma attacks can be minimized. 

An asthma treatment plan will be two-pronged: control of chronic asthma and treatment of acute asthma symptoms. Together, these two paths will help minimize the chances of attacks and make them easier to deal with when they do occur. 

Typical acute asthma treatments include:

Medications

When you have asthma, your doctors will work out a treatment plan designed to minimize the attacks. An important part of that treatment plan will consist of medications given to you by an allergist to reduce the impact of triggers.

Short-acting beta2 agonists

This class of drug works quickly to open the airways and return breathing to normal. Short-acting beta2 agonists are more often found in inhaler form for the fastest effect. These are typically the rescue inhalers used to stop an asthma attack. 

Anticholinergic bronchodilators

Inhalers in this class also help to open the airways but work more slowly. Rather than being used as a rescue inhaler, they are often longer-lasting medications that are used once per day to help you breathe easier and reduce the risk of attack.

Corticosteroids

In some cases, the symptoms will persist or worsen even with the use of the inhalers above. For those times, doctors may prescribe corticosteroids to help reduce inflammation in the airways. This class of drugs is available in pill or inhaler form.

Supplemental oxygen

In the case of a severe or life-threatening attack, your doctor may give you supplemental oxygen⁷ before and/or after other treatments to help your body make up for the oxygen the attack deprived it of.

Lifestyle change 

Even with medication, you’ll need to make lifestyle changes to avoid acute asthma attacks. This means identifying the triggers of the attacks and taking steps to avoid them.

Can acute asthma be prevented?

With proper care, you can learn the triggers that cause your acute asthma attacks and try to avoid them. 

Because it might not always be possible to avoid the triggers, your doctor will likely provide you with a rescue inhaler that can help restore you to normal breathing should you feel an asthma attack coming on. 

Complications of acute asthma

If asthma is well controlled, it will usually have minimal impact on your lifestyle. However, an asthma attack can interfere with work, school, sleep, and recreational activities. Having poorly controlled asthma makes this worse. 

In extreme circumstances, a severe asthma attack can result in death. Thankfully, the number of deaths due to asthma is declining. In 2016, asthma was an underlying cause of death in only 10 people per million.⁸ The chances of an asthma attack resulting in death increase with age.

When to visit a doctor

Any unexplained or severe difficulty in breathing could be a potentially serious issue. We’ve discussed a number of conditions that can result in such difficulties, and consulting with a doctor as soon as possible after it happens will help determine the underlying cause. 

If you’ve already been diagnosed with asthma and have an attack that does not improve with your rescue inhaler, see a doctor immediately. If you notice your symptoms worsening, make an appointment as soon as possible.

The lowdown

Asthma itself is a chronic condition that can’t be cured. However, acute asthma attacks can be minimized or prevented by avoiding the conditions that trigger them and following the treatment plan laid out by your doctor. 

Both genetic and environmental factors can increase the likelihood of you developing asthma. Seeing a doctor as soon as you notice symptoms such as difficulty breathing, tightness of the chest, or unexplained coughing will help you develop a treatment plan and provide you with information that can help you better identify the triggers you need to avoid.