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Asthma is a chronic condition affecting almost 339 million¹ people globally. If you have asthma, your airways narrow and swell, making breathing difficult. Common asthma symptoms include trouble breathing, chest tightness, wheezing, and coughing.
An asthma attack is when you experience worsening symptoms even when using medications correctly. The symptoms may be mild and only require an inhaler or be severe and need emergency medical care.
An asthma attack may manifest uniquely in each person. Therefore, signs and symptoms may differ from one person to another. Below are the most common:
You may experience difficulty breathing or breathlessness like you would feel after running.
You may feel as if something heavy is sitting on your chest. The sensation feels as if your lungs are squeezed and unable to expand.
Sometimes you may experience chest tightness alongside a dull ache or stabbing pain in the chest.
An asthma attack may cause persistent dry coughs.
Excess mucus is one of the symptoms of an asthma attack. Your lungs and lung airways may produce extra mucus, causing them to narrow and making it difficult to breathe.
This feels like you are not getting adequate air and may pass out. This symptom is due to the narrowing of the airways caused by inflammation and the presence of phlegm.
As you breathe, the air forces its way through the constricted passages producing a sound similar to an insect's buzz. The high-pitched whistling sound often occurs when breathing out, although it can also happen when inhaling.
An asthma attack results from swelling of the small tubes (bronchi) that allow air movement through the lungs. The bronchi become inflamed and more sensitive when you experience an asthma attack. There is no definitive answer to what causes this inflammatory process, and it is an area of active investigation.
New observations suggest that the origins of this chronic condition primarily occur during childhood².
Asthma develops because of particular genetic and environmental exposures. An asthma attack occurs when you get exposed to an asthma trigger—a factor that can set off or worsen asthma symptoms. Triggers include allergens such as:
Waste from pests such as mice and cockroaches
An asthma attack may also occur due to non-allergic triggers such as:
Outdoor air pollution
Infections such as flu and colds
Occupational factors such as breathing industrial or chemical dust at work can also trigger an asthma attack.
The following risk factors may put you at a much higher risk of experiencing asthma attacks:
A family history of asthma may influence the risk of developing the condition. Having a parent with asthma means a higher risk of developing the condition due to your genetic makeup. A study³ found that childhood asthma risk increased with the number of family members with the condition.
Obesity has a significant impact on asthma risk. People with obesity may be at a much higher risk of developing asthma and experiencing more symptoms. Researchers believe the link between the two disorders is the immunological mechanisms and increased swelling in the airways.
Obesity causes significant changes to the mechanics of the chest wall and lungs, reducing lung function. These changes lead to asthma symptoms such as wheezing and airway sensitivity.
Bacterial and viral infections play a crucial role in asthma development. You may develop asthma if bacteria colonize your airway and intestinal mucosal barrier. Viral lower respiratory tract infections can contribute to the development of asthma in childhood.
Exposure to indoor and outdoor air pollution remains a major predisposing factor for asthma development and symptom onset. Polluted air contains harmful substances that may be irritating or toxic to the airways, causing inflammation.
Active smoking can predispose you to asthma. Controlling asthma in smokers is more difficult compared to nonsmokers. The severe effects of smoking on asthma are corticosteroid insensitivity and altered airway inflammation. Prenatal or postnatal passive smoke may put a child at increased risk of developing asthma.
The work environment can be a risk factor for asthma development and exacerbation. Exposure to compounds such as flour dust, acid anhydrides, metals, and other substances in the work environment may lead to occupational asthma. Unfortunately, this form of asthma is often underreported and underdiagnosed, thus progressing to disease.
People with chronic stress may be at a much higher risk of asthma attacks. The potential mechanisms behind the association include changes in the genes that regulate immunologic and behavioral responses to stress.
You should always take your medication even when you feel your condition has improved. Asthma requires consistent care and proper management, so you need to have an inhaler to use when you experience an attack. But what should you do if you don’t have an inhaler when you have an asthma attack?
Here's how to treat an asthma attack if you don’t have your inhaler:
In addition to causing an attack, asthma triggers may worsen the symptoms. Find a way out of areas with triggers such as cigarette smoke, chemical odor, and dust.
Stop what you are doing and sit up straight to keep your airways open. Lying down or bending over when experiencing an asthma attack may constrain your breathing even more.
Panic can worsen your symptoms. Calming down can prevent the chest muscles from tightening further, easing your breathing. You can keep calm by playing some music or distracting yourself.
Take slow and deep breaths in through the nose and out through the mouth to slow down your breathing and prevent hyperventilation.
Hot caffeinated drinks such as coffee might open up the airways a little, offering temporary relief.
See a medical provider if your coughing, wheezing, and breathing problems persist after resting.
The duration of an asthma attack varies from person to person and depends on the cause and extent of inflammation. If you don’t have your inhaler, the duration depends on whether the asthma attack is mild or severe. It may also depend on whether you try coping techniques.
Generally, mild asthma attacks often last a few minutes, while severe attacks can last from an hour to days. Severe attacks typically require medical attention.
Ensuring your asthma is well-controlled is the best way to prevent an attack. That means sticking to your treatment plan and taking your medications as directed. You may not completely eliminate the risk of an asthma attack but may reduce the likelihood of experiencing one.
The two common types of asthma medications are long-term and quick-relief medications. You take long-term medications daily to reduce airway swelling and prevent asthma attacks. They include inhaled corticosteroids, which reduce swelling of the bronchial tubes, and bronchodilators, which open up the airways. Leukotriene modifiers are long-term asthma medications that reduce airway swelling and mucus secretion.
It is worth noting that the Global Initiative for Asthma⁴ no longer recommends using short-acting beta-agonists (SABA)⁵, such as albuterol, alone to treat asthma in adults and adolescents. However, SABA is appropriate for symptom relief in children five years or younger.
If you still experience bothersome or frequent asthma symptoms while on your treatment plan, see your medical care provider to establish whether it is the right time to adjust your treatment.
An inhaler is an essential mobile kit that delivers asthma medication directly to the lungs when you experience an attack. But if you experience an asthma attack with no inhaler, remedies such as sitting up straight and taking long deep breaths can improve your breathing.
However, monitor your symptoms to see if they worsen or improve. Seek emergency medical attention if your symptoms worsen.
GINA asthma strategy: what’s new for 2021? | Guidelines in Practice