Asthma a Potentially Fatal Ailment

Posted on Wed., Jan. 16, 2008
By Dr. Stephen J. Daniels

"Laura, where's my other inhaler?" called Martin to his wife. Half-asleep at 3 a.m., Laura took a few seconds to understand what was happening. "Oh, I threw it out with some other expired medicines."

Martin returned to bed, wheezing loudly. "Well, I guess I'll have to call Dr. White first thing in the morning."

At 4 a.m., Martin sat up suddenly. Gasping for air, panting and sweating, he grabbed for his wife and was barely able to whisper, "9-1-1."

When the paramedics arrived, Martin lay unconscious and gray while Laura frantically tried to blow air between his blue, lifeless lips. Taken to the hospital, he survived... "barely, by a matter of seconds," his doctor said.

DEATH FROM ASTHMA: This situation, in which an asthmatic doesn't have enough medicine and a refill is not readily available, is an all-too-common cause of asthma emergencies and deaths.

The lesson is: Plan ahead. Always keep enough asthma medicine on hand.

For many asthmatics, a severe asthma attack can develop suddenly. Even better, use medicines (called "controllers") to prevent severe asthma.

WHAT WILL MY ASTHMA BE LIKE?: Asthma symptoms can vary dramatically from person to person. Some people develop asthma symptoms only once or twice in a lifetime, usually associated with a cold. Others get asthma a couple of times per year - usually in the spring - related to pollen, and associated with colds or the flu.

Still, others have asthma on and off during their whole lives. It's hard to know in advance which sort of asthma any one person might have.

WHAT IS ASTHMA?: Asthma is caused by blockage of the breathing tubes deep in the lungs. The blockage comes from three causes.

First, the tubes themselves become narrower (constricted) because the muscles within the walls of the tubes contract. The inner linings of the tubes become inflamed and swollen. And mucus is secreted into the tubes, blocking and narrowing them even further.

All of these problems can contribute to the shortness of breath, coughing and/or wheezing (squeaky, noisy breathing) that are the typical signs of asthma.

CONTROLLER VS. RESCUE MEDICINES: "Doc, this inhaler doesn't work for me. ...I don't feel anything after I use it." This is a common misunderstanding among asthma patients: expecting to feel immediate benefit from all inhalers.

In fact, some inhalers (and asthma pills) are designed to prevent ("control") future asthma symptoms, not cure ("rescue") the patient immediately.

The lesson: Just because you don't feel immediate relief from an inhaler doesn't mean it's not working. Controller inhalers, such as QVAR or Flovent, take a few hours or even a few days to work, so they won't work fast enough if you are in the middle of an asthma attack.

By contrast, rescue inhalers, such albuterol, work within a few minutes, and are designed to treat an asthma attack quickly.

WHEN SHOULD I GO TO THE ER?: Go to the emergency room if:

You are short of breath, using all your medicines and not getting better.
You are having asthma symptoms, can't get a refill or see your doctor, and might run out of medicine.
Call 9-1-1 if you are having severe problems breathing.

Dr. Stephen J. Daniels practices Family Medicine at the Concord and Pittsburg Health Centers, affiliated with Contra Costa Health Services.