In the UK, there are in the region of 1800 deaths from asthma every year. It affects both children and adults and an attack can be rapidly fatal if not treated effectively. Fortunately, a well trained first aider can make a real difference to the outcome.
Asthma is extremely common in high income countries and it's not fully understood why this has become the case. Asthma is closely related to several other conditions, including anaphylaxis, eczema and hay fever and the evidence is starting to suggest that these are all different manifestations of the same disease process. Indeed, it's sometimes difficult to differentiate between an asthma attack and anaphylaxis, as they may share many of the same features.
Asthma is a chronic condition where airways have become thickened and more sensitive. An inappropriate immune system reaction then results in widespread narrowing of the lower airways. The muscles around the airways contract, the walls of the airways swell, and then these narrowed tubes become congested with sticky mucus. This can significantly impair gas exchange, leading to respiratory distress and lowered oxygen levels.
Triggers
The triggers for asthma are specific to the individual, who will usually know what causes them to have an attack. Common triggers are:
Weather - hot, cold, changes of temperature or thunderstorms
Chest infections, colds and flu, Covid-19
Indoor environment - cooking, fires, sprays, damp and mildew, VOCs
Pollution, pollen and cigarette smoke
Emotions - crying, laughing, excitement, stress, anxiety
Alcohol and recreational drugs
Animals and dust mites
Exercise - including sex!
People often find their asthma is worse in the winter as there are more triggers about.
Prevention better than Cure
Asthma is commonly managed through the use of ‘preventative’ measures and medication. Avoidance of triggers is effective where possible, and medication such as steroids reduces the risk of a trigger leading to an attack.
Attacks can sometimes happen when a change in routine means that preventative medication has been missed. The change from school to holidays, or going on an expedition are good examples. Definitely worth some focus around these times if you’re a parent or work in a school.
Signs and Symptoms
Like many diseases, an asthma attack can be anything from mild to life-threatening. It may come on gradually over a few days, or very suddenly.
When someone is experiencing an attack, they are likely to recognise it as an asthma attack. They may be coughing, wheezing, breathless or be experiencing chest tightness, and be sitting in a 'tripod' position.
Imagine trying to breathe through a straw - they'll also be anxious. If a person can't complete a whole sentence in one breath, it's classified as a severe attack and needs immediate help from a healthcare professional - call 999.
Treatment
Like with other conditions, treatment involves:
Calling for help
Helping someone to take their medication
Keeping them calm
Medication usually comes in the form of an inhaler, commonly a Metered Dose Inhaler, but many other types are available.
When having an attack, particularly if it's severe, the person may need you to help them take their medication effectively. Watch these videos from Asthma UK to get the correct technique for each inhaler. Note, if someone has a spacer, use this to make their technique more effective.
Follow up
Recent research shows that a high proportion of people will have another asthma attack within the next couple of weeks.
Encourage them to contact their asthma doctor or nurse to arrange an appointment to see if they could be doing something to reduce the risk of having another attack.