That’s what it can feel like to have an asthma attack. “Some people will say that it feels like they have an elephant on their chest,” says pulmonologist Dr. Michael Wechsler, MD, a professor of medicine and director of National Jewish Health’s Cohen Family Asthma Institute in Denver, Colorado. “Some people will say that it feels like a noose is around their neck. And some people will say that they can’t stop coughing … there is something in their airway that they can’t get out.”
Here’s what’s happening during an asthma attack
Normally when you breathe, air flows through your nose or mouth, past your trachea and into the airways in your lungs, bringing oxygen-rich air to the air sacs, or alveoli, in your lungs. And then your airways carry the waste product, carbon dioxide, back out of your lungs. You do this over and over again when you breathe. Those airways, however, are already sensitive when you have asthma. And when something triggers your airways to react, that can generate an asthma attack or exacerbation. Here’s exactly what happens: First, your airways become swollen and inflamed. The muscles around your airways begin to contract, and your airways begin to narrow. Plus, your airways may also produce extra mucus, which also reduces the space for air to flow through. You may start coughing or wheezing, or you might realize that you’re feeling short of breath. Your chest may feel tight and painful. You may feel like you’re not able to breathe in enough air–or you may feel like you’re trying to breathe through a straw, saysS. Shahzad Mustafa, MD, an allergist and immunologist with Rochester Regional Health in Rochester, New York. And these uncomfortable sensations can worsen as the clock is ticking. You may indeed feel like that proverbial elephant is trying to sit on your chest, or something is tied around your throat. An asthma attack can also feel a little like a panic attack in some situations. “But asthma can also cause anxiety, so they can double up on each other,” says Dr. Mustafa.
Asthma attack symptoms vary
Asthma attacks are the same. They don’t all start the same way, and they don’t all progress in the exact same way, either.“Asthma symptoms can come on very abruptly or acutely, or they can come on very slowly,” says Dr. Wechsler. “That’s one of the concerning things.” “There is such a range, and it’s so variable,” agrees Dr. Joi Lucas, MD, a pediatric pulmonologist in Orlando and author of Your Roadmap to Successful Asthma Treatment: A Parent’s Guide to Preparing for Your Child’s Doctor Visits and Long-Term Care. Triggers for asthma attacks vary from person to person, too, although there are a number of common triggers. The Centers for Disease Control and Prevention (CDC) lists these common culprits:
SmokeDust mitesPet danderAir pollutionCockroaches, mice and other pestsMoldCleaning and disinfecting productsPollenViral illnessesExercise
Additionally, some medicines, acid reflux, fragrances, some foods, and cold dry air can trigger asthma attacks in some people.
What to do when you recognize that an attack is happening
As soon as you noticed that you’re experiencing the signs of an asthma attack, you should act. People with asthma should always follow the specific instructions on their individualized asthma action plans, but the first step is often to take two puffs of their rescue inhaler. Rescue inhalers contain a short-acting bronchodilator like albuterol or levalbuterol to relax those clenched muscles around the airways and help open up those narrowed airways. “Usually, albuterol has an onset of action that is 15 to 20 minutes, and it lasts for four hours,” says Dr. Lucas. Hopefully, a couple of puffs will do the trick, and you’ll notice the symptoms begin to subside. If you don’t notice any improvement after about 20 minutes, another two puffs may be warranted. However, if you get to six puffs of albuterol within a four-hour time period, that’s a sign that you should probably head to the urgent care center or the emergency department, says Dr. Lucas. Some people use a portable hand-held device called a peak flow meter to measure their lung function. This devicemeasures how much air you can push out of your lungs in one swift exhale. If you use one during an asthma attack, you may get low peak expiratory flow (PEF) readings. Depending on how low the reading is, this can also be a sign you need to seek emergency care.
Speak up if you need help
If you have a child with asthma, encourage them to speak up if they feel like they are on the verge of having an asthma attack. “If they are home, they need to tell whomever is there to help them,” says Dr. Luis Torero, MD, a pediatric pulmonologist with Northwestern Medicine’s Regional Medical Group. “If they are at school, the same thing. They shouldn’t be shy.” And if you’re the one with asthma, the same advice applies. If you need help, ask.
Let your doctor know if your attacks are happing more frequently
If you’ve started experiencing asthma attacks more frequently, don’t blow it off. “Anyone can have an asthma attack, but your risk of an asthma exacerbation is much higher if your asthma is poorly controlled,” says Dr. Mustafa. For example, think back. Do you remember any symptoms occurring more frequently, or perhaps have you been using your rescue inhaler a lot more than usual? “Waking up in the night with respiratory difficulties is also a sign of poor control,” adds Dr. Mustafa. If you experience any of these symptoms, let your doctor know. It may be time to adjust your long-term control medication. Next up: If You or Someone You Love Has Asthma, Here Are the 8 Most Common Triggers to Know About
Sources
Joi Lucas, MD, pediatric pulmonologist and authorS. Shahzad Mustafa, MD, allergist and immunologist. Rochester Regional Health.Luis Torero, MD, pediatric pulmonologist. Northwestern Medicine’s Regional Medical Group.Michael Wechsler, MD, pulmonologist. National Jewish Health.Asthma Attack. Mayo Clinic.Asthma Facts & Figures. Asthma and Allergy Foundation of America (AAFA).Bronchodilators & Asthma. Cleveland Clinic.Common Asthma Triggers. Centers for Disease Control and Prevention (CDC).How the Lungs Work. National Heart, Lung, and Blood Institute (NHLBI).Measuring Your Peak Flow Rate. American Lung Association.Smoking & Asthma. Cleveland Clinic. What is Asthma?American College of Allergy, Asthma & Immunology
