An asthma exacerbation is a sudden worsening of asthma symptoms, also known as an asthma attack or flare-up. These episodes can range from mild to severe, making breathing difficult due to the narrowing and swelling of airways in the lungs. During an exacerbation, muscles around the airways tighten, and the lining of the airways produces excess mucus, further obstructing airflow. Prompt and effective treatment is important to manage these episodes, as severe exacerbations can be life-threatening.
Immediate Actions at Home
When an asthma exacerbation begins at home, using a rescue inhaler, specifically a short-acting beta-agonist (SABA) like albuterol, is the first step. These inhaled bronchodilators work within minutes to relax the muscles around the airways, helping to open them and ease breathing. It is important to use the inhaler correctly, ideally with a spacer, which helps ensure more medication reaches the lungs. Follow the specific instructions for your inhaler and spacer, including shaking, breathing technique, and waiting between puffs. Rinsing your mouth afterward can reduce side effects.
Following a personalized asthma action plan is also important for guiding immediate home treatment. This plan, often color-coded (green, yellow, red zones), outlines when to use rescue medication, how much, and when to seek emergency medical help based on symptoms or peak flow readings. The yellow zone, for instance, indicates worsening symptoms and prompts the use of quick-relief medicine to prevent further escalation. A peak flow meter can measure how quickly air can be forced out of the lungs; a reading below 80% of one’s personal best can signal an attack and indicate a need for action as per the plan.
Recognizing when to seek emergency medical care is also part of immediate home actions. Signs indicating a need for immediate attention include rapid worsening of breathlessness or wheezing, no improvement after using a quick-relief inhaler, difficulty speaking due to breathlessness, blue lips or fingernails, severe chest pain or tightness, a rapid heart rate, or feelings of agitation or confusion. If these signs occur, or if an asthma inhaler is unavailable, calling emergency services is necessary.
Professional Medical Care
Upon arrival at an urgent care facility, emergency department, or hospital, healthcare professionals will conduct an initial assessment to determine the severity of the asthma exacerbation. This assessment includes checking oxygen levels, often aiming for a saturation above 92%, and sometimes performing lung function tests like peak expiratory flow (PEF) measurements. Clinical signs of a severe exacerbation can include a heart rate above 120 beats per minute, a respiratory rate exceeding 30 breaths per minute, and the use of accessory muscles for breathing.
Inhaled bronchodilators are a primary treatment in a medical setting, often administered via a nebulizer, a machine that converts liquid medication into a fine mist for inhalation. Short-acting beta-agonists (SABAs), such as albuterol, are given to relax airway muscles, often in repeated doses. Short-acting anticholinergics, such as ipratropium bromide, may also be added to SABAs for additional airway relaxation, particularly in moderate to severe cases.
Systemic corticosteroids are administered to reduce airway inflammation, which is a major component of asthma exacerbations. These medications, such as prednisone or methylprednisolone, can be given orally or intravenously. They are given orally or intravenously, depending on the severity and patient’s condition. Corticosteroids are usually started within the first hour of treatment to hasten symptom resolution and decrease the risk of relapse or hospitalization.
Supplemental oxygen therapy is provided to maintain adequate oxygen levels in the blood, especially if saturation falls below 90-92%. Oxygen is delivered through a face mask or nasal tubes to supply additional oxygen to the lungs, helping to alleviate shortness of breath and reduce strain on other organs. Oxygen therapy should only be administered by medical professionals during severe asthma attacks to ensure correct concentration and avoid potential risks.
For very severe cases that do not respond sufficiently to initial treatments, additional therapies may be considered. Intravenous magnesium sulfate may be used as it can help relax bronchial smooth muscles. In rare instances, particularly if respiratory failure is imminent, advanced airway management, such as intubation, may be necessary. In such cases, specific medications may be used during intubation to help relax airway muscles.
Monitoring of the patient’s response to treatment is continuous, including repeated lung function tests and oxygen saturation measurements. The decision for hospital admission versus discharge is based on several factors. Patients are generally discharged when their lung function improves significantly and their symptoms are minimal. Other considerations for discharge include a good response to bronchodilator therapy, having appropriate medications, and a clear understanding of their asthma management plan. Patients with persistent severe symptoms, poor lung function after initial treatment, or other high-risk factors often require hospital admission.
Preventing Future Episodes
After an asthma exacerbation, follow-up care with a healthcare provider, such as an asthma specialist or primary care doctor, is important. This appointment, ideally soon after discharge, allows for a review of the recent episode and adjustments to the long-term management plan. Regular check-ups, at least annually, are also recommended to ensure the asthma is well-controlled.
Maintenance medications play a role in preventing future exacerbations by controlling underlying airway inflammation. These daily medications, such as inhaled corticosteroids (e.g., fluticasone, budesonide), are designed to reduce swelling in the airways and are often the first choice for long-term management. Long-acting bronchodilators, including long-acting beta-agonists (LABAs) or long-acting muscarinic antagonists (LAMAs), may be added to inhaled corticosteroids to further prevent airway narrowing and improve symptoms, but they should not be used alone.
Identifying and avoiding personal asthma triggers is another important strategy for prevention. Common triggers include allergens like dust mites, pollen, pet dander, and mold, as well as non-allergic factors such as respiratory infections (colds, flu), cigarette smoke, cold air, and exercise. Simple measures like regular hand washing, getting annual flu vaccinations, avoiding known allergens, and maintaining good indoor air quality can help reduce exposure.
An updated, personalized asthma action plan is important following an exacerbation. This plan should incorporate any lessons learned from the recent episode, providing clear instructions on daily medication use, recognizing worsening symptoms, and knowing when to seek urgent medical help. The plan helps individuals and their caregivers proactively manage symptoms, decrease the risk of emergency room visits, and maintain better asthma control over time.