Asthma is a chronic disease that affects the airways of the lungs. It causes repeated episodes of wheezing, breathlessness, chest tightness, and nighttime or early morning coughing. Asthma is not curable, but with proper management, people with asthma can lead normal, active lives.
What causes asthma attacks?
Asthma attacks or exacerbations are caused by triggers that irritate the airways and lead to inflammation and narrowing of the airways. Common triggers include:
- Allergens – pollen, dust mites, mold, pet dander
- Irritants – cigarette smoke, air pollution, chemicals
- Weather conditions – cold air, changes in weather
- Exercise
- Infections – cold, flu, sinusitis
- Stress and emotions
When exposed to these triggers, the airways become inflamed, swell up and produce extra mucus. The muscles around the airways tighten, making the airways narrower. These changes make it difficult to breathe and can lead to wheezing, shortness of breath, coughing and chest tightness.
What happens during an asthma attack?
Severe asthma attacks involve a significant narrowing of the airways that restricts oxygen supply to vital organs. Symptoms of a severe asthma attack include:
- Severe shortness of breath
- Difficulty talking
- Blue tinge to lips or fingernails (cyanosis)
- Confusion and agitation
- Gasping or struggling for breath
- No relief from quick-relief inhaler
- Fatigue from working hard to breathe
Without adequate treatment, severe asthma attacks can lead to a loss of consciousness or even death from hypoxia and respiratory failure. Seek emergency care immediately if an asthma attack is not improving with medication or peak flow readings are less than 50% of normal.
What factors increase the risk of death from asthma?
While fatal asthma exacerbations are relatively uncommon, some factors can increase the risk:
- Poor adherence to control medications – Not taking inhaled corticosteroids regularly is associated with increased asthma-related deaths.
- Overuse of reliever medications – Excessive use of short-acting beta-agonists like albuterol can increase mortality.
- Previous severe exacerbations – Having a history of near-fatal attacks or ICU admissions increases risk.
- Co-existing psychological problems – Anxiety, depression and other mental health issues are linked to increased mortality.
- Socioeconomic factors – Poverty, low education, inadequate housing, reduced access to care.
- Substance abuse – Cigarette smoking and illicit drug use adversely affects asthma control.
- Comorbidities – Heart disease, gastroesophageal reflux, sinusitis, obesity.
While these risk factors increase the chance of death from asthma, they can be modified through proper education and management.
How can you prevent death from asthma?
Here are some key strategies to prevent fatal asthma exacerbations:
Take control medications correctly
Inhaled corticosteroids are the most effective drugs for controlling asthma long-term. They treat inflammation and prevent asthma attacks from being triggered. Taking them daily as prescribed is essential. Do not stop them abruptly without medical advice.
Avoid overusing reliever medications
Quick-relief bronchodilators like albuterol provide rapid symptom relief but do not treat inflammation. Use them only as needed for symptom flare-ups, not daily for prevention. Overuse can increase risks.
Identify and avoid triggers
Avoiding or reducing exposure to known asthma triggers like allergens and irritants can help prevent exacerbations.
Get recommended vaccinations
Getting the annual flu vaccine and other recommended immunizations helps prevent respiratory infections that can worsen asthma.
See your doctor regularly
Have regular asthma reviews with your doctor every 3 to 6 months to monitor control and adjust medications as needed. This helps keep asthma well-managed.
Follow an asthma action plan
Work with your doctor to create a written action plan that explains daily management and how to recognize and handle worsening asthma. This helps you know when to adjust medications or seek emergency care.
Use a peak flow meter
Using a peak flow meter at home helps monitor lung function. Rapid drops in peak flow can signal worsening asthma and the need for intervention before a severe attack occurs.
Treat co-existing conditions
Manage heartburn, sinusitis, anxiety, depression or other conditions that can aggravate asthma. Treating them helps improve overall control.
Maintain a healthy lifestyle
Steps like eating a balanced diet, exercising regularly, managing stress, and quitting smoking can help strengthen lungs and prevent acute flare-ups.
Seek emergency care for severe attacks
Severe, uncontrolled asthma attacks can be fatal. Seek emergency care if symptoms are getting worse despite medication or peak flows are very low.
Get help for substance abuse problems
Get treatment and support for cigarette, alcohol or drug dependency issues. These worsen asthma control and increase risks.
Consider immunotherapy
For people with asthma triggered by allergies, allergy shots or sublingual immunotherapy can help reduce sensitivity to certain allergens over time.
Get recommended screening tests
Some screening tests like chest x-rays and sputum analysis help identify complications or co-existing conditions that can impact asthma control and outcomes.
Ask about monoclonal antibodies
New injectable monoclonal antibody drugs like dupilumab can reduce asthma attacks in moderate-to-severe asthma for patients over 12 years old.
Consider bronchial thermoplasty
This procedure uses heat energy to reduce smooth muscle mass in airways and decrease bronchoconstriction. It helps severe, persistent asthma.
Carry emergency medication
Always carry your quick-relief inhaler and keep instructions on using any emergency oral steroids you’ve been prescribed. This allows prompt treatment of any asthma attacks.
Educate friends and family
Teach people close to you how to recognize signs of worsening asthma and what to do during a severe attack.
Obtain support and education
Joining asthma support groups and taking educational classes can promote better self-management and outcomes.
Conclusion
While fatal asthma exacerbations are uncommon, they can occur in those with poorly controlled or high-risk asthma. Preventing deaths from asthma is possible through adherence to controller medications, avoiding triggers, closely monitoring symptoms, treating co-existing conditions, and seeking prompt care for attacks. With proper control and risk reduction strategies, most asthma-related deaths can be prevented.