Asthma is a chronic lung disease that causes inflammation and narrowing of the airways, making breathing difficult. For most people, asthma is manageable with proper treatment and care. However, for some, asthma can become severe and life threatening. Recognizing the signs of severe, uncontrolled asthma is important for getting prompt emergency care.
What are the signs of severe asthma?
Look for these signs that asthma symptoms are getting worse and require emergency care:
- Shortness of breath that is constant and worsens with minimal activity
- Chest tightness or pain
- Trouble speaking in full sentences
- Wheezing when exhaling
- A cough that won’t go away
- Rapid, shallow breathing
- Flared nostrils when breathing
- Hunched shoulders from difficulty breathing
- Feelings of anxiety or panic
Severe asthma episodes can also be accompanied by these warning signs:
- A rapid heart rate
- Sweating
- Blue tinge to lips or fingernails
- Confusion and agitation
- Unconsciousness
When are asthma symptoms considered an emergency?
Seek emergency medical care if you experience any of these:
- No improvement even after taking quick-relief inhaler medication
- Shortness of breath that persists after initial inhaler use
- Worsening shortness of breath, chest tightness, or wheezing
- Inability to do daily activities or speak comfortably due to shortness of breath
- Lips or fingernails turning blue from lack of oxygen
Call 911 or go to the emergency room right away if you are having a severe asthma attack that is not improving with medication. Severe symptoms that continue to worsen require immediate medical attention to prevent a life-threatening situation.
What causes sudden severe asthma episodes?
Sudden flare-ups of asthma can occur in people with chronic asthma or even those who have not previously had symptoms. Common triggers leading to life-threatening asthma attacks include:
- Exposure to allergens like pollen, pet dander, mold, or dust mites
- Respiratory infections
- Airway irritants like cigarette smoke or air pollution
- Extreme weather conditions like cold, dry air or thunderstorms
- Strong emotions or stress
- Exercise or physical activity
- Some medications like aspirin or NSAIDs
In many cases, experiencing multiple triggers together can set off a severe asthma attack. Even those with well-managed asthma are still at risk if they encounter a new or uncommon trigger.
What happens during a severe asthma attack?
In asthma, the inside walls of airways become inflamed and swollen. This inflammation leads to narrowed airways – making it hard to breathe as less air can flow in and out.
During a severe asthma attack, inflammation causes the airways to significantly narrow. Combined with mucus buildup and tightening of the muscles around airways, the end result is extremely obstructed breathing.
As less oxygen is able to reach the lungs and vital organs, the body struggles to function properly. Emergency care is critical to open the airways and restore normal breathing.
What does a severe asthma attack feel like?
The experience of a severe asthma attack may vary between individuals but commonly includes:
- Shortness of breath – Feeling unable to fully inhale or exhale with a tight, squeezed, suffocating sensation in the chest.
- Wheezing or high-pitched whistling – Breathing makes loud noises as air struggles to pass through narrowed airways.
- Coughing – Frequent, dry coughing from irritation and inflammation in the lungs and airways.
- Chest tightness or pain – Discomfort or tight squeezing feeling in the chest as breathing becomes strained.
- Rapid breathing – Fast, shallow breaths in an effort to compensate for inadequate air intake.
- Panic and anxiety – Fear and anxiety triggered by feeling unable to breathe properly.
The combination of not getting enough air, low oxygen levels, and panic can make someone feel they are suffocating and nearing death during a severe asthma attack. Getting emergency medical treatment immediately is vital.
How is a severe asthma attack treated?
Emergency asthma care involves:
- Oxygen – Given through a mask or nasal tube to bring oxygen levels up.
- Bronchodilators – Inhaled medications that rapidly relax airway muscles and open up airways.
- Steroids – IV corticosteroids help reduce airway inflammation during an asthma flare-up.
- Magnesium – IV magnesium is sometimes used for acute asthma attacks unresponsive to other treatments.
Additional medications, breathing treatments, and monitoring may be needed depending on the severity. Those experiencing a life-threatening asthma attack may need assistance with breathing using a ventilator machine.
What is status asthmaticus?
Status asthmaticus refers to a severe asthma attack that does not improve with initial emergency treatment. It usually involves a peak flow at less than 30% of normal along with dangerously low blood oxygen levels.
Status asthmaticus is a medical emergency needing intensive asthma treatment interventions. People with status asthmaticus are at high risk of respiratory failure if airways cannot be opened.
How can you prevent severe asthma attacks?
These asthma management strategies can lower the risk of life-threatening flare-ups:
- Take inhaled steroids and bronchodilators daily as prescribed.
- Avoid known asthma triggers. Remove pets or dust if allergic.
- Create an asthma action plan with your doctor for handling worsening symptoms.
- Get a flu shot every year.
- Wear a medical alert bracelet or necklace.
- Know your peak flow range and check it regularly.
- Carry a quick-relief inhaler at all times.
Ongoing medical monitoring is also key. See an asthma specialist at least once or twice a year for evaluation of lung function and asthma control.
Does asthma lead to death?
It is possible for someone to die from a severe asthma attack if emergency care is not received in time. Each year asthma results in around 1,500 deaths in the United States.
Some of the ways asthma can turn fatal include:
- Severe bronchospasm leading to respiratory arrest
- Exhaustion from fighting for air resulting in respiratory failure
- Dangerously low oxygen that causes brain damage or heart arrhythmias
- Inability to get enough oxygen to vital organs like the heart, kidends, liver
Death from asthma is far more common in those with poorly controlled asthma that use quick-relief inhalers frequently without also taking long-term control medication.
Can you have a heart attack from asthma?
There are some connections between asthma attacks and heart attacks or other cardiovascular complications.
During an intense asthma episode, decreased oxygen levels and increased inflammation can place significant strain on the heart. Trying to breathe through narrowed airways also increases blood pressure.
The lack of oxygen may lead to angina or even a heart attack in some people. Those with existing heart disease are at increased risk of heart-related complications during or after a severe asthma attack.
When should you go to the hospital for asthma?
Go the emergency room or call for an ambulance if:
- Your quick-relief inhaler does not improve symptoms after 10-15 minutes.
- Breathing problems worsen or persist after taking medication.
- It becomes very difficult to walk or talk due to shortness of breath.
- Lips or fingernails start turning blue or gray.
- You have chest pain along with breathing difficulty.
- Peak flow is less than 50% of your personal best.
Don’t delay emergency care if your symptoms are getting more severe. Severe asthma attacks can progress quickly from bad to life-threatening.
When should you call a doctor for asthma symptoms?
Make an urgent call to your doctor if:
- You need your quick relief inhaler more than twice per week.
- Asthma symptoms disrupt your sleep more than once weekly.
- Asthma symptoms interfere with normal daily activities.
- Peak flow readings decrease below 80% of personal best.
Frequent asthma flare-ups, worsening of symptoms, or declining lung function are signs your asthma is not well controlled. Your doctor may need to adjust medications or investigate potential complications.
What are some asthma complications to watch for?
Make sure to monitor for signs of these serious asthma complications:
- Respiratory infections – Asthma increases risk of infections like pneumonia which can flare symptoms.
- Airway remodeling – Long-term inflammation can cause permanent airway changes.
- Lung collapse – A blocked lung passage can cause collapse of part of a lung.
- Side effects of oral steroids – Problems like osteoporosis, diabetes, or hypertension.
Other issues like sinusitis, acid reflux, obstructive sleep apnea, or nasal polyps can also worsen asthma. Mental health disorders are more common in people with chronic asthma too.
Is asthma considered a disability?
Asthma is considered a disability under the Americans with Disabilities Act (ADA) if it substantially limits one or more major life activities. This can include impaired breathing, walking, working, performing manual tasks, and functioning of the respiratory system.
Whether asthma qualifies as a disability is determined on an individual basis. Factors like severity, frequency of flare-ups, and degree of breathing obstruction are considered.
Those with disabling asthma that meets ADA criteria may get legal protections against disability discrimination at work or school. Workplace accommodations like schedule changes can be requested to help manage symptoms.
Can you develop asthma as an adult?
New onset asthma frequently occurs in adulthood. Around half of all diagnosed asthma cases are in adults over age 18. Risk factors include:
- Obesity
- Allergies
- Smoking
- Viral respiratory infections
- Chronic sinusitis
- Exposure to irritants or pollution
- Aspirin sensitivity
- Stress
- Hormonal changes in women
Adult-onset asthma often persists for many years and requires the same chronic disease treatment as childhood asthma. Symptoms in adults tend to be less frequent but more severe.
Can asthma symptoms come and go?
The variable nature of asthma means symptoms can improve or worsen over time. Ongoing management is needed.
Having intermittent, mild symptoms does not mean asthma has resolved. Airway hyperresponsiveness remains. Allergy, viral infection, or air pollution exposure can lead to sudden recurrence of symptoms.
Likewise, periods of good symptom control do not mean asthma is cured. Maintenance medication should still be taken even when symptom-free to prevent flare-ups and keep asthma well controlled.
Conclusion
Severe asthma attacks requiring emergency care can happen even with proper treatment. Knowing the warning signs – like persistent shortness of breath, inability to speak, and blue lips or fingers – is key. Seeking prompt medical care for worsening symptoms may be life-saving.
Protect yourself against future severe asthma episodes by avoiding triggers, following your asthma action plan, taking maintenance medications, and monitoring breathing function. With vigilance and an active partnership with your doctor, the potentially life-threatening complications of asthma can often be avoided.