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Signs of an Asthma Attack Onset
Being able to recognise the signs and symptoms of an asthma attack onset is crucial to preventing an asthma emergency.
Although asthma is a very treatable and manageable condition, in some cases it can be fatal without proper attention. If you or someone you know has asthma, having a solid understanding of the signs and symptoms may help you stop a dangerous situation from developing.
Due to a number of asthma awareness groups and a wide range of educational initiatives, this number fell to 378 back in 2011. The numbers fluctuate every year, but currently are increasing. In order to keep this number on the decline people need to take the appropriate preventative measures and learn the warning signs of an asthma attack onset.
Signs and Symptoms
During an asthma attack, the airways become constricted by tightened muscles and the inside lining of the airways becomes swollen and produces thick, sticky mucus.
The most common and obvious signs of an asthma attack include:
- Wheezing
- Shortness of breath
- Chest tightness
- Coughing fits
- Difficulty breathing
- Dry, irritating, persistent cough, particularly at night and early morning
Danger signs
If you or someone else is having a severe asthma attack you should call 000 immediately.
Symptoms of a severe asthma attack include:
- Gasping for breath having little or no wheeze due to lack of air movement
- Severe difficulties breathing
- Severe chest tightness
- Only able to speak a few words at a time
- Feeling distressed and anxious
- Blue discolouration on or around the lips (if skin colour also changes this can be hard to see)
- Pale and sweaty skin
- Sucking in of throat and rib muscles
- Using shoulder muscles or bracing with arms to help with breathing
- Symptoms rapidly getting worse or frequently using reliever more than every 2 hours
- Children may become restless, unable to to settle or become drowsy
- Children may also have trouble eating and drinking due to shortness of breath
- A child may have severe coughing or vomiting
Understand the five symptoms of an asthma attack to better get the treatment you need during an episode.
Asthma is a chronic respiratory disease characterized by episodic swelling and narrowing of the airways. While it often starts in childhood, adult-onset asthma is also possible.
Asthma attack symptoms arise due to inflammation in the airways, stress or seasonal changes. These symptoms may or may not occur suddenly. In fact, they often develop slowly over a few hours or days. Identifying when an asthma attack is about to occur can better help you manage your symptoms.
Here are five ways to identify an asthma attack:
- The hallmark of asthma is wheezing, which is a whistle-like noise emerging from the airways when patients exhale. Some patients, however, may not have any wheezing.
- Chest tightness or discomfort when breathing.
- Cough variant asthma may be present with dry (nonproductive) coughing that does not respond to antihistamines and worsens at night or in the early hours of the morning.
- Patients experience breathing issues where they feel like their breathing is getting faster, they cannot catch their breath and the skin on their chest or neck sinks or moves inward as they breathe.
- Nonspecific symptoms such as a pale or sweaty face during an attack, irritability and feeling low.
What are the three types of asthma?
Understanding the different types of asthma can help patients seek the most effective treatment during an asthma attack. The three most common types of asthma are:
Exercise-induced asthma or exercise-induced bronchoconstriction
- Exercise does not directly cause asthma, but physical exertion during exercise can trigger the condition.
- Coughing and wheezing are the most common symptoms of exercise-induced asthma.
- With exercise-induced asthma, airway narrowings peak 5 to 20 minutes after exercise begins, making it difficult to catch a breath.
- Symptoms begin within a few minutes of exercise and peak or worsen a few minutes after exercise ends.
- Usually, doctors recommend a bronchodilator (an asthma inhaler) for this type of asthma.
Allergic asthma or occupational/seasonal asthma:
- Inhaling allergens is the most common trigger for inducing allergic asthma, which includes:
- Dust mites
- Pet dander
- Pollen
- Mold
- Sometimes, allergic asthma may be due to a patients’ occupation (paint, metal or gas); hence, patients must determine the exact trigger and consult an allergist or immunologist.
- Few patients may develop asthma only during the winter season because the cold can trigger asthma attacks.
- Anyone who has an allergy due to allergens, the season or their occupation may require an immunologist or allergist intervention.
- Doctors recommend preventive and reliever inhalers for this type of asthma.
Nocturnal asthma:
- Patients may develop nocturnal asthma along with another type of the condition, including all those mentioned above.
- Usually, patients wake up coughing, wheezing or with chest pain; hence, more effective and long-term treatment is required for this type of asthma.
- Studies show that most deaths related to asthma occur at night due to these potential reasons:
- Increased exposure to allergens (asthma triggers)
- Cooling of the airways
- A reclining position
- Hormone secretions
- Sometimes, normal heartburn can trigger asthma symptoms at night.
- Doctors may recommend diet changes, eye drops, nasal decongestants and regular saline nasal rinse to wash out allergens.
What are the common treatment options for an asthma attack?
Long-term control and prevention are the key methods to stop asthma attacks before they start. Treatment usually involves recognizing triggers and avoiding them as much as possible.
There’s currently no cure for asthma, but treatment can help control the symptoms so that patients may be able to live a normal, active life. Treatment may include:
Inhalers:
- These may relieve symptoms when they occur (reliever inhalers) and stop symptoms from developing (preventer inhalers). Some patients need an inhaler that does both (combination inhalers).
Tablets: Patients may need to take tablets if using inhalers alone is not helping to control their symptoms.
- Leukotriene receptor antagonists (LTRAs): LTRAs are the main tablets used for asthma. They also come in syrup and powder form.
- Theophylline: Doctors may recommend theophylline if other treatments do not help control the patient’s symptoms.
- Steroid tablets: Doctors may recommend steroid tablets if patients are unable to take any of the above medications to control their symptoms. They may give these tablets as an immediate treatment or every day for long-term treatment to prevent the symptoms.
Injections:
- For some patients with severe asthma, doctors may give an injection, such as Fasenra (benralizumab), every few weeks to control their symptoms.
- These medicines are not suitable for everyone and can only be prescribed by an asthma specialist.
Surgery:
- Doctors may offer a procedure called bronchial thermoplasty as a treatment for patients with severe asthma. This procedure works well, and there are no serious concerns about its safety.
- Doctors may sedate patients using general anesthesia during bronchial thermoplasty. The procedure involves passing a thin, flexible tube down the throat and into the lungs.
- Heat is then used on the muscles around the airways to help stop them from narrowing and causing asthma symptoms.
Breathing exercise:
- There’s some evidence that breathing exercises can improve symptoms and reduce the need for reliever medicines in some patients, but they should not replace asthma medications.
How Eosinophilic Asthma Differs From Other Asthma
When you have asthma, the airways in your lungs get narrow and swollen. They also make too much mucus. This sets off spasms in the tubes that let air in and out of your lungs (bronchial tubes). The spasms make it hard to breathe. You may also wheeze and cough. Its an ongoing, lifelong condition.
There are several different types of asthma. Each type has different triggers. These can be things such as exercising too hard or stuff in the air like smoke or pollen.
One type is a serious kind called eosinophilic asthma. Its harder to control with typical medications. Science links it to higher levels of white blood cells called eosinophils. These cells are part of your immune system. They help to kill things that dont belong in your body such as harmful bacteria. They also control inflammation.
Researchers have found that the more eosinophils in your blood, the more likely you are to have a serious asthma attack. But they arent sure what causes their numbers to go up. They have learned that eosinophilic asthma is different from other forms of the condition in a few ways:
Who It Impacts
Asthma often starts when youre a child, but the eosinophilic type most often appears in adults around middle age.
Even though this kind of asthma does happen in children and older adults, its more likely to first come on when youre between the ages of 35 and 50. Its not clear how many people it affects. But researchers think that less than 10% of people with asthma have a type as serious as eosinophilic asthma. Theyve also found that men and women get this type in equal numbers.
Triggers and Symptoms
Many times, an allergy to things like pollen or pet dander can trigger asthma symptoms. But people with eosinophilic asthma dont tend to have these allergies. What sets this type apart from other forms of the condition is a higher number of eosinophils in your blood, lung tissue, and coughed-up mucus (sputum).
Symptoms like wheezing, coughing, and shortness of breath happen in all types of asthma. But this kind affects your entire respiratory system. This means that youll likely get a lot of sinus infections. You may also get nasal polyps, noncancerous growths in the nasal passages or sinuses. You may also notice that the lining in your nose (mucous membrane) gets swollen and irritated.
Your symptoms may not look and feel like those of what you think of as typical asthma. They could seem more like chronic pulmonary obstructive disorder (COPD). This is a lung disease that causes long-term breathing problems and poor airflow. Sometimes doctors diagnose eosinophilic asthma as COPD by mistake.
Diagnosis
To figure out if you have asthma, your doctor will give you a physical exam. Theyll ask you about your symptoms and other health problems. You may also have to take lung function (pulmonary) tests. These will tell you how much air you can breathe out and how quickly you can do it.
To diagnose eosinophilic asthma, you may need some extra tests to look for eosinophils:
- Blood test. A doctor or nurse will draw your blood to measure the number of eosinophils in it.
- Sputum sample. Youll cough up a sample of mucus. Your doctor will then examine it under a microscope.
- Bronchial biopsy. This test is less common. Your doctor will put a tool called a bronchoscope into your nose or mouth. Theyll use it to get several small tissue samples from your lungs (biopsy). Theyll analyze these for eosinophils. Youll need to drugs to stop pain (anesthesia). You may have to stay in the hospital.
Treatment
There are two goals for treatment of this type of asthma: control your breathing and reduce eosinophils. You may feel symptom relief from typical asthma treatments. These include drugs that stop inflammation (corticosteroids) and quick-relief inhalers (bronchodilators).
But these medications dont always work for people with eosinophilic asthma. Your doctor could also give you a medicine called a biologic. It targets eosinophils and makes your body less able to make them. Youll take it along with other asthma drugs.
Its important to diagnose and treat this condition early so you can stop lasting damage to your lungs, such as lung tissue scarring and thickened airway walls. See your doctor once a year to go over your treatment plan and make sure its still right for you.
Get the Most Out of Eosinophilic Asthma Treatment
What can you do to help your eosinophilic asthma treatments work their best? There are simple steps you can take each day to improve symptoms, quality of life, and overall health.
More Serious Asthma
Eosinophilic asthma is often more serious than other types of asthma. Your lungs, blood, and mucus have high levels of white blood cells called eosinophils. Having more eosinophils in your blood can lead to worse asthma attacks.
This condition affects everyone differently. You may not respond as well to the same therapy as another person with the same disease.
With this type of asthma, there are many things that can cause inflammation and block your airways. Your genes and environment may both affect how your treatments work for you.
Targeted Treatment Plan
Your doctor will make a treatment plan tailored for you. Youll get more from your plan if you stick to it. Take your drugs at the same time every day to get the best results and control airway inflammation.
First, your doctor may prescribe a steroid inhaler. A steroid can lessen swelling and mucus so your airways stay open. You have to take inhaled steroids every day to manage your condition.
Some people with this kind of asthma dont respond well to inhaled or oral steroids. They may not get relief from other standard asthma treatments either, like long-acting beta-2 agonists (LABA). Others do well on these controller drugs.
If your symptoms dont get better, your doctor may prescribe one of a newer group of biologic drugs. It will cut down on the number of eosinophils. Itll also target and block the sources of your inflammation.
Stick to Your Plan
Eosinophilic asthma drugs work only if you take them on schedule. You must take them regularly to manage symptoms and keep inflammation under control. You need to take some medicines daily or weekly.
Some biologic drugs come in prefilled syringe pens so you can give yourself shots at home. Its your responsibility to take your medicine on time and not miss doses.
Let your doctor know if you have any problems with your plan. Tell them if you have any side effects or schedule conflicts that make it hard for you to stick to it. They may be able to change your dose or prescribe a similar medicine that works better for you.
Does Diet Matter?
Some research shows that a high-fat, low-fiber diet could make your flare-ups worse. A diet rich in red meat and processed foods could boost the eosinophils that cause inflamed airways.
The Mediterranean diet, which includes more fresh fruits and veggies, may help lower inflammation in your airways. Eating more fiber may also help you keep a healthy balance of bacteria in your gut. Research suggests that this can lower inflammation too.
A vitamin D supplement may help people who have this asthma. Your doctor can test you to see if youre low in this vitamin. If not, supplements wont do you any good.
If youre overweight or obese, you may feel better if you lose the extra pounds. People who are obese and have asthma often have worse symptoms. Talk to your doctor about how to lose weight and keep it off.
Dont Smoke
Smoking makes it harder for you to control your asthma. It makes drugs like inhaled steroids less effective. It can also trigger asthma attacks and make them worse.
If you smoke, stop. Stay away from secondhand smoke too. Vapes and other e-cigarettes may also be unhealthy for your lungs. If you smoke tobacco or vape, talk to your doctor about how you can get help to quit.
Get Plenty of Exercise
Regular physical activity is good for everyone with asthma. Exercise keeps your lungs and heart healthy.
Take your medications as your doctor prescribes to keep your airways open. This will let you do regular exercise without wheezing or getting out of breath.
Before you head outside to exercise, check for any poor air quality alerts in your area. Try not to exercise outdoors when the air is bad because of high smog, wildfires, or very hot and humid weather. These environments can be risky for people with asthma. Exercise indoors instead.
Manage Stress, Get Enough Sleep
Too much tension and anxiety can lead to higher eosinophilic inflammation in your lungs.
This can bring on symptoms like shortness of breath. They may feel worse at times like this. While you cant stay away from all stress, learn ways to manage it and relax. Exercise is one way to burn it off.
If your treatment doesnt control your condition well, you may not sleep well. And asthma raises your chances of having sleep apnea, which can lead to high inflammation in your airways. Its a vicious cycle.
Its not clear whether poor sleep makes asthma worse. But it can sap your energy and make it harder to manage stress, too.
Try to have good sleep habits so you get enough rest. Set a regular bedtime. Turn off the TV and your electronic devices when its time to rest. Cut back on caffeine. Dont nap if it keeps you awake all night.
Understanding the Cycle of Control and Breakthrough Symptoms with E-Asthma
Eosinophilic asthma (e-asthma) is a rare form of the breathing disease that can be very hard to treat successfully. That can put you in a frustrating cycle of asthma attacks. People with e-asthma are less likely to have their asthma under control, and more likely to have serious attacks.
Understanding whats happening in your body and what you can do about it may help you break the cycle.
Why Is E-Asthma Different?
People with e-asthma have too many infection-fighting white blood cells called eosinophils in their lung tissue, blood, and mucus. These cells are ready to react to a threat. If the cells are overactive, they can cause inflammation. In the respiratory system, that means swelling that narrows breathing passages, and extra mucus in your lungs.
Doctors dont know why some people have high levels of eosinophils, but they can also cause problems in other parts of your body, like your stomach or bladder.
E-asthma doesnt always have the same triggers as more common forms of asthma. And it may not respond well to the asthma medications that are prescribed most often. So even if you avoid allergens like dust and pet dander and use a daily inhaler, you may keep getting flare-ups of your symptoms.
If you have asthma thats severe or hard to treat, it may be eosinophilic asthma. Here are some signs:
- Your symptoms are triggered by something other than allergens.
- Youre often short of breath, especially after exercise or other physical effort. And your lungs dont work as efficiently as they should, even when you take medicine to open up your airways.
- You keep having attacks even though youre using inhaled corticosteroids. Symptoms may stop when you take oral corticosteroids, but come back when you go off of them.
- You get sinus infections often, and you have growths inside your nose or sinuses called nasal polyps.
It can take time to get to the right diagnosis. The symptoms are more likely to point to chronic obstructive pulmonary disease (COPD). The most reliable test for e-asthma involves coughing up mucus. But it can be hard to do and not every lab can process the results.
What to Watch For
To avoid eosinophilic asthma flares, its important to stay on top of your symptoms. If you can spot an attack coming on, you may be able to prevent it. You may want to keep a symptom diary to make note of how you feel every day. Some people use a device called a peak flow meter that measures how hard you can blow air out of your lungs.
Signs that lung inflammation is getting worse include:
- Your peak flow number is down.
- Your chest feels tight.
- Youre coughing.
- Youre unusually tired.
You and your doctor should come up with an asthma action plan. It tells you which symptoms to watch for and what to do when you have them.
How to Get Control
If youre stuck in a cycle of flares, you and your doctor may need to rethink your treatment. The typical daily treatments – like inhaled corticosteroids and inhaled bronchodilators – dont always work on eosinophilic asthma. It can help to add one of these more powerful treatments:
- Oral corticosteroids: Many times, e-asthma can be brought under control with steroid medicines you take as a pill. These can have serious side effects, and when you take them for a long time, youre more likely to get glaucoma, diabetes, and osteoporosis. But sometimes it may be worth the risk to prevent attacks.
- Omalizumab (Xolair): This biologic drug targets your bodys reaction to allergens. Studies found it lowers the levels of eosinophils in your blood and in your airways, and cuts down on asthma attacks. Its approved to use with moderate to severe asthma thats triggered by allergies. If your doctor prescribes this for you, you get it as a shot once or twice a month.
- Other biologics: Drugs that are specifically approved to treat e-asthma are benralizumab (Fasenra), dupilumab (Dupixent), mepolizumab (Nucala), reslizumab (Cinqair), and tezepelumab-ekko (Tezspire). These work against proteins in your blood that activate eosinophils. They can lower your number of serious attacks and the amount of oral steroids you have to take. You take them as shots or IVs.
You may be able to try a biologic drug if you’ve been taking standard asthma treatments but still have attacks often. Youll need tests to measure your levels of eosinophils and your bodys reaction to allergens.
What You Can Do
You play a big part in getting control of your e-asthma and preventing attacks.
- Take your medications exactly the way your doctor tells you. Make sure you know how to use your inhaler. See your doctor every 3-6 months to check in on how well your treatment is working.
- Figure out what things trigger your attacks, and do your best to stay away from them.
- Watch for signs that an attack is coming on.
- Pay attention to your overall health. Exercise regularly, eat nutritious foods, and get to a healthy weight. Get vaccinated for the flu, pneumonia, and COVID-19. Respiratory viruses are one of the main causes of asthma flares.
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