Guide to Asthma

Practice Session #3 ("Home Improvements"):

You have "exercise-induced asthma". By this term ("exercise-induced asthma"), your doctor means that you have asthma and that exercise is the main trigger that brings on narrowing of your airways.

Your doctor has given you an albuterol inhaler to take prior to exercising in order to prevent your symptoms of cough, wheeze, and chest tightness. If you develop any of these symptoms at any other time, you use your albuterol inhaler (usually one puff is sufficient) and obtain rapid relief.

This week the workmen have come to begin the long-awaited renovations on your bedroom. There is lots of plaster dust in the air, and you find yourself coughing at night. You think little of it (your spouse, who doesn’t have asthma, has also had some coughing) until you develop a low-grade fever and a bad "head cold." Your coughing now keeps you (and your spouse) up most of the night. You can’t lie down in bed without becoming short of breath. Each breath is accompanied by an uncomfortable rattling in your chest. It is difficult to talk or do any light physical exertion without stimulating long bouts of coughing.

You suspect that this severe coughing and chest congestion may be a sign of your asthma. You borrow your neighbor’s peak flow meter to measure your breathing capacity. The peak flow result, 300 liters per minute, is only two thirds of the value measured when you were in your doctor’s office. You use your albuterol inhaler with improvement. The coughing lessens and your peak flow increases to 330 liters per minute. However, 30 minutes later you are again coughing severely, and the peak flow is now 280 liters per minute.

What would you do next?


Our strong recommendation, in brief, is "get help." You are having a serious asthmatic attack, and the medication that you have available to treat asthma, the albuterol inhaler, is not providing more than very temporary relief. You will need stronger therapies both to get better and to prevent your getting worse, possibly dangerously ill.

Many people in this circumstance report that their quick-relief bronchodilator "stopped working." In fact, what has probably happened is that the bronchial tubes have become swollen and filled with mucus. The problem is no longer just spasm of the muscles surrounding the bronchial tubes, and the solution can no longer be just a medicine that causes those muscles to relax. You now need an anti-inflammatory medicine — a steroid medicine — to reduce the swelling and excess mucus production. This type of medicine for asthma treatment is not available "over the counter"; you will need a doctor’s prescription.

The action that you take will depend on the health care resources available to you at that moment. Perhaps you will call your doctor and get advice immediately. Perhaps you will make an urgent visit to your doctor’s office. Perhaps you will need to go to a nearby emergency department or other urgent care facility. Do not delay. The danger in waiting is that your asthma may worsen quickly, perhaps to the point that every breath becomes an effort and that even walking slowly seems like an impossible task. Before this crisis stage, before calling a rescue squad or "911" becomes your only option, seek medical help.

While you await a call from your doctor or during your trip to a medical facility, you can continue to use your quick-relief (bronchodilator) inhaler. It will likely continue to help a little bit for short periods. You can take up to 4 puffs at a time, up to every 20-30 minutes for the next hour or two, until other medical treatments are begun.

It would be a mistake, however, to rely solely on the temporary improvement that your albuterol inhaler provides. This is the most common mistake made in severe asthmatic attacks, the very bad attacks that end in hospitalization or even death. The brief, minor help in breathing that the albuterol inhaler gives can fool you into thinking that you are getting better. Or it may convince you that you will start getting better soon. All the while your bronchial tubes continue to swell and become plugged up.

Steroid treatment for swelling of the bronchial tubes works better and quicker when started early. In this example, with the help of the peak flow meter, you can tell that you are getting worse, not better. There is no need to wait longer. Avoid the excuses, such as: "I hate to bother the doctor" or "I’m sure that I will get better if I just rest for a little bit." Start now to get the medical treatments that you need.