Step 1 Get Away From The Asthma Trigger - Plan For An Asthma Attack: Asthma

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Step 1: Get away from the asthma trigger

Step 1: Get away from the asthma trigger

The first step to controlling an asthma flare-up should be obvious: Try to get away from whatever trigger has caused your asthma to worsen. It may be awkward to leave a smoke-filled party or the home of a dear friend who has recently adopted a cat, but breathing is a priority. Getting away from your asthma trigger is a first — and sometimes indispensable — step to recovering your ability to breathe.

Step 2: Assess severity

How best to deal with an asthma attack depends in part on how bad the attack is. Sometimes you can recognize a severe attack based on how you feel. You are having a severe attack if you have shortness of breath walking slowly on level ground, if you need to interrupt your speaking to catch your breath, if you are struggling so hard to breathe that you are perspiring, or if you can't lie down because of difficulty breathing. At other times you may have severe narrowing of your breathing tubes but be unable to detect it based on how you feel — or you may not truly comprehend just how bad it really is.

To assess how bad your asthma attack is, and whether initial treatment with the quick-acting bronchodilator is working, use a peak flow meter to measure your breathing (see "Measure peak flow"). If your peak flow is less than half of your best value, you are having a severe attack. For most people, a peak flow of less than 200 L/min indicates a severe attack.

Step 3: Use a quick reliever

The fastest way to relieve an asthma attack is to use a quick-acting bronchodilator such as albuterol. The usual dose is two puffs, inhaled slowly and deeply. In a sudden severe crisis of breathing, you can safely use as many as four puffs at a time (with each puff inhaled with a separate intake of breath).

Continue using the quick-relief bronchodilator until your breathing becomes more normal or until you find that the medicine is not working. Although it is usually recommended that under normal circumstances you use your quick-relief bronchodilator no more than four times a day, you can safely use it as often as every 20 minutes for as long as two hours, if necessary, to treat an asthma attack. If you have it available, a nebulizer can be used in the same way, every 20 minutes for several doses. The major side effects to anticipate are a jittery feeling and racing of the heart.

Step 4: Suppress inflammation

Quick-relief bronchodilators treat only one part of an asthma attack, the portion caused by constriction of the muscles surrounding the bronchial tubes. Treating the other part — the swelling of the walls of the bronchial tubes and overproduction of mucus — requires an anti-inflammatory medication, typically a corticosteroid.

If your attack is relatively mild and getting better with the quick-relief bronchodilator, you can take an inhaled steroid. The inhaled steroids include beclomethasone, budesonide, flunisolide, fluticasone, mometasone, and triamcinolone. If you already use one of these medications every day as your controller medicine, double your daily dose during an asthma attack. If you use the combination drug Advair, which contains both an inhaled steroid and a long-acting bronchodilator, you have two options to increase your inhaled steroid. You can either take another inhaled steroid, such as fluticasone, in addition to your Advair, or you can obtain an Advair inhaler with a larger dose of inhaled steroid (e.g., Advair 250/50 or Advair 500/50).

For a severe attack, increasing your usual inhaled steroid dosage isn't enough; you will need to take prescription steroid tablets, such as prednisone or methylprednisolone, in addition to the inhaled steroid. A typical starting dose is 30 to 60 mg. The steroid tablets usually take six or more hours to take effect. You can continue to use your quick-relief bronchodilator in the meantime, as often as every hour, if needed.

Your doctor may want you to have steroid tablets available at home to use in the event of a severe asthma attack. Or your doctor may call your pharmacy with a prescription when you need one. In either case, be sure to keep your doctor informed if you are having serious difficulty with your breathing.

Step 5: Know when to call for help

Severe asthma attacks can be dangerous. If you are not getting better despite following your asthma action plan, get help immediately. Friends, family, and your doctor are all allies and only a phone call away. If nothing else seems to be working, you can always summon emergency help by calling 911.

Step 6: Practice

Planning is important, but practice is even better. In the following section, you will have an opportunity to practice your responses to different types of asthma attacks. Some of these hypothetical situations may mirror your own experiences; others may not seem relevant to your asthma or to the treatments that you have available to use at home. Even so, it is valuable to consider how you would react in various situations, if only to be more familiar with different asthma management strategies.

As in real life, you will be asked to make some initial decisions. An important part of the decision-making process is to know when to seek help. Remember that managing asthma attacks does not mean having to stay at home and care for your asthma yourself. Rather, it means two important things: first, knowing what initial steps you can take to get better, and second, knowing where and how to get help when you need it quickly.

Last updated:	September 27, 2007