Scenario 2 The Neighbors Cat - Practice Exercises: Asthma

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Scenario 2: The neighbors' cat

Imagine that you have multiple allergic sensitivities that worsen your asthma, including an allergy to cats. Nonetheless, you have been feeling well this fall, using your inhaled steroid medication every day (two inhalations twice daily). You are active and enjoy working out at the gym. You routinely use your bronchodilator inhaler before exercising but otherwise rarely seem to need it. Sometimes you wonder whether you still have asthma at all.

Then you are invited to your neighbors' home for dinner. Your neighbors took in a stray cat last month, but because of your allergies, they promise to keep the cat outside or in the basement during your visit.

The evening seems to be going fine, until you sit on a certain sofa. Soon thereafter you begin to sneeze and develop watery, itchy eyes. You feel a tightening in your chest and itching below your chin. You use your bronchodilator inhaler once, but get only minor relief. You start coughing and raise some clear mucus. Your neighbor offers you some water. What do you do next?

Management options

Step one is pretty clear: Leave the neighbors' house. It is likely that you are allergic to something in their house, probably cat dander on the sofa and elsewhere. The best first step in treating an asthma attack is, if at all possible, to end exposure to your asthma trigger.

In this circumstance, it is safe to use your bronchodilator inhaler more often than the usual limit of four or five times per day. If necessary, you can take it every 20 to 30 minutes for an hour or two, or less than that if you start to feel more comfortable.

Use your peak flow meter to check your breathing capacity and help you judge how severe this asthma attack is. You may be able to estimate an attack's severity by how you feel, especially by how breathless you are as you walk around. However, you can be fooled. The greatest concern is that you might underestimate just how sick you really are. Many people tend to minimize their symptoms; it's human nature not to want to admit that something might be seriously wrong.

If your peak flow is more than half of your normal best value, you can be reassured that you are experiencing a mild to moderate attack. If your peak flow is less than half of your normal best value, you are having a severe attack, which will require more intensive treatment and greater caution.

Assume that when you arrive back home, you find that you can walk up to your second-story apartment without much shortness of breath. You continue to experience some coughing and wheezing. You use your quick-relief bronchodilator again, and soon thereafter check your peak flow. It is 400 L/min. Normally your peak flow is quite steady at 500 L/min. All indications are that this is a mild to moderate asthma attack.

A good strategy for treating a mild to moderate asthma attack is to double your dose of inhaled steroids. In this example, you would begin taking four puffs twice daily (or two puffs four times a day) of the steroid inhaler. The results are usually not as rapid and dramatic as with steroids in tablet form (such as prednisone or methylprednisolone), but side effects are far fewer.

It is likely that this two-part strategy — ending your exposure to cat dander in the neighbors' house and increasing your dose of inhaled steroids — will bring your asthma back under control over the next 12 to 24 hours. During this time, keep close watch on your asthma symptoms and continue to monitor your peak flow values to make sure that you are improving. If you are not getting better, contact your doctor for advice. If you are improving, continue the extra puffs of the inhaled steroid for three or four more days. At that point, if you are back to normal, you can resume your usual dose, which is typically the lowest dose sufficient to control symptoms and prevent further attacks when your asthma is under control. Choosing the appropriate doses should be done with your doctor.

Last updated:	September 27, 2007