How would you treat an Asthmatic Attack?

Immediate Response and Emergency Care:

• If experiencing severe symptoms or signs of status asthmaticus, immediate hospitalization is necessary.
• Mechanical ventilation may be required to assist breathing and oxygenate the patient.
• Medications during a severe attack:
  • Bronchodilators: Delivered via inhalers or nebulizers; primarily beta-2 adrenergic agonists to relax bronchial smooth muscles.
  • Anti-cholinergic agents: Used as additional bronchodilators; relax airway smooth muscle.
  • Anti-inflammatory drugs: Glucocorticoids to reduce airway inflammation.
  • Epinephrine: Can be helpful to rapidly dilate bronchioles during acute attacks.

Prevention and Monitoring:

• Use of Peak Flow Meter: Regular monitoring with a peak flow meter helps detect early airway narrowing, preventing progression to severe attacks or status asthmaticus.
• Adherence to Medications: Consistent use of prescribed inhalers and medications reduces attack frequency and severity.

Bronchospasm Management & Diagnostic Testing:

• Spirometry and lung function tests: Measure forced expiratory volume (FEV1); typically reduced in asthmatic individuals.
• Trigger identification: Skin tests help pinpoint allergens. Avoidance of triggers like specific allergens or irritants (e.g., chlorine in swimming pools) is crucial.
• Exercise: Regular exercise like walking or swimming helps strengthen respiratory muscles. Athletes may wear masks or scarves outdoors to filter cold air and prevent attacks.

Breathing Techniques & Additional Medications:

• Breathing exercises: Help reduce anxiety and improve breathing control during attacks.
• Medications:
  • Inhalers: Deliver bronchodilators (beta-2 adrenergic agonists).
  • Anticholinergic agents: Relax airway smooth muscle.
  • Anti-inflammatory agents: Reduce airway inflammation.
  • Epinephrine: For rapid relief during severe attacks.

Prophylactic Medications:

• Leukotriene receptor antagonists: Prevent leukotrienes from binding to their receptors, thereby reducing inflammation.
• Cromlyn sodium (not necessary to memorize): Reduces white blood cell activity, preventing airway inflammation.
• Timing: Taken before an attack to prevent airway narrowing and inflammation.

Chronic Asthma:

Considered part of Chronic Obstructive Pulmonary Disease (COPD) family when persistent and long-term, requiring ongoing management to control symptoms and prevent exacerbations.

Summary:

Effective asthma management involves regular monitoring, avoidance of triggers, timely use of bronchodilators and anti-inflammatories during attacks, and prophylactic medications to prevent future episodes. Severe attacks require emergency hospital care with ventilatory support and aggressive medication therapy. Proper technique, adherence to medications, and lifestyle modifications play key roles in controlling asthma.