Asthma Attack: Recognizing Signs and Symptoms

Signs of an Asthma Attack

• Asthma attacks can develop gradually over hours or days, or rapidly within seconds or minutes.
• During an asthma attack, asthma symptoms worsen and may not respond to the usual reliever medication.
• Reliever medication may not provide quick relief or last as long as expected, needing more frequent use.
• Typically, a reliever should provide relief for at least 4 hours and begin working within 4 minutes.
• Needing a reliever again within 3 hours indicates a severe asthma flare-up, impacting normal activity.
• Other symptoms may include difficulty breathing, chest tightness, coughing, and wheezing.
• It's important to note that not everyone may wheeze during an asthma attack.
• Feelings of fear, anxiety, and worry can accompany an asthma attack.
• Individuals should trust their instincts and act on warning signs, even if they seem minor.

Signs of Worsening Asthma

• Asthma First Aid should be initiated before symptoms become severe or life-threatening.
• Follow your Asthma Action Plan.
• If you don't have a personalized Asthma Action Plan, follow Asthma First Aid.
• Symptoms such as shortness of breath, cough, wheeze, or chest tightness (especially at night or upon waking) indicate a flare-up.
• Increased use of reliever medication is also a sign of worsening asthma.
• Individuals might still be able to walk and talk in full sentences but with some interruption to normal activities
• Severe flare-up includes obvious difficulty breathing and inability to speak in full sentences without pausing for breath.
• Other signs include needing reliever more frequently (within 3 hours), skin pulling in at the ribs, neck, or throat, worsening cough, wheeze, or chest tightness, waking up frequently due to asthma, lethargy, and possible tummy pain in young children.
• Emergency signs include extreme shortness of breath, inability to speak more than 1-2 words per breath, reliever medication not working, drowsiness, confusion, exhaustion, paleness, clamminess, blue tinge around the lips, very little air movement, and potential collapse or unconsciousness.

After a Flare-Up or Asthma Attack

• It's crucial to schedule a doctor's appointment promptly, ideally on the same day or as soon as possible, to prevent another flare-up.
• Following a hospital discharge, a doctor's appointment should be made as soon as possible or within 3 days.

Warning Signs

• An asthma attack or flare-up can occur rapidly with minimal warning signs.
• Waking up at night or earlier than usual due to asthma is a potential warning sign.
• Increased frequency of reliever medicine use over a month is another warning sign.
• A hospital visit due to an asthma flare-up or attack should serve as a warning sign to take asthma seriously.
• A doctor should be consulted soon after an asthma attack or flare-up.
• Consulting with Asthma Educators can help prepare questions for the doctor's appointment.

Review, Maintain, Recover After a Hospital Visit

• Schedule an urgent Asthma Review within 3 days of leaving the hospital.
• A follow-up appointment 2-4 weeks later ensures asthma is back on track and to discuss needed medication changes to prevent another flare-up.
• Doctors will inquire about asthma symptoms and address concerns.
• Inquire about the reasons behind the asthma attack, potential risks, and the expected recovery time.
• Inform the doctor of any new medicines given in the hospital, how long to use them, and if a repeat prescription is needed.
• Request a demonstration from the doctor or pharmacist on how to use asthma puffers correctly.
• All individuals with asthma should have a written Asthma Action Plan detailing medication usage.

Maintaining Asthma Control

• Taking prescribed asthma medications, including completing the full course of steroid tablets as directed, is crucial to avoid another asthma attack.
• Side effects of steroid tablets, such as mood changes, sleeplessness, and appetite changes, are usually short-lasting.
• Continuing to use the prescribed preventer inhaler, even with steroid tablets, is essential.
• If a preventer is not prescribed or has not been used, discuss finding a suitable one with a doctor.
• Gargle, rinse, and spit after using a preventer.
• Reliever medicine should be used as needed, but increased usage may cause side effects like headache, shakiness, increased heart rate, or feeling sick.
• Reduce reliever use once symptoms improve, as long-term regular use indicates uncontrolled asthma.
• Use a spacer with puffers.
• Always rinse your mouth, gargle, and spit after using a preventer to avoid side effects.

Recovering After an Asthma Attack

• Individuals may experience emotional and physical tiredness after an asthma attack.
• Rest as much as possible to combat fatigue, which may result from disrupted sleep.
• Aches and pains may occur due to using different muscles to breathe.
• Emotional fragility and feeling scared are normal responses.
• Talking to family or friends or calling Lifeline (13 11 14) can provide emotional support.
• Appetite changes may occur due to steroid tablets.
• Fuel the body with healthy foods, drink plenty of water, and avoid processed foods.
• Gradually build up activity levels.
• Always keep a reliever puffer available.
• Discuss using a reliever before activities with a doctor.
• Schedule an asthma review appointment to adjust treatment if necessary and prevent future flare-ups.
• Consider a lung function test (spirometry) to check lung health.
• Practice breathing exercises to improve breathing patterns.

Managing Child's Asthma After Hospitalization

• Learn Asthma First Aid.
• Consult the doctor regarding management of worsening symptoms, including medication dosages and effectiveness.
• Ensure instructions are written on the Asthma Action Plan.
• Treat symptoms and allergies early, continue preventer medication if prescribed, and follow the Asthma Action Plan.
• Consult the doctor at the first signs of a flare-up or if unsure what to do.
• Always see the doctor after an asthma attack or flare-up.
• Contact Asthma Educators for support and guidance.

Avoiding Future Asthma Hospital visits

• Regularly visit your doctor to discuss asthma.
• Ensure proper puffer technique is checked by a healthcare professional.
• Use preventer medicine daily if prescribed, irrespective of feeling well.
• Avoid triggers when possible.
• Treat symptoms early.

Hypoglycaemia

• Exercise-induced hypoglycemia, or low blood sugar, can occur during or after physical activity, especially in individuals with diabetes.
• Recognizing hypoglycemia is critical because severe cases can lead to loss of consciousness, seizures, and even life-threatening situations.
• Hypoglycemia can manifest with symptoms similar to other conditions or injuries, such as weakness, dizziness, confusion, or altered consciousness.
• Physiotherapists need to differentiate between hypoglycemia and other potential causes of these symptoms to provide appropriate care.

Managing Hypoglycaemia

• Hypoglycaemia, also known as a hypo, occurs when blood glucose level drops below 4mmol/L in people living with diabetes who use insulin or other glucose-lowering medications.

Causes of Hypoglycaemia

• Taking too much insulin or other glucose-lowering medication.
• Injecting insulin into skin that has lumps from repeatedly injecting into the same area (called lipohypertrophy).
• Delaying or missing a meal.
• Not eating enough carbohydrate foods.
• Doing unplanned physical activity.
• More strenuous exercise than usual.
• Drinking too much alcohol.
• Drinking alcohol without eating enough carbohydrate food.

Symptoms of a Hypo

• Weakness, trembling or shaking
• Sweating
• Lightheadedness or dizziness
• A headache
• A lack of concentration or behaviour change
• Tearfulness or crying
• Irritability
• Hunger
• Numbness around the lips and fingers
• A fast heartbeat
• Blurred vision
• Blood glucose level should be checked if any of these symptoms arise.

Treating a Hypo

• Have some easily absorbed carbohydrate (that you find easy to swallow) such as:
• glucose tablets equal to 15g of carbohydrate
• 6-7 regular jellybeans or 4 large glucose jellybeans
• 1 tube of oral glucose gel (equal to 15g of carbohydrate)
• 1 /2 a can (150ml) of regular (not ‘diet’) soft drink
• 100ml of Lucozade®
• 3 teaspoons of sugar or honey
• 1 glass (125ml) of fruit juice
• After 15 minutes, recheck your blood glucose level to make sure it has risen above 4mmol/L.
• If it hasn’t, repeat the previous step.
• If you are taking diabetes medication that can cause hypos in combination with a medication called acarbose (Glucobay®), you must treat the hypo with pure glucose such as glucose tablets, glucose gel or Lucozade®.
• Once your blood glucose level is above 4mmol/L, you will need to eat some extra carbohydrate. If your next meal is more than 20 minutes away, eat some carbohydrate food such as:
• 1 slice of bread
• 1 glass (250ml) of milk or soy milk
• 1 piece of fruit
• 4 dried apricots
• 1 tablespoon sultanas
• 1 small tub (1 00g) fruit yoghurt.
• For individualised advice on hypo treatment, talk to your doctor or diabetes health professional.

Insulin pumps and continuous glucose monitoring (CGM)

• If you are using an insulin pump or CGM, talk to your diabetes health professionals about how to treat and manage hypos.

Untreated Hypos

• Untreated hypos can lead to severe hypoglycaemia (unconsciousness or seizures).
• A severe hypo is one that you can’t treat yourself and where you need help from someone else.
• In case of a severe hypo, glucagon can be injected to raise the blood glucose level
• Notify your doctor if you have experienced a severe hypo

Unconscious, Drowsy or Unable to Swallow

• Do not give any food or drink by mouth.
• Place the person on their side and make sure their airway is clear.
• Give an injection of glucagon if available and if you are trained to give it.
• Phone for an ambulance (dial 000) and explain that the person is unconscious and has diabetes.

Hypo unawareness

• Occurs when people don’t feel the early warning symptoms of a hypo and only realise they are having a hypo when their blood glucose levels drop very low or when they check their level.
• Always treat a hypo when your blood glucose level is less than 4mmol/L, even if you feel fine.
• If your blood glucose levels are low without any symptoms, you need to discuss this with your doctor or diabetes health professional.