Your 10-year-old daughter is having difficulty breathing. The child has had a cold for the past few days, and you've been giving her over-the-counter medications. Today, after she had been playing outside, you noticed she began making a lot of noise as she breathed. Soon, she began having more difficulty breathing. She has a history of asthma. She is sitting upright on her bed, flaring her nostrils and using her neck muscles to breathe. She is breathing fast and her pulse is very rapid. What should you do?
Asthma is a common, serious disease affecting an estimated 15 million people nationwide. About 3 percent to 5 percent of the adult population and as much as 12 percent of all children experience asthma. It is also a fatal disease whose mortality rate, for unclear reasons, is climbing (6,000 deaths yearly). Some experts believe this rise is the result of undertreatment of the disease by physicians and may be particularly due to corticosteroid underuse as well as victims' delay in seeking care.Asthma is a reactive airway disease caused by bronchial airway hypersensitivity to stimuli such as allergens or cold air, which cause bronchospasm and mucus hyper- secretion.
Some victims have allergic asthma. These often have a long personal and family history of allergic diseases. Physical exercise is another cause of asthma.
Usually the asthma victim has coughing, shortness of breath and wheezing. Usually, the coughing isn't productive (nothing is produced) because the victim's mucus plugs are so thick they are difficult to cough up.
The primary goal of asthma first aid is to ensure adequate breathing. Therefore, the priorities of treatment are:
- Check for an opened airway, breathing and circulation (known as the ABCs).
- Have the victim assume a position of comfort.
- Help the victim take his or her physician-prescribed bronchodilator medication.
The first priority is maintaining the ABCs. Respiratory and cardiac arrest due to asthma present some special problems. In these cases, the victim still has bronchospasm and thick mucous blockage. Air can't move through narrowed bronchi tubes.
Any asthmatic victim experiencing difficulty in breathing should be allowed to assume a position of comfort as long as the victim's position does not deter treatment or affect safety. Remember, it is easier to breathe sitting up than lying down.
The treatment for asthma victims is the use of a bronchodilator. These agents have been shown to be safe and effective in the out-of-hospital setting.
Ask the victim about any asthma medication he or she may be using. Most asthma sufferers will have some form of asthma medication, usually given through physician-prescribed, hand-held inhalers. The victim breathes the mist, which carries the bronchodilator agent into the small airways. The inhaler can be extremely effective and easy for victims to use. Although a number of agents are available for nebulizer use, albuterol has gained popularity because its effect lasts slightly longer than other agents. In theory, albuterol affects the heart less and, therefore, fewer side effects, such as tremors, heart arrhythmias and low blood pressure.
Here's how to use an inhaler:
1. Confirm medication and expiration date on canister.
2. Vigorously shake the canister.
3. Victim should hold canister upright and in front of his or her mouth.
4. As the victim starts to take a deep breath, have him or her trigger the inhaler and inhale.
5. Have the person hold breath for 5 to 10 seconds, then exhale.
6. Repeat as needed.
Asthma is common. As a rule, it also is treated fairly easily. However, do not wait too long to get medical help for the victim of a severe asthma attack.
Alton Thygerson, professor of health sciences at Brigham Young University, is the National Safety Council's first aid and CPR author and technical consultant. For more information, the new National Safety Council First Aid Handbook by Alton Thygerson is available in local bookstores.