What happens if you have an asthma attack while sleeping, and how do you relieve a flare-up?

You should definitely get someone to get your inhaler for you! In the meantime, steam from a warm shower could help your airways some. You still need the inhaler though so you don’t keep getting worse. I would guess a major flare up would wake you up.

How to Cope With an Asthma Attack

How to Cope With an Asthma Attack

You start to panic because you are short of breath. If you’re out in public, you’re likely to also become embarrassed by your situation. And next, your asthma control disappears. It’s a vicious cycle: fear of an asthma attack can actually make the experience of an actual asthma attack even worse, which creates more fear and worry about when the next attack might occur.

But the good news is that you can get a handle on this escalating cycle by learning how to cope, relax, and be prepared, all at the same time.

An Asthma Attack and Stress: What’s Going On?

The problem starts in your brain, and spirals from there. “The interesting mind-body part of asthma is that the anxiety parts of our brain are very finely attuned to breathing problems, meaning that if people’s carbon dioxide levels go up or their oxygen levels go down, the brain very quickly tweaks the fight or flight response,” explains Wayne Katon, MD, vice chair of the department of psychiatry and behavioral sciences at the University of Washington Medical School in Seattle. Dr. Katon and colleagues have published widely about depression, anxiety, and panic disorder in asthmatics.

Once people have had a traumatic asthma attack experience, Katon says, they are likely to think, “Oh no, this is going to be bad again,” which can lead to a panicked, hyperventilation response. And that increased rate of breathing just feeds into the panic/asthma spiral. Katon calls these thoughts “catastrophic” because they assume the worst will happen — and in a way, because your mind can affect your body’s response during an asthma attack, the thoughts do become self-fulfilling. “The asthma might provoke these catastrophic cognitive self-statements, which can bring on fear and anxiety that can [then] worsen the attack,” explains Katon.

To complicate matters, Katon’s research suggests that people with asthma are nearly twice as likely as their peers to suffer from depression and/or anxiety, making it harder to unravel whether asthma attacks cause anxiety, or the reverse.

How to Develop Emotional Asthma Control

Knowing you are prepared to handle an asthma attack is one way to counter these catastrophic thoughts, says Katon, who recommends that your asthma management plans include:

-Extra rescue inhalers. Keep them with you wherever you are, and in several places at home, at work, or in school. “Have extras around so you are not ever caught without it” Katon says.

-Emergency numbers and cell phone. Keep your doctor’s number and a cell phone close at hand at all times. Remember that if your asthma does spiral completely out of control, you should call 9-1-1 directly rather than calling your family or doctor first.

-Daily corticosteroid use. If you use a daily, inhaled corticosteroid for asthma control, be sure to take your medication consistently.

-Prep work. Be prepared for ups and downs, There will be seasons when your allergies and asthma triggers are worse. This is a good time to plan several doctor visits in advance, Katon says.

Focusing on how you can improve your asthma control helps you prioritize positive thoughts over negative ones, Katon notes.

Now the Hard Part: Learning to Relax

Even though learning to relax may seem like an impossible task, Katon says people are successful at gaining asthma control, despite stress and anxiety, using techniques learned in:

Yoga


Deep breathing


Meditation

When to Get Help for Asthma Control

If your depression, anxiety, or panic disorder is preventing you from participating in daily activities, even when you usually have good asthma control, you should seek help from a mental health care professional. Katon recommends going to someone who specializes in cognitive behavioral therapy — a style of therapy that can help you concentrate on your strengths and exchange positive thoughts for the negative ones that may be keeping you in a panic and asthma attack cycle.

So, if fear of your next asthma attack is causing you to give up on good asthma control, take heart. With preparation and some relaxation training, you can conquer the intimidating dread of having an asthma attack.

Nurse refuses student inhaler during asthma attack

School says medical release form lacked parent’s signature

Volusia County School officials stand by a Deltona High School nurse’s decision to refuse a student his inhaler during an asthma attack, citing a lack of a parent’s signature on a medical release form.

“It’s like something out of a horror film. The person just sits there and watches you die,” said Michael Rudi, 17. “She sat there, looked at me and she did nothing.”

He said the school dean found his inhaler during a search of his locker. The inhaler was still in its original packaging — complete with his name and directions for its use; however, the school took it away because his mother hadn’t signed the proper form for him to have it.

School leaders called Sue Rudi when her son started having trouble breathing. She rushed to the office and was taken back to the nurse’s office by school administrators and they discovered the teen on the floor.

“As soon as we opened up the door, we saw my son collapsing against the wall on the floor of the nurse’s office while she was standing in the window of the locked door looking down at my son, who was in full-blown asthma attack,” Rudi said.

Michael Rudi said when he started to pass out from his attack, the nurse locked the door.

“I believe that when I closed my eyes I wasn’t going to wake up,” he said.
The Director of Student Health Services, Cheryl Selesky, said that parents must sign the medical release form each year, which allows students to carry their prescribed drugs with them in school.

This year, the district had no record of his Rudi’s signature, said Selesky.

“I mean its common sense if I saw an animal on the street in distress I would probably stop to help, why wouldn’t she help a child,” Sue Rudi said.
But Rudi is a senior, and his mother said the district has had records of his asthma throughout his years in the school.

She thinks her son could have died because of a technicality.

“How dare you deny my son something that we all take for granted, breath,” said Sue Rudi. “Why didn’t someone call 911?”

Selesky said the district is looking into whether proper procedures were followed by the school, and while nurses can’t give medications without the proper authorization, it is district policy to call 911 when a student cannot breath.

Selesky could not explain why 911 was never called.

“I understand if you can’t give it to him call 911,” Sue Rudi said. “Why did you not call 911?”

Sue Rudi said she worries about the next student caught in a similar situation, and has filed charges against the nurse with the Volusia County Sheriff’s Office.

“I want to press child endangerment charges for something they did to my son,” Rudi said in the 911 call.

Signs of an impending asthma attack

Considering we spend quality time on this blog writing about how signs of nasal drainage, chest congestion and excessive secretions are treated as asthma, I thought this would be a good time to make a list of the signs of an impending asthma attack.

While RTs and doctors should know these signs, I also believe it is the responsibility of parents of asthmatics to be educated on and be vigilant for the signs of an impending asthma attack. Likewise, I also think it’s important for anyone in contact with kids to know the signs, including teachers, baby sitters and day care moms.

So, just for the heck of it, I’ve created this list of the signs to be on the look out for. I will follow each sign with a brief description based on my own experience either as a former child asthmatic, current dad of one, and an RT:

1. 
   Itchy neck and chin: I have no clue why this happens, and as far as I know scientists don’t either, but this is a classic, and quite often overlooked sign. For me, when I was a kid, this most often occurred when I forgot to take my preventative medicine, and this was my cue to take it, and fast. So, if you see an asthmatic kid scratching his neck and chin, or if you see scratch marks there, you should think asthma, or at least rule it out. If he’s an older child responsible for his own medicines, you may want to question his compliance.


2. 
   Mood change: All of a sudden your child is quiet, suddenly moody, appears to be anxious, or stressed.


3. 
   Coughing: I remember a friend of mine telling me about his mother getting annoyed with him for coughing all night, and even making him turn on his side and put his head in the pillow when he coughed so his mother didn’t have to hear it. I’m not providing this information to make fun of a mom, but to show that she was missing one of the classic signs of asthma. There might be other reasons for a cough, such as sinus drainage, but asthma should at least be considered, especially in an asthmatic child.


4. 
   Audible Wheezing: This is usually caused by increased secretions in the upper airway, which is a symptom to asthma. This is usually an early sign, but it may also be a sign that the lungs are opening up after bronchodilator has been used.


5. 
   Wheezing (not audible): This is the classic sign of bronchospasm, or that an asthma attack is occurring. In the hospital we use a stethoscope to listen for this, but my dad used to put his head to my chest. Hearing wheezing is a good sign, for it means there is still air movement.


6. 
   Chest tightness: This is something the asthmatic will feel, so it’s less likely to be a sign for a parent to pick up on, but if your child complains that his chest hurts, you should think bronchodilator.


7. 
   Increased respiratory rate: Even to this day when I’m around an allergen that really irritates my asthma, I notice an increased respiratory rate. If you notice this, especially when the child is sedentary, you are observing a classic sign of asthma.


8. 
   Itchy, burning feeling in chest: Another classic signs that’s difficult to pick up on by pure observation. However the child may tell you he feels funny in the chest.


9. 
   Feeling of breathlessness: Again, more subjective than objective, and you may need to ask a few questions to find out if this is the case. Or, you may pick up on the signs that follow, which are indicative of breathlessness.


10. 
    Leaning on things to breath: This is a sign that an asthma attack is occurring, and a definite sign of shortness-of-breath.


11. 
    Hunched shoulders: This may be coupled with #10 above. Asthmatics do this in an attempt to increase lung capacity so they at least feel like they are getting air in (although getting air in is not the problem, it’s that they are not getting it out.)


12. 
    Paradoxical breathing: Normally people have no chest movement with each breath, and their abdomen goes in and out. When a person is having bronchospasms, he will breath more with his chest, shoulders and upper body.


13. 
    Retractions: This is a classic sign especially with small children and babies that are having bronchospasm. When I’m assessing these children in the hospital I place my palm on the child’s chest. If I feel the chest being sucked in, I know that child is retracting, and thus having bronchospasms. Thus, while it is impossible for a baby to tell you he is short of breath, his retractions will talk for him.

When my 4 YO daughter was having an asthma attack last month, she showed many of the classic signs of bronchospasm, and, perhaps if I wasn’t educated, I might have missed the signs. She had obvious retractions, increased respiratory rate, and wheezing. One dose of Albuterol did the trick for her.

However, every child is unique. So keep in mind the signs provided by each child will be unique as well.

And, while your initial reaction might be the use of a rescue inhaler, there may be other options that work best for your child when you see one or more of these signs. It’s up to you to know what’s best for your child.

For example, when I was a kid and my neck itched and my chest had the itchy, scratchy burning feeling. The first several times this occurred this caused anxiety, especially when my rescue inhaler didn’t work. However, in time I learned this feeling was caused because I forgot to take my Theophylin. And, within 20-30 minutes of taking it, I started to feel relief.

I’ve never heard of any other asthmatic who observed this, so I’m assuming it was unique to me. Thankfully, however, I’ve since been weaned off that nasty stuff.

Another good example was provided to me by Asthma mom. She said that her doctor wanted her to give Albuterol to her child when her daughter coughed. But later, as an observant mother, she learned that the coughing often occurred due to throat irritation or sinus problems, and Albuterol was not indicated.

My friend whose mom was annoyed by his nocturnal coughing that I mentioned above told me, in retrospect, he remembers his doctors telling his mom not to give him cough medicine, nor allergy or cold medicine, due to what it says on the box, “This medicine should not be used if you have… asthma.”

The theory here is that it may cause bronchospasm. I remember when I was a kid having the sniffles and feeling miserable, and my parents were told the same thing about cold and allergy medicine. When I got older one of my new doctors told me to go ahead and take the stuff, and it worked wonders. Thank God for new doctors and updated research.

My point is that most of the time Albuterol might work fine, but it’s good to be observant for other options. If your child has a cold, then that’s probably the underlying problem causing the problem. Same thing with allergy signs, which often accompany the signs of asthma.

Same thing with child compliance.

Regardless, when you see these signs, you should have a plan that you and your doctor have pre-arranged. And, if this doesn’t work, or you still don’t know what to do, then you should take your child to his physician or to the hospital where he or she will be treated as appropriate.

And please keep in mind this is just an extemperaneous list based on my humble opinion. After all, I am just a lowly RT.

What happens during an asthma attack

http://www.youtube.com/watch?v=EK8nzKzdnIM