Asthma Symptoms

The unhappy marriage between increased airway responsiveness and chronic inflammation causes periodic narrowing of the airways that we call an asthma attack. In general, the more the airways narrow, the worse the attack. Most people describe an asthma attack as a sensation of "air hunger" or "chest tightness," as if they can't get enough air into their lungs. However, the converse is actually true; people with asthma cannot get enough air out of their lungs. This is because airway narrowing obstructs airflow and prevents air from leaving the lungs, a process called "air trapping." People with asthma feel like they can't get enough air because the trapped old air is filling up the lung and not leaving enough room for the fresh air to get in.

 

One of the hallmarks of asthma is that between attacks, the vast majority of asthmatics feel fine. Asthma is an episodic condition characterized by occasional attacks interspersed by symptom-free periods that can range from hours or days to months or years. The fact that asthma comes and goes often presents a challenge to physicians, since it is difficult to establish a diagnosis of asthma unless the person is having symptoms. This is why some asthmatics wait months or years before a physician will commit to a diagnosis of asthma.

 

Attacks are usually accompanied by variable amounts of wheezing that can range from so fine that it can only be heard through a stethoscope to wheezing that can be heard across the room. Coughing is another symptom commonly reported by asthmatics. In fact, some asthmatics never wheeze and instead, their chief complaint is a chronic, nonproductive (dry) cough. This type of asthma is called "cough-variant asthma" (the type of asthma I have). Some people only have asthma symptoms following exercise, which is known as "exercise-induced asthma." Many asthmatics will also tell you that their symptoms are worse at night. It is not uncommon to find an asthmatic who awakens short of breath in the middle of the night or early in the morning.

 

Asthma attacks usually evolve gradually over a period of minutes, and the classic allergic asthma attack can be divided into an early and late phase. The early phase is characterized by bronchoconstriction and produces the symptoms traditionally associated with asthma. This phase usually lasts for thirty to sixty minutes and is often described as "chest tightness" that is frequently accompanied by a dry cough. Wheezing, if present, may be initially heard only during expiration, but if the constriction becomes moderate to severe, wheezing may be audible during expiration and inspiration. Most asthmatics know when an attack is over and feel fine almost immediately afterwards. For many asthmatics, the end of an attack is often heralded by a dry cough that turns into a productive cough generating thick, stringy mucus. Surprisingly, however, though an asthmatic may tell you that an attack is over, studies have shown that impaired lung function can persist for hours or days after an attack.

 

The second phase of an allergic asthma attack occurs approximately three to eight hours after the first phase and is also characterized by airway obstruction. Unlike the first phase, airway obstruction in the second phase is caused by inflammation and edema. These two phases of the allergic asthmatic response have implications for the conventional medical management of asthma. This is in part why standard medical therapy includes albuterol and inhaled steroids. Bronchodilators like albuterol are often used to treat the initial bronchoconstriction, whereas anti-inflammatory steroids are used to treat the inflammatory phase. As you will learn, not only do many natural remedies have bronchodilatory and anti-inflammatory effects, but many are also directed toward prevention and boosting the body's natural antioxidant defenses.

 

One of the best lessons you can learn is that most doctors would be hard-pressed to find two asthmatics whose symptoms and triggers are exactly alike. Asthma symptoms and severity vary markedly from person to person, and the list of potential asthma triggers is virtually endless. A "typical" asthma attack can last from minutes to hours to days. Some people have multiple daily attacks, whereas others have symptoms only once or twice a month. Some people have symptoms year-round, while others have allergy-related asthma that only acts up during the spring or fall.

 

Some asthmatics have very mild asthma, while others have unpredictable and unusually severe attacks. The majority of asthmatics fall somewhere in between these two extremes, with most asthma attacks ranging from mild to moderate.

 

Despite the almost endless variation among asthmatics, the overwhelming majority of people with asthma have mild to moderate asthma that is predictable. While it is also true that, .under the right circumstances, even a person with mild asthma can have a severe attack, most asthmatics will never experience such an attack. Equally assuring, the typical asthmatic can look forward to their symptoms becoming less severe over time. This is especially true for those individuals who learn about and take care of their asthma.

 

Still, everyone should know the warning signs of a severe or a potentially severe asthma attack. One of the first and strongest warning signs is how the asthmatic feels. For most asthmatics, their symptoms are often predictable and one attack doesn't vary much from the last. Most asthmatics can tell if they're getting better or getting worse. So, the first sign that trouble may be on the horizon is that your symptoms are getting worse. Another warning sign is when your symptoms don't respond to the usual treatment that, in the past, tended to put an end to an attack.

 

Another danger signal is nasal flaring, meaning that the soft bottom sides of your nose move out away from the midline as you breathe. Nasal flaring is usually only seen during a moderate to severe attack and indicates increased trouble breathing. Asthmatics with a severe (potentially life-threatening) attack may have difficulty speaking in full sentences and may only be able to say two or three words at a time. More severe attacks are characterized by an inability to speak with or without accessory muscle use. The accessory muscles, like the neck or chest muscles, help people breathe during a severe attack. You can tell someone is using accessory muscles if they shrug their shoulders as they breathe or if their breathing appears labored.

 

During a life-threatening attack, the wheezing may become high-pitched or even disappear. An asthmatic who stops wheezing while still short of breath is an asthmatic in serious trouble. Wheezing is caused by bronchoconstriction that partially obstructs, but does not completely prevent, airflow. When an asthmatic stops wheezing, it means one of two things: the asthma attack is over, or the person has stopped moving air through his or her lungs.

 

Life-threatening attacks can also cause cyanosis, or turning blue. Cyanosis is an ominous sign and means there is a profound lack of oxygen in the blood, a condition known as hypoxia. Hypoxia is extremely dangerous because the less oxygen the blood has, the less it can deliver to vital organs like the brain and heart. Stated bluntly, hypoxia is what kills asthmatics.

 

Fortunately, such severe attacks are extremely rare. However, if you or a loved one is having an attack and appears drowsy, is gasping for air, starts to turn blue, or stops wheezing without feeling better, do not hesitate to call 911—this is a medical emergency.

 

If you find yourself in the emergency room for an asthma attack, I strongly recommend taking full advantage of modern medicine. You may not be happy receiving steroids and other drugs, but if your symptoms are so severe that you land in the hospital, your first priority should be getting better and leaving the hospital alive. Once stable, you can learn from what happened and make sure it doesn't happen again.