- Symptoms:
- Include shortness of breath worse with exertion, chest tightness, cough, wheezing
- Importance of diagnosis:
- Exacerbations can occur with triggers or illness and require advanced care
- Treatment:
- Often with medications and treatments to help open airways and reduce inflammation, oxygen
What are the symptoms of asthma?
• Shortness of breath. Shortness of breath can be worse with exertion(activity) or exercise. Sometimes you might not even realize you are breathing hard or short of breath and instead just feel fatigued or worn out. Other times if more severe, you can feel panicked or anxious as you try to feel a sense of taking a full breath.
• Chest tightness. This can feel like pressure/fullness in your chest or pain.
• Cough. The typical asthma cough is often worse at night and can be a cause for poor quality of sleep.
• Wheezing. This can sometimes be audible to others and often worse after exercise or with a cold or lung infection. Of note if someone is wheezing and then stops wheezing, this can be a very emergent situation as it means that they are breathing even less air then before. They should be transported immediately to a hospital.
• Blue lips or fingertips. These are emergent findings of imminent respiratory failure and risk of death.
Why does it happen?
Asthma is an inflammation of the “pipes of the lungs”, the bronchial tubes. When these bronchial tubes are narrowed or constricted, it is called bronchospasm. Mucous or secretion production can worsen symptoms.
How do I know if I have asthma?
The above listed symptoms may be a clue that asthma is causing you to feel this way. Symptoms can be very mild or more severe. Your asthma may be controlled and stable for a long time, but suddenly flare for many different reasons (triggers) and this is called an asthma attack. Undiagnosed asthma can cause you to have low energy. A new diagnosis of asthma is one not to miss. Treating this common condition can help you live your life much more comfortably and fully.
Statistics suggest that greater than 10% of kids have asthma and many are diagnosed as early as 5 years old. Sadly, asthma is becoming more common and doctors are working to determine why this is happening. Genetics can play a role, so a family history of asthma or even eczema can be a warning sign. Environmental factors contribute greatly as well.
What is RAD?
Some people might not have true asthma but rather a “reactive airway disease”, meaning that they have an episode of airway inflammation or bronchospasm. It may be the diagnosis given to a patient when asthma is suspected but not fully diagnosed or may be what is the result of a recent ongoing viral or bacterial illness. You can think of it as a “temporary” or uncategorized shortness of breath or wheezing.
Often when the cold or bronchitis clear, the asthma-like symptoms clear as well.
Also, this diagnosis may be given more commonly to very young children or infants. Of note, those who have RAD symptoms with one illness may be more likely to have it again.
How is asthma diagnosed?
A full history, including family history and environmental history is advised. A full physical exam including lung auscultation is necessary. Lung function tests to see how air passes in and out of the lungs can give important information about your breathing and potential asthma diagnosis to your doctor.
Your testing results before and after administration of a bronchodilator medication can provide valuable information, as can a trial of an inhaler to see how you respond. Some of the names of lung tests include: spirometry, peak airflow, exhaled nitric oxide FeNO test or provocation test. X-Rays, allergy tests or a visit to a pulmonologist (lung doctor) can also be necessary.
Asthma is often differentiated into 4 categories. These include:
- Intermittent asthma: symptoms <2 days/week and <2 nights/month
- Mild persistent asthma: symptoms 2 or more days/week and 3-4 nights/month
- Moderate persistent asthma: symptoms occur daily and 1 or more nights/week
- Severe persistent asthma: symptoms occur daily and nightly (every day and night)
How can an urgent care help?
Urgent cares can be very helpful in the case of a mild, non-emergent asthma attack. Unfortunately it can seem as though these episodes never tend to happen during office hours but at less convenient times like evenings or weekends.
Triggers can include (but are not limited to the following) the following:
- Respiratory illnesses such as colds, sinus infections, bronchitis etc
- Activities such as running or playing a pick up game of soccer
- Outside environmental ones such as allergies, smog, cold air
- Inside environmental ones such as dust, perfume, cigarette smoke, pets, gas from stoves, noxious smells from paint or other chemicals, or poor living conditions with cockroaches or mold exposures
Avoiding triggers can be a great way to avoid these issues but sometimes are not avoidable. In addition, tracking symptoms in a green/yellow/red asthma action plan can be a concrete way for your doctor to instruct you in how to proceed in different situations. Urgent cares are able to prescribe additional treatments or medications to help with symptoms and provide the guidance that you need and warning signs to look out for. Bringing your medications with you to your visit can best help your urgent care provider to help you best.
What different treatment options are out there?
Asthma inhaler. These come in many different forms (HFAs, DPIs or nebulizers) and may contain bronchodilators and/or steroid medications or mast cell stabilizers. The inhaler is the fastest way to quickly deliver the medication from your hand-held device to your airways and lungs.
Bronchodilators can be designed to act quickly (short-acting) or provide longer relief (long-acting) and have different mechanisms of action. Beta agonists can offer quick relief to dilate the breathing tubes (such as albuterol) or come in a longer acting form. Anticholinergics take longer to kick in but aim to open airways and reduce secretions. Inhaled corticosteroids can also offer long term control. Of note some inhalers are combination agents meaning that they have two medicines in one. A spacer or mask can help with medicine delivery.
Oral steroids- Can help in more advanced situations
Supplemental oxygen- Can help if oxygen levels are low.
Antibiotics- If a bacterial infection is causing a concurrent sinus or lung infection, oral antibiotics may be needed to cure the inciting cause. Your urgent care can help.
Other: these are not the first line therapy but may be prescribed if other therapies are not adequate. Include: oral theophylline, oral leukotriene modifiers, or IV infusions or injections of biologics. These are more likely to be prescribed by a pulmonologist.
Smoking cessation. Quitting smoking is always a good idea especially if you or a loved one has asthma. Your doctor can help. It’s never too late!
How to use an inhaler correctly
Metered dose inhaler (MDI)- An MDI is a small, handheld canister with medication. Depressing the top of the canister will release a specific amount of medication to your lungs. Sit or stand. Remove the cap and hold the inhaler in the proper upright position. (Use a spacer if it has been provided.) Shake the inhaler and as you do, turn your head and blow all of the air out of your mouth/lungs. Keep your head up and neck long as you put the inhaler to your mouth and seal your lips. Press down quickly and simultaneously breath in slowly in a count of 3. Hold your breath for 10 seconds, remove the inhaler, then breathe out slowly. Repeat if instructed. Rinse mouth if instructed.
Dry powder inhaler (DPI)- A DPI is a powder form of inhaled medication and has similar steps to a more-common MDI. Sit or stand. Turn your head and breathe out air. Place the discus in your mouth and take a full slow and steady breath in to fill lungs. Hold your breath for 10 seconds, remove the discus, and breathe out slowly.
Nebulizer- A nebulizer delivers your medicine more slowly than an inhaler in the form of a mist. This is great for young children or older individuals that may find inhalers tricky. A mouthpiece or mask may be used. The mask should fit snug against the face and if applicable secure with an elastic band. Make sure the medications are not leaking and irritating the eyes. Relax and breathe normally until the treatment is complete.
The Takeaway
Asthma is a very common ailment that affects many of us. Unfortunately there are exacerbating factors that can cause symptoms to flare. Mild asthma exacerbations can be very safely treated at Urgent Cares, while severe attacks should prompt you to highly consider an urgent trip to the emergency room.
