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Medical Author:

George Schiffman, MD, FCCP

George Schiffman, MD, FCCP

Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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If you go to the emergency department for an asthma attack, the health care provider will first assess how severe the attack is. Attacks are usually classified as mild, moderate, or severe. This assessment is based on several factors:

• symptom severity and duration,
• degree of airway obstruction, and
• the extent to which the attack is interfering with regular activities.

Mild and moderate attacks usually involve the following symptoms, which may come on gradually:

• chest tightness,
• coughing or spitting up mucus,
• restlessness or trouble sleeping, and
• wheezing.

Severe attacks are less common. They may involve the following symptoms:

• breathlessness,
• difficulty talking,
• tightness in neck muscles,
• slight gray or bluish color in your lips and fingernail beds,
• skin appear "sucked in" around the rib cage, and
• "silent" chest (no wheezing on inhalation or exhalation)
.

If you are able to speak, the health-care provider will ask you questions about your symptoms, your medical history, and your medications. Answer as completely as you can. He or she will also examine you and observe you as you breathe.

If this is your first attack, or the first time you have sought medical attention for your symptoms, the health-care provider will ask questions and perform tests to search for and rule out other causes of the symptoms.

Measurements of how well you are breathing include the following:

• Spirometer: This device measures how much air you can exhale and how forcefully you can breathe out. The test may be done before and after you take inhaled medication. Spirometry is a good way to see how much your breathing is impaired during an attack.
• Peak flow meter: This is another way of measuring how forcefully you can breathe out during an attack.
• Oximetry: A painless probe, called a pulse oximeter, will be placed on your fingertip to measure the amount of oxygen in your bloodstream.

There is no blood test than can pinpoint the cause of asthma.

• Your blood may be checked for signs of an infection that might be contributing to this attack.
• In severe attacks, it may be necessary to sample blood from an artery to determine exactly how much oxygen and carbon dioxide are present in your body.

A chest X-ray may also be taken. This is mostly to rule out other conditions that can cause similar symptoms.

Asthma Treatment

Since asthma is a chronic disease, treatment goes on for a very long time. Some people have to stay on treatment for the rest of their lives. The best way to improve your condition and live your life on your terms is to learn all you can about your asthma and what you can do to make it better.

• Become a partner with your health-care provider and his or her support staff. Use the resources they can offer -- information, education, and expertise -- to help yourself.
• Become aware of your asthma triggers and do what you can to avoid them.
• Follow the treatment recommendations of your health-care provider. Understand your treatment. Know what each drug does and how it is used.
• See your health-care provider as scheduled.
• Report any changes or worsening of your symptoms promptly.
• Report any side effects you are having with your medications.

These are the goals of treatment:

• prevent ongoing and bothersome symptoms;
• prevent asthma attacks;
• prevent attacks severe enough to require a visit to your provider or an emergency department or hospitalization;
• carry on with normal activities;
• maintain normal or near-normal lung function; and
• have as few side effects of medication as possible.

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