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Wednesday, January 16, 2008

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.


Glenna said...

Another off the wall one for me is that I suddenly get very tired, unreasonably tired, and feel like I have to shut my eyes RIGHT NOW. It took me a while to figure it out but once I did, I got that even if I take that 30 minute nap I'll wake up wheezing and coughing. I've heard one other person say that (a patient). It's like the scratchy neck and chin for you.

Amy said...

Well, this lowly mom thinks your lowly RT post is fabulous and really important for parents. :)

Peds. just don't sit you down and say "THIS is asthma" and "THIS is what to look out for" and "THIS is how you treat it," etc. etc. etc.

I would have LOVED to read blogs like this one when my daughter was younger and so severe and I just wasn't getting any answers. Would've saved me a whole lot of guessworks and sleepless nights and my kid a whole lot of ER visits and unnecessary oral meds.

(And thanks for the shout-out, too.)

Anonymous said...

You rock. This is exactly what I needed. Like amy said, peds don't tell you this stuff. At least mine didn't; just gave me Rx's for the MDI's and a spacer. Fortunately I had some knowledge (I'm an LPN) but that was all limited to grown-ups and big kids who can say "I can't breathe. I need my inhaler." Thanks!

Stephen said...

Great Post!

I never had the scratchy neck thing, but just like Glenna, if I get an overwhelming sleepy feeling out of the blue , it usually means that a severe exacerbation is brewing.

Believe it or not,the biggest problem I have is NOT recognizing my symptoms until I'm already sick.

Because I'm SOB most the time, my perception of my own breathlessness can be a little out of wack . Whenever I think I'm feeling tighter than usual,I always verify my symptoms with my peak flow readings just to make sure I'm not crashing.

Bishop John said...

This has been very helpful for me as well. I used to get the scratchy neck symptom so severely, that I would simply start bleeding if I only touched the itchy spot, never mind scratch it. I assumed it was because my beard was starting to come in my early twenties. Now that my asthma is relatively under control, I rarely experience this symptom, however.

Thank you very much!

Bishop John