Asthma Attacks - Out of the Blue?

Do these happen to you? Right from nowhere? Just all of a sudden?

Or is it a gradual buildup of irritation and tightness in your chest? That’s what I experience, so I medicate before it gets bad.

But I know asthma attacks kill people every year - how does that happen? Do they ignore early symptoms? Or are they highly sensitive to some really awful irritant?

It can happen in a minute when you have a bad immune response. Think of a person with a bee sting allergy but it happening in the lungs. This is what usually results in death. It used to seem that I had little warning like maybe a half hour that I would be in trouble. After a while I learned that a headache would often proceed my attacks by 4 hours or so. The key was to recognize when a headache was starting and take the medicine. It reduced the severe stuff greatly, but it’s stuff like that you have to recognize in the first place. Yes I do get a tightness and fatigue feeling in the lungs, but that only clued me into the attack half an hour or less before it was serious.

I had asthma extensively as a child (fortunately the kind you eventually grow out of), and my precursor was always a tiny, tiny wheeze, and a tightness in my chest. Then I’d know to go get Mom with the bottle of Tedral, which was EVIL stuff, so I always put it off as long as possible, by which time of course I was wheezing in earnest. And I can remember a few times when the wheezing was brought on by exertion, such as running and playing outside, and feeling that tiny first wheeze, and knowing that I had to stop running or else have to suffer a spoonful of Tedral, so I stopped running and stood very still, and the attack abated.

As I got to be a teenager and was entrusted to self-medicate with the little bottle of “white pills” (Phenobarbitol), I discovered that I needed to wait and see if the tiny wheeze was going to develop into a full-fledged attack before I actually took a pill, because if it wasn’t going to, then the “white pill” was going to make me unpleasantly jittery for the next four hours.

My asthma attacks usually start as coughing fits that sort of start out of the blue*. If I don’t use the inhaler it can progress to wheezing and tightness in the chest and a feeling that I can’t breathe. I have mild asthma but certain triggers can set me off. Before I was diagnosed I attributed my coughing fits to allergies so I’d usually take an antihistamine which would help a little but now that I have an albuterol inhaler it works much better. I try to use it as soon as I start coughing.

*Out of the blue is usually exposure to a trigger (like cigarette smoke or some chemicals) and since I can smell the trigger I know what’s happening. But every once in a while I start coughing without having noticed a trigger. I don’t have hayfever but my doctor told me that certain pollens, molds, etc. that trigger allergies can also cause a sensitivity in people with asthma so that you react to it as if you were allergic.

I have trouble when I get a cold or the flu. The problem is that I am usually sick enough that I disregard the symptoms of an asthma attack until it gets really bad then. I once had my doctor lecture me on the phone about it & tell me to drive immediately to a hospital because he could hear me wheezing. While I drove, he told me all about people like me that ignore it & end up dead. Thanks, doc (even though you were right).

That’s what that is? Asthma?

I guess I’d better call my doctor then…

Do! For me it’s a feeling that there’s a 15 lb weight on my chest. I thought I was just getting old. :smack:

I’ve found that Advair (steroid/bronchodilator combination) really helps, I use it once, maybe twice per month. You’re supposed to throw the thing away 30 days after opening it, but at $43 a disc there’s no way I’m doing that.

When first diagnosed last August I also had a wheeze, but eliminating allergens in my home took care of that.

Not for me. I have mild, persistent asthma, for which I take Asmanex and use Albuterol (they’ve changed it to ProAir (?), actually) sometimes. I’ve never had an actual attack, though. All I ever get is a bit wheezy. Of course a bit of wheezing, for some folks, is a precursor to an attack. For me, though, it’s just a bit of wheezing.

I found out that it’s likely tied into me being allergic to dust mites. So, I am treating the allergy with snorts of Nasonex and a Zyrtec pill a day, and the asthma is nearly nil, unless I get a cold or sinus infection, in which case I double up on the asthma meds (per Dr’s orders). But the best thing I did was to get rid of the carpet in my bedroom and get hypo-alergenic pillows, etc. No allergies, no asthma, for the most part (knock on wood).

I’ve had it since I was a kid. Only when I run or overexert myself (and yet not all the time)… it happened this morning actually, I was late and saw the bus as I was starting to cross the walkway so I had to run to catch it… about halfway across I could feel a tingle start in my chest, by the time I got to the bus (not that far away) I was gasping and my chest/throat felt tight and tingly. It slowly abated, but didn’t go away completely for another 20 minutes or so… though it’s still a little sore even now if I take a deep breath (this was about 5 hours ago).

That’s usually how it happens.

Well, I had to call my doc for a checkup anyway. May as well make an appointment for that at the same time.

Mine aren’t out of the blue, I know what sets it off but they do seems fairly random to people that aren’t me. Not only exercising, but also weather changes, cold air, hot air, humidity, smoke, animal dander, allergens in the air, etc, etc. There is no off season :frowning:

I should do a daily medicine - but I hate taking drugs and usually only do the daily for season I expect it to be worst and just deal with it the rest of the time.

As for those who actually die from asthma, I’ve always wondered how that happens too. I know my triggers and my attacks are generally gradual. Because I’ve had it my entire life (yes - I even have a bubble picture from when I was a baby) I know the signs and symptoms for me.

My guess is that those not as well versed are caught off guard and don’t know what to do or how quickly to act. There might also be teenage deaths because it’s “not cool” to use an inhaler (luckily- my parents taught me it was cool with The Goonies :cool: ).

I’ve never had a severe attack, though I’ve witnessed many of my mother’s. For me it’s usually either a. I’ve overexerted myself (shoveling snow, chasing the dog around the neighborhood etc) and I cough and cough. or b. it’s due to the weather/humidity or speaking too much (during trainings when I alone speak for over an hour at a stretch) and my chest feels really tight and I feel like I can’t get enough air into my lungs. Using an inhaler cuts both off at the pass.

However, my mom is much more severely effected, and I’ve seen her go from fine to gasping like a fish out of water within minutes of exposure to her triggers. I assume those who die of it have it even worse than she does. Or that they don’t have an inhaler when a severe attack occurs.

Sudden changes in humidity will do it for me, too. I once had a job interview in Dallas & flew from Detroit. Door opened on the plane & my lungs closed up. Stupid me, I should have recognized it - but I didn’t because I was so focused on the interview. I went to the job interview & boy did it go bad! I was coughing all through it, and being somewhat oxygen deprived, let’s just say I was a little less coherent than I normally am. (Needless to say, I did not get offered the job.) I finally figured out what was going on when I was back at the airport that evening - almost called 911 then.

Is there such a thing as adult onset asthma? A few years ago when I had a persistent dry cough (no, I don’t smoke) my doctor diagnosed me with asthma. I was a bit :dubious: because I’d never had it as a child. She gave me an inhaler, it helped, then I stopped using it.

The cough is gone, but about three or four times a month I’ll get this squeezing in my chest like my breastbone is caught in a vise. I don’t have problems breathing, but I find myself breathing deeply to see if that helps the pressure/squeezing/whatever it is.

Just wondering…I have an appointment for a physical next week…I’ll ask.

Asthma, or Reactive Airway Disease, is a disease of inflammation. The bronchioles, or breathing tubes, deep inside the lungs, get irritated and inflamed, usually due to an allergic or immunologic response to irritants.

When the inflammation (and concomitant excess mucus production) is severe enough, or when another irritant just pushes someone over the threshold, the muscles which line the bronchioles go into spasm, and cause the characteristic severe shortness of breath and wheezing. This can be life-threatening, and in the US, 5000 people each year die from acute asthma attacks.

Some folks can go from normal to severe attack in a few seconds, some folks decline slowly, some folks do both at different times.

Rescue treatment is generally based on drugs which relax the spasming bronchiole muscles. Albuterol in inhaled form is the most common rescue drug. Rescue medicines should generally be taken only when an acute attack is occurring.

Maintenance treatment is designed to be taken chronically, and it reduces the amount of inflammation in the bronchioles, and helps keep down the production of mucus. Drugs like inhaled steroids (flovent, Qvar), steroid/long-acting dilator combinations (advair), leukotriene inhibitors (singulair, accolate), or even prednisone, fall into this category. Proper use of maintenance medication reduces the number of acute attacks.

The proper diagnosis of asthma depends on taking a good medical history and doing a good physical exam, along with doing some basic tests like lung spirometry (both before and after using rescue inhalers) and having the patient take their own peak flow measurements, both when feeling short of breath, and when in their normal state.

Doing the above helps a doc confirm or rule out a diagnosis of asthma, and if needed, tailor-make a control plan to suit the needs of the individual.

I had that test last year and was diagnosed with asthma. I’d never had breathing problems before, so yes, Ivylass, I have adult-onset asthma (a few other Dopers have said they do as well).

But I’ve never had an acute episode or “attack”. Just the feeling of heaviness.

I don’t know if my allergen sensitivity changed because of my pregnancy, because we moved to a city with bad air, just because I’m older, or because I’ve exposed myself to irritants while painting (turpentine and such). It’s a mystery.

This spring I saw an allergist who did the “scratch test” on my back, and I discovered I’m highly allergic to dust and cats. So I’ve taken a lot of steps to remove both from the house (bye-bye BoBo).

My daughter has asthma, too, so I’m trying to learn more in order to anticipate possible problems with her breathing. She’s had one attack, but no other problems (except when she’s got a cold) in the months since I de-allergized our home. She’s too young to get a really good diagnosis yet.

I, too, have adult-onset asthma, and carry an Albuterol inhaler everywhere I go.

My triggers are exercise, cold air temperature, and high humidity.

I’ve never had a life-threatening attack, but I err on the side of caution, just in case I encounter a previously unknown trigger.

My diagnosis came just 5 years ago (at age 42) and was from a simple PFT (pulmonary function test), i.e., how much volume can you exhale into this tube?

But I also did describe to my doctor that I had chest pains after getting on the treadmill or stationary bike after about five minutes into my exercise routine.

I don’t think I had a lung spirometry test. What does it entail?

Blowing real hard into a tube connected to a measuring device. It measures how much air one can push out, and at what rate. Normal lungs can empty more than 80 percent of their volume in six seconds or less. In asthmatics who are having bronchospasm, it takes significantly longer to empty the lungs.

Peak flow meters are like mini-spirometers. Every asthmatic who needs a maintenance medication should have a peak flow meter, to assess the daily status of their asthma, along with their own asthma control plan.

Huh! I’m glad you mentioned that - I had no idea.

Uh, a steroid inhaler used “once or twice a month” isn’t going to do a whole lot of good - you’d be better off with a regular bronchodilator (e.g. albuterol) or the standalone long-acting bronchodilator that Advair contains (salmeterol) from a cost-effectiveness standpoint. The steroid doesn’t relieve an urgent asthma attack, it just reduces inflammation over a period of a day or two. Also that disk is not likely to be as effective if it’s left open (I presume; I haven’t used it and won’t; can’t tolerate dry-powder products and dislike combined-medicine inhalers). Anyway if you need both salmeterol and fluticasone, which are the ingredients in Advair, consider asking the doc for separate metered-dose inhalers for each, then you won’t have the “going stale” problem.

Re the OP: The only times I’ve ever had the “suddenly can’t BREATHE” situation, it’s been on exposure to sulfites on salads. Then it’s one minute, I’m breathing fine, next minute I’m wheezing, coughing and struggling to breathe. Highly unpleasant. The rest of the time it developers over a few minutes, at a minimum; more often over a few hours.