Asthma Attacks and Air Temperature

Patients should also consider air temperature. Cold air is extremely irritating in patients with bronchial asthma and may produce severe attacks. Individuals with asthma appear to warm cold air less quickly and efficiently than nonasthmatics. This warming takes place in the large air passages of the nose, sinuses, throat, and windpipe. One simple measure patients should take is to wrap the face with a scarf that warms air before it is inhaled. A cold air mask is commercially available and may provide more protection in the winter.

How to Avoid Severe or Fatal Asthma Attacks

Patients who experience severe or near-fatal asthma attacks must be active participants in monitoring and managing their asthma. Several characteristics of fatal or near-fatal asthma attacks stand out and I emphasize them here.

There is usually a period of falling airflows and increased wheezing, cough and shortness of breath that precedes a severe attack. In this critical time the introduction of oral cortcosteroid or an adjustment of maintenance treatment may prevent a near-fatal asthma attack. Unfortunately,patients with severe and subsequently fatal asthma often experience denial of their condition and symptoms. These patients are particularly vulnerable to fatal attacks, since they often disregard instructions to monitor flows and take medications. Usually, these patients admit to self-medication without communication with the physician, lowering dosages or omitting entirely oral and inhaled corti co steroids (for fear of side effects despite a life-threatening disease), and reducing the number of sprays from the recommended dosages of B-agonists, cromolyn, and nedocromil.

It is not clear why these patients place themselves at greater risk through denial of their disease and lack of communication with physicians. Unfortunate childhood experiences may playa role in how an adult deals with disease. Poor rapport with the physician or lack of detailed understanding of the nature of asthma may also be factors. It is only through education that patients may reach a better understanding of the potential severity and life-threatening aspects of bronchial asthma. Professional counseling may be necessary to reduce denial and to enlighten patients as to why they often do not follow instructions.

It has been reported recently that patients who have had near-fatal asthma attacks may have a reduced perception of shortness of breath.These patients may also have less response to reduced blood oxygen levels. These characteristics would make fatal attacks more likely. By carefully monitoring peak flows, these patients stand a better chance of recognizing the increased narrowing of airways that signals an asthma attack. When flows are reduced 25 percent from the patient's personal best, action must be taken at once. Written instructions help ensure an appropriate response.

Who Is Most Likely to Experience a Near-Fatal Attack?

Patients who have already experienced a severe attack that required respiratory support are the likeliest candidates for fatal asthmatic attacks.

When respiratory support is needed, the patient's airway or windpipe is intubated with a tube connected to a mechanical ventilator or respirator. Another characteristic that identifies "high-risk&" patients is an extremely variable or unstable airflow. These patients may have peak flows that drop or increase precipitously. Patients who have required frequent courses of oral corticosteroids or who are maintained on oral steroids should also be considered at greater risk for severe attacks.

About 10 to 25 percent of all deaths from asthma occur within three hours after the onset of an attack. These patients may progress from minimal sYmptoms to a collapse of their respirations in a short time. Investigators term this malady "sudden asphyxic asthma." For most patients there is a longer period during which the patient and physician can detect deterioration and instability and act quickly to avoid severe and near-fatal episodes. Without careful home monitoring of peak flows and close communication and compliance with physician instructions, patients who are at high risk for severe asthmatic attacks are likely to experience repeated episodes.

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