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Asthma management


In 2017, there were 441 deaths due to asthma in Australia according to the National Asthma Council Australia ... when you compare that to the 2 deaths associated with snake bites in the same year, it seems obvious why we place importance on this topic in our First Aid courses. 

"It starts with a cough, or a wheeze. Soon your chest feels tight, your breathing speeds up and gets shallower, making you feel short of breath." These are the common initial symptoms of an Asthma Attack.

The airway on the right shows how bad a casualty's airways can become during an asthma attack. Particularly affecting the smaller airways of the respiratory system (bronchi and bronchioles), the lining of the airways becomes red and inflamed... the smooth muscle around the outside of the airways begin to constrict... and there is lots of excess sticky mucus being produced...

Imagine trying to breathe through all that. Asthmatics have difficulty expelling air from their lungs due to all this restriction and congestion. The thoracic cavity continues to expand as they get more air in to their lungs, but are unable to expel the air again. As this hyperinflation of the lungs continues, their chest becomes tighter and tighter, more and more uncomfortable, and their anxiety levels understandably dramatically increase. 

The intercostal muscles work desperately to expand and contract the chest wall, and the muscles in the neck strain as the casualty fights against the obstruction. At the same time, the expansion of the lungs can become so severe that the thoracic cavity squashes the Inferior Vena Cava, and prevents the heart from refilling with blood. 

Death can result from prolonged respiratory exhaustion, lack of oxygen to vital organs, and impaired venous return, due to the increased intrathoracic pressure.

Prevalence of asthma is highest in children aged 0-14 years, however this age group also seems to be the best managed. Asthma management plans, and monitoring from parents ultimately assist in ensuring children take their preventative medications.

Mortality rates are highest in females, elderly, and in particular, indigenous communities and families.

One of the greatest influences on mortality rates appears to be poor management, excessive use of reliever medications, and not enough use of preventative medications. 

4 x 4 x 4 (4 puffs, 4 breaths, 4 mins)

1. Sit the person upright 
- Be calm and reassuring
- Do not leave them alone

2. Give 4 separate puffs of blue/grey reliever puffer 
- Shake puffer
- Put 1 puff into spacer
- Take 4 breaths from spacer
Repeat until 4 puffs have been taken
Remember: Shake, 1 puff, 4 breaths

3. Wait 4 minutes 
- If there is no improvement, give 4 more separate puffs of blue/grey reliever as above

4. If there is still no improvement call emergency assistance. Dial Triple Zero (000)
- Say 'ambulance' and that someone is having an asthma attack
- Keep giving 4 separate puffs every 4 minutes until emergency assistance arrives

Signs you are having an ASTHMA ATTACK...
You have increasing wheezing, cough, chest tightness or shortness of breath  
You are waking often at night with asthma symptoms  
You need to use your reliever again within 3 hours

Your symptoms get worse very quickly  
You have severe shortness of breath, can’t speak comfortably or lips look blue  
You get little or no relief from your reliever inhaler
Call an ambulance immediately:  
Dial 000 

Everyone should manage their asthma by taking the following actions:
-Don't ignore or dismiss breathing problems
-See your doctor for regular asthma check-ups
-Follow an up-to-date asthma action plan
-Ask your pharmacist to show you how to use your inhaler correctly
-Tell your doctor and pharmacist about other medication you are taking
-Get your flu shot in winter
-Quit smoking and avoid other people's cigarette smoke
-Ensure those close to you know what asthma first aid steps to take.