Share, , Google Plus, Pinterest,


Posted in:

Clearing the air about asthma

Not being able to get enough breath is incredibly scary. In an asthma attack, the airways narrow giving a feeling of drawing air through a straw. Even for mild attacks, medical treatment should begin right away; otherwise, the condition often worsens.

Just over eight percent of Americans have asthma, roughly 20 million adults and six million children. Asthma is more common in those who grew up in or are living in an urban area, probably from pollutants in the air. Obesity and smoking are risk factors, too.

Asthma is diagnosed based on its symptoms, which include shortness of breath, chest tightness, wheezing and coughing at bedtime. Asthma won’t show up on a chest X-ray, but certain breathing tests can help your medical provider make the diagnosis.


Several factors can incite an acute asthma attack, including sinus infections, air allergens like pollen or perfumes and medications like aspirin. For some people, cold air, exercise or psychological stress can induce an attack. Certain food additives like sulfites can trigger an attack, too. These are found in processed beverages and foods like fruit juices, dried fruits, some soft drinks, potato chips and most wines.

Asthma is caused by a tightening of the midsize breathing tubes called bronchi. Two factors are involved: acute narrowing from stimulation and chronic narrowing from inflammation. For proper control of asthma, both conditions should receive proper medical care.


Treatment comes in two forms: emergency inhalers for the acute attack when needed and anti-inflammatory drugs taken daily for long-term prevention and control. The emergency medicine Albuterol can be administered either via an inhaler or a machine called a nebulizer. Inhaled albuterol will open the airway tubes and usually reverse an acute attack. For those whose attacks are both rare and mild, over-the-counter Primatene mist or a steamy shower may be sufficient. However, all these treatments deal only with the acute attack and won’t address the underlying inflammation issue.

Inflammation causes chronic swelling of the airways, making what otherwise might be a mild asthma attack much more serious. Taking anti-inflammatory medications every day will greatly reduce the frequency and intensity of asthma episodes. The three types are inhaled corticosteroids (Flovent, Pulmicort), combination inhaled corticosteroids with long-acting beta-agonists (Advair, Symbicort) and leukotriene receptor antagonists (Singulair, Accolate). Patients should be aware that these will only work when taken daily. Waiting to use any of these during an acute attack is unlikely to help; use a rescue inhaler or nebulizer instead.


There are several recommendations for how to use a rescue inhaler for an acute attack. The “rule of 10” says take one puff off the reliever inhaler every minute — up to 10 puffs in 10 minutes. Children under 6 should be limited to six puffs in 10 minutes. The “rule of four” says administer four separate puffs, taking four breaths for each puff every four minutes. If the patient isn’t getting better with these treatments, he or she should go to an emergency room promptly.

Discuss with your provider the frequency and intensity of your asthma symptoms to develop an appropriate treatment plan. With proper medical control, a person with asthma can lead a comfortable, healthy life.


  • Shortness of breath
  • Chest tightness
  • Wheezing when exhaling
  • Trouble sleeping caused by shortness of breath, coughing or wheezing

Written by Dr. Philip Levin

Dr. Philip L. Levin is a retired emergency medicine specialist in Gulfport. Learn more or contact him at

32 posts

Leave a Reply

Your email address will not be published. Required fields are marked *