What Happens During an Attack of Asthma?

The best description of asthma is given in a story of a patient who came to a doctor and gasped. 'Doctor, if you can take my air out, I swear, I will never breathe in again.' During an asthmatic attack there is difficulty in breathing, more especially in breathing air out. The chest is distended in a desperate effort to drive out the air through the obstructed airway. The obstruction of the airway causes a wheeze (a whistling sound) which becomes faint as the severity increases due to poor movement of air. Besides difficulty in breathing, coughing, and a sense of constriction in the chest, apprehension and anxiety may be experienced. This disrupts the normal activity. If the attack is prolonged ­lasting for several hours - and does not respond to the usual treatment, it is called status asthmaticus or acute severe asthma. In this the patient may get fatigued and dies of respiratory arrest. Vigorous emergency treatment becomes essential to save the life.

Causes

Asthma is caused by obstruction of the airway, chiefly due to broncho-constriction, that is, constriction of the passage of air in the lungs, and to a lesser extent by secretions and swelling of the respiratory passage. There can be various causes for broncho-constriction but three factors which possibly interact with each other are worth considering, as their removal may help in curing asthma. These are: 1) allergic reactions, 2) infection of the respiratory tract, and 3) psychological factors. However, it must be emphasized that in most cases the underlying cause is unknown and the only alternative is to provide symptomatic treatment with bronchodilator drugs.

Allergic Reactions

Reaction to inhaled or ingested substances to which a person is allergic appears to be the commonest cause of asthma. This is called allergic asthma. It can be either seasonal or non-seasonal. Seasonal asthma is the more common of the two and is due to inhaled pollens, moulds, and eating of certain vegetables and fruits. A mite found in house dust appears to be the main bug responsible for 'house dust allergy'. Non-seasonal asthma may be due to allergy to feathers, animal-dander, foods (tartrazine is a yellow food additive which cause allergy), and drugs like penicillin, aspirin, and indomethacin.

Infection of the Respiratory Tract: Respiratory infection is a common cause of asthma in young children, the very old, and in most of the severe cases. These patients initially suffer from a common cold which progress into bronchial asthma.

Psychological Factors

Emotional stress and strain play an important role in asthma. Asthmatics are usually irritable and stubborn. The disease can also be a factor in aggravating their suffering and emotional behaviour. They have a peculiar psychological make-up or 'asthmatic personality'. A dry cough at night, exercise, crying or a hearty laugh have also precipitated acute attack in some cases.