Breathing techniques taught by a physical therapist or a physician may prove useful in stopping or at least relieving an asthma attack. Breathing becomes even more important during periods of stress or increased activity; it should be done through the nose, slowly and smoothly, and the air should be released slowly from the lungs. The upper chest should be relaxed, and an attempt should be made to fill the lower part of the lungs. The entire chest and abdomen move when a person breathes deeply. Changes of position may also help, for example, lying down, sitting, leaning forward while sitting on a pillow, and sitting and leaning forward with a straight back.

The best time to treat a severe attack of asthma is several days be­fore it happens. Complications such as infection or exposure to aller­gens may be responsible. At the same time, the fault may lie with the patient, the physician, or both. Occasionally a patient visits the emer­gency room, receives treatment in the form of epinephrine (Adrena­lin), and improves enough to be sent home—only to return with severe problems later that day or the next. Such a course of treatment contributes to the development of a severe asthma attack. In discussing the treatment of a severe attack of asthma, I am as­suming that a diagnosis of asthma has already been made, and that the physician is aware that other problems may be present. Certain complications of severe asthma, such as seepage of air from the lungs into the chest cavity, must also be ruled out. Once laboratory tests have been performed, a diagnosis is made and a treatment program is selected, based on the seriousness of the patient’s case:

Allergy shots, also called immunotherapy or hyposensitization, are advised for certain cases when allergens such as pollens or molds are believed to contribute to the asthma, and when the elimination of these allergens from the environment is not practical. The group in which immunotherapy may prove most effective will, it is hoped, be better defined with improved diagnostic techniques such as bronchial inhalation challenges. Better control of studies is needed in evaluating immunotherapy for treating asthma patients. Although asthma is a chronic disease characterized by periodic bronchial obstruction, patients who understand their illnesses and medication programs, and who are willing to work closely with their physicians, can expect to live a relatively normal, productive life.

Antibiotics may be effective in treating some patients, while in others they may have no effect. In general, antibiotic therapy should be reserved for asthmatic patients with bacterial infections believed to contribute to bronchial obstruction. Antibiotics frequently are given empirically and before recurring data which report the identity of the organism that caused the infection. Asthmatics and bronchitics who chronically produce sputum may benefit from antibiotic therapy even though no specific causative bacteria have been identified. In such cases, broad-action spectrum antibiotics such as ampicillin or tetra­cycline can be prescribed along with a therapy that promotes good bronchial hygiene. Under these circumstances, antibiotics sometimes work because they decrease the total number of bacteria. Mucolytics and Expectorants The administration of fluids is the best way to thin secretions. Sometimes the fluids are given intravenously. Some fluids may be given with a nebulizer which, when combined with postural drainage and aerosolized bronchodilators, can be useful. Expectorants such as a saturated solution of potassium iodide (SSKI) or guanefesin have limited usefulness. Less Commonly Used Medications Atropine sulfate has been used as an aerosol and is helpful to some patients. Antihistamines also may provide relief of asthma in certain patients, but, because of their drying properties, they should be dis­continued if it becomes difficult for the patient to bring up sputum. Other medications—for example, the antibiotic troleandomycin and such alpha adrenergic blocking agents as phentolamine—have specific but limited uses and should be given only under the supervision of a physician.

A hospital is the best environment in which to treat severe cases of asthma. The ideal environment is a respiratory intensive care unit operated by specialists and equipped with continuous monitoring equipment. Repetitive blood-gas tests (which measure the levels of oxygen and carbon dioxide, as well as acid-base relationships) are necessary for the physician to decide whether breathing assistance is needed. Whether oxygen and so­dium bicarbonate are used depends on the patient’s clinical con­dition.

Because we know that psychology plays an important role in physi­cal health, techniques designed to teach patients to cope psychologi­cally with asthma can and should be employed. These techniques may be learned in an environment specially suited to individual therapy, or they may be taught in a group-therapy environment. Either way, the therapy usually centers on the alteration of asthma-related, inap­propriate behavior and adherence to a program of medication. Some patients must be taught to avoid breathing too fast (hyperventilation), since hyperventilation itself can provoke an asthma attack. Unfor­tunately, there are no standardized approaches to the treatment of asthmatics; therefore, individualized therapy must be employed, be­cause of the differences in individuals and the different forms symp­toms may take. Therapeutic Agents

Proper exercise will not only help a patient lose weight, it will also help maintain better health and functioning of the body. By exercising, a person gradually increases his or her capacity, as well as lowering the heart rate for a given exercise. This increased capacity is what is known popularly as keeping fit. For asthmatics, however, certain exercises should be carefully monitored by a physician or a physical therapist. Medication is sometimes given just before exercise to prevent subsequent difficulty. Various medications should be tried and coordinated under the supervision of a physician.

Cromolyn sodium (disodium cromoglycate), also called Intal, is a powder that can be propelled into the lungs by a special device called a spinhaler. Unlike the medications discussed above, which produce an immediate bronchodilatory response, cromolyn is a pre­ventive medication. Patients will not benefit immediately, and, be­cause of cromolyn sodium’s occasional irritant qualities, some may develop slight bronchoconstriction. The irritation can be lessened and the penetration improved by using cromolyn after an aerosolized bronchodilator. Occasionally, a trial period of four to six weeks is indicated before the patient can be categorized as a nonresponder.

As is true of any drug, tranquilizers should be administered cautiously. Sometimes tranquilizers are administered to asthmatic patients in an attempt to counteract the stimulant effect of a bron-chodilator. Because an anxious patient may also manifest a low level of oxygen in the blood, tranquilizers or sedatives should never be used when this condition is suspected. Instead, treatment with oxygen is usually recommended.

by Sheldon L. Spector, M.D.
Not all the material in this chapter applies uniformly to every patient. Only by working closely with your physician can you understand your condition and improve it.