What happens during an asthma attack?

Fifteen year old Chris is having a severe
asthma attack. His immune system has made what could be a fatal mistake (“I can’t breathe”) and is shutting down his airways. (“I really can’t breathe”) Without help from the medical team, Chris’ body may shut down completely (“I’m going to die”).
The breathing tubes in Chris’ chest are squeezing tightly shut, and filling with sticky mucus,
blocking his vital oxygen supply. If he is not treated soon, he will die. Here’s a really
life-threatening episode of asthma. Asthma is pretty common in our community, and most
of the time it’s not this life-threatening, but this one is quite serious. Chris’ allergic
reaction has tricked his immune system into shutting down his airways, blocking vital
oxygen to the rest of his body. The drugs are supposed to help the muscles around Chris’
airways to relax, but there is a problem. The mucus stops the drugs from reaching his blood supply. Time is running out – Chris’ body takes emergency action. His shoulders and neck muscles swing
into action to help inflate his lungs, but even this is not working. As the pressure
mounts, the team must find a treatment to get the drugs past the mucus. Chris is by
no means an isolated case. One in nine Australian children suffer from asthma, but for Chris
the situation is looking dangerous. Chris is currently having Ventolin or Salbutamol
through a nebuliser which is breathing into his lungs. This acts on the muscles around
the small airways and helps to open them up. Unfortunately sometimes when the airways are
very closed down, the Salbutamol doesn’t reach the areas that it needs to get to. If the inhaled
Ventolin is not working, then we often will go to a different form of medication – again
a relaxant for the muscles around the small airways, and it helps to open those airways
up, and it’s given as a one-off dose over about 10-15 minutes in severe asthma. Inside Chris’ body, the
airways start to open as the drugs take effect. Air finally returns to Chris’ lungs, inflating
the three hundred million tiny airsacs. At last, he can breathe. Chris seems to be feeling
a lot better now. The intravenous medication seem to have taken effect. He still is very
tired, because he’s been working very hard with his breathing, but we’re a lot happier
with his clinical progress now. Chris was admitted to intensive care for three days,
with a further three days in a medical ward before being sent home. He is now back at
school, playing soccer, and is aware that it is important to look after his asthma and
tell his teachers and family when he’s not well. Chris had always expected other people
to look after his asthma, but after this emergency, he now understands that he must recognise
when he is having asthma and follow his asthma action plan. Before leaving hospital, Chris
learned what asthma is, how to manage his triggers, what his medications do, and how
to use them correctly. Chris now uses a spacer to have his medication. He also learnt how
to recognise when his asthma was worse, and the need to follow his asthma action plan.
Chris has taken control of his asthma.