By Mary Carpenter
A TWENTY-SOMETHING athlete fell to the ground recently at a DC-area gym, telling those nearby he had asthma and couldn’t breathe. No one called 911 —because most listings of emergencies requiring immediate treatment do not mention asthma and because most people underestimate its dangers. While his worried friend was rushing to purchase an inhaler, the boy died.
Most published emergency lists are predictable, with heart attack usually at the top. Warning signs are familiar. For heart attack, one list includes “pale skin, a cold sweat, exhaustion, a tightening of the back and chest…and pain that radiates from the chest to the arms, shoulders, and neck.” Following heart attack, this list prioritizes choking, car accident, fire and profuse bleeding.
Such familiar heart attack signs, on the other hand, don’t always apply to women—who are “much more likely to get…indigestion, shortness of breath and back pain, sometimes even in the absence of obvious chest discomfort,” according to Johns Hopkins Heart Failure Clinic director Lili Barouch.
Stroke on these lists only appears first under headache, at #15;” followed by #16, “stroke symptoms”—although in the stroke-warning acronym FAST, the “T” points to the crucial element of time elapsing before treatment to achieve the best outcome. For the other three letters, symptoms that necessitate emergency care include F for drooping face (check the smile); A for arm weakness (raise both arms and compare); and S for speech difficulty (repeat a simple sentence like “the sky is blue”).
Heart disease remains the country’s number one killer. In 2021 updated statistics, CVD (cardiovascular disease) is responsible for 2,380 deaths per day—and 12% of people having a heart attack will die from it. Stroke accounts for 405 deaths every day.
Asthma, meanwhile, kills about 11 Americans each day, although some 25 million people in the U.S — one in 13 —live with the condition. Female adults are more likely to have asthma and to die from it than male adults. According to the Asthma and Allergy Foundation of America, “nearly all of these [asthma] deaths are avoidable with the right treatment and care.”
The symptoms of chest discomfort or pain that signal asthma, however, can be very similar to those of a heart attack. Pediatrics professor at Minnesota’s Mayo Clinic Young Juhn stresses the importance of differentiating the two problems “because asthma increases the risk of heart attack and treatments for each are quite different.”
“Asthma attacks tend to sneak up [on the sufferer] before you notice symptoms have worsened,” according to the Mayo Clinic. One clue that someone might be having a serious attack is the “inability to speak more than short phrases due to shortness of breath.” Others include severe breathlessness or wheezing and having to strain chest muscles in order to breathe.
“It feels like an elephant is sitting on your chest,” said local filmmaker L.K., a family friend of the boy who died recently and who always carries with her the prescription “rescue” inhaler albuterol. (“Rescue” or “reliever” inhalers differ from “preventer” options that include different inhalers as well as long-acting bronchodilators.) L.K. traces her asthma to early childhood years spent with parents who smoked several packs of cigarettes a day.
Usually beginning in childhood, asthma narrows the airways and produces excess mucus—and can result from the environment, such as with family members who smoke as well as from inherited genes and from having respiratory infections during infancy or childhood. But it can also arise in adults, linked to smoking, obesity and female hormones. Of three telltale asthma symptoms, the “classic” one is wheezing, a high-pitched whistling sound created by obstructed bronchial passages, along with shortness of breath and cough.
Like asthma, bronchitis can also involve wheezing and shortness of breath, but the main symptom of “acute” bronchitis is a cough lasting at least five days. Both bronchitis and asthma result in less air than usual entering the lungs, and both can create excess mucus (coming from the nose and sinuses) or phlegm (produced by the lower lungs). But while asthma causes airways to narrow due to inflammation, bronchitis causes cells to become inflamed as the immune system fights infection.
Bronchitis, whether viral or bacterial, commonly lasts one to three weeks and clears up on its own. By contrast, asthma is a chronic condition involving damage that cannot be repaired—and symptoms can flare in response to triggers such as pollen and changes in weather. Frequent respiratory infections, however, can also lead to chronically persistent bronchitis.
The two conditions can also occur together in “asthmatic bronchitis”—with bronchitis making symptoms worse in those who have asthma. In addition, “exercise-induced asthma” occurs in about 90% of people with the condition but can also arise in those without asthma. “Reliever medicine” taken before exercise can help both groups.
Deadly sudden asthma attacks are rare—and more likely to occur in asthma sufferers with a history of sudden attacks. In a small study, deadly attacks occurred in the presence of high levels of specific allergens that activated an immune system response, in several cases involving soybean dust —in the Minnesota farmlands and at docks receiving soybean cargoes. Most severe asthma sufferers carry an EpiPen, a device containing epinephrine that spurs quick recovery—but only if bystanders know they should search for the pen and call for emergency help.
I had always been hesitant to dial 911—even when my young son had a high temperature in the early morning hours with wintry weather threatening. On the evening when someone slipped on ice in our driveway, I called 911 only because the person wanted me to. After inspecting the ankle, the EMTs told me they suspected a compound fracture, which comes with a high risk of going into shock and requiring emergency help. Then they carried the patient out on a stretcher.
—Mary Carpenter regularly reports on need-to-know topics in health and medicine.