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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.
Published medical emergency lists are predictable, with heart attack usually at the top—and most people assume they know the symptoms: “mild pain or discomfort in the center of your chest… pressure, squeezing, or fullness…complicated because these symptoms may be related to something less serious, such as heartburn,” according to PennMedicine.
But familiar heart attack signs 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. Following heart attack, most lists prioritize choking, car accident, fire and profuse bleeding.
On many lists, stroke often appears first under headache—way down the list, and after that under “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”).
Asthma kills about 10 Americans each day, although some 25 million people in the U.S—one in 13—live with the condition—compared to almost 2,500 from CVD (cardiovascular disease); and just over 400 per day from stroke. 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, which says, “Nearly all of these [asthma] deaths are avoidable with the right treatment and care.”
Symptoms of chest discomfort or pain that signal asthma, however, can be similar to those of a heart attack—and asthma increases the risk of heart attack. But determining the correct diagnosis is important because treatments for each are quite different. According to EmergencyPhysicians, one clue that someone might be having a serious asthma attack is “the inability to complete a sentence without pausing for breath”—as well as 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 are 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 temperature above 105 degrees 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. But after inspecting the ankle, the EMTs told me they suspected a compound fracture—and because that comes with a high risk of going into shock and requiring emergency help, they carried the patient out on a stretcher.
—Mary Carpenter regularly reports on topical subjects in health and medicine.