Wilderness: Asthma

Asthma attacks occur when the lower airways (bronchioles) constrict (narrow) in reaction to an allergic substance (an allergen that triggers a reaction), a respiratory infection, or other triggers. People with asthma often have a history of previous attacks.

Asthma is present in about 5% of the US population and in up to 10% of all children.

• Features of an allergic reaction, such as itching, watery eyes, or stuffy nose, may accompany an asthma attack.
• 
  
• Consult with a health care provider prior to traveling because asthma often worsens during travel. Asthma is a potentially life-threatening condition and requires special considerations that people with asthma should not ignore when planning a trip.
• 
  
• Travelers with asthma who frequently use inhaled bronchodilators or who are planning to participate in intensive exercise on a trip may be at an increased risk to develop an asthma attack. Increased asthma therapy prior to exercise will achieve better disease control, but intensive exercise should be discouraged.
• 
  
• Scuba diving requires special considerations by people with asthma.
  
  
  • Physical and psychological fitness are required for scuba diving. Certain people with asthma find scuba diving too big of a risk. Indeed, some countries consider scuba diving absolutely too risky for people with asthma.
  • 
    
  • People with asthma who experience frequent symptoms or have a measurable baseline airway obstruction may be susceptible to lung injury and should not scuba dive.
  • 
    
  • People with asthma who have perfectly normal measures of pulmonary function with rare acute episodes may be able to scuba dive, but they should seek advice from their health care provider before doing so. The person with asthma who chooses to scuba dive should, however, be aware that significant shallow-water injuries occur even in swimming pools.
• 
  
• High altitude travel also deserves special consideration by people with asthma.
  
  
  • People with asthma with airway obstruction may be susceptible to lung injury in high altitudes. In addition, the cooler and drier air or the participation in strenuous activities at high altitude may precipitate an asthma attack.
  • 
    
  • On the other hand, fewer allergens are present in the air at high altitude. During longer stays at high altitude, people with asthma may actually experience improvement in their asthma control.
• 
  
• Anyone known to have asthma generally should not scuba dive or venture too far from medical facilities. A sudden asthma attack under water or where medical facilities are not accessible could be fatal.

The most common symptom of asthma is wheezing. This involves a "tight" feeling in the chest and a high-pitched whistling sound heard during exhalation. A person with asthma’s exhalation will be prolonged due to the increased resistance to airflow through the lungs.

Asthma symptoms vary depending on the severity of the attack.

• Mild - Cough, wheezing, and shortness of breath indicate a mild attack. Fever with these symptoms may indicate a pulmonary infection.
  
  
• Moderate – In addition to the above symptoms, people with moderate asthma attacks sit up stiffly, bracing themselves on straight arms. They use their neck and abdominal muscles to assist with inhalation. Retractions (dimpling in) of the skin and tissues between the ribs may occur.
  
  
• Severe - Wheezing may decrease due to poor/absent air movement, retractions become more pronounced, and the skin becomes blue (cyanotic) during a severe asthma attack. The person may experience respiratory arrest and an irregular heartbeat.
  
  
• WARNING: Someone with asthma may complain of "tiring out" if breathing is very labored. This may signal impending respiratory collapse and the need for emergency intubation and mechanical ventilation.

• Treat mild asthma reactions with the person's own inhaler, which induces airway opening (bronchodilation). Try to identify and remove any potential trigger, such as smoke exposure or certain foods.
  
  
• Treat moderate-to-severe reactions immediately with multiple puffs from the person's inhaler. An office or emergency room visit will be necessary.
  
  
• If the person having an asthma attack is not improving or seems to be getting worse, or if other allergic symptoms such as tongue/throat swelling appear, epinephrine from the Ana-Kit or EpiPen may prove life saving (see Allergic Reaction). People with asthma who have steroid pills, such as prednisone or methylprednisolone (Solu-Medrol), may take them for moderate-to-severe attacks. However, steroids take several hours to slow the allergic response. Antibiotics may benefit the individual if there are any signs of respiratory infection, such as fever or large amounts of yellowish-white to green phlegm.
  
  
• WARNING: Older people in congestive heart failure may also have wheezing. Always ask about a history of this condition because the treatment is different (see Congestive Heart Failure).
  
  
• Give CPR and oxygen as needed.

• All but the mildest cases of asthma require medical attention at a hospital's emergency department as soon as possible.
  
  
• Consult a doctor regarding available medications used to treat asthma attacks.

|Web Links|

Allergy and Asthma Network, Mothers of Asthmatics

American Academy of Allergy, Asthma and Immunology

American College of Allergy, Asthma and Immunology

American Lung Association

Asthma and Allergy Foundation of America

National Asthma Education and Prevention Program, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Lung Diseases Information

National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health

MedlinePlus, Asthma

MayoClinic.com, Asthma

asthma, asthma attack, asthma trigger, allergic reaction, allergic response, allergen, wheezing, shortness of breath, inhaler, rescue inhaler, Ana-Kit, EpiPen, epinephrine, steroid pills, prednisone, methylprednisolone, Solu-Medrol, insect sting, bee stings, wasp stings, asthma FAQs, asthma frequently asked questions, occupational asthma, exercise-induced asthma, asthma in pregnancy, asthma in school children, asthmatic, breathing passages, airways, chronic airway inflammation, wheeze, asthma medications, allergies, hay fever, asthma assessment, asthma quiz 

Author: Irina Petrache, MD, Instructor, Department of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins University.

Coauthor(s): Scott H Plantz, MD, FAAEM, Research Director, Assistant Professor, Department of Emergency Medicine, Mount Sinai School of Medicine.

Editors: Ryland P Byrd Jr, MD, Chief of Pulmonary Medicine, Medical Director of Respiratory Therapy, Quillen VA Medical Center; Professor, Department of Internal Medicine, Division of Pulmonary Diseases and Critical Care Medicine, James H Quillen College of Medicine, East Tennessee State University; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, ; Zab Mosenifar, MD, Director, Division of Pulmonary and Critical Care Medicine, Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center, Professor of Medicine, University of California at Los Angeles School of Medicine.