HEALTH LINE
Take my breath away!
“Your asthma patient’s face suddenly turns red, then violet,then white and then she dies before your eyes!”
I heard these words during my medical school days when I gasped for air at the emergency room (ER), too exhausted to ‘pull-back’ to life a witnessed ‘arrest’ (patient whose breathing and heartbeat have stopped).
“She was active and even joked around some hours ago but she suddenly became restless and began gasping for air after she inhaled smoke from burnt twigs and cellophane coming from our neighbor’s yard,” the sister said.
Tube Of Life
Acute Severe Asthma (a.k.a. Status Asthmaticus), a life and death situation, is tough and tricky at the ER. The muscle-fatigued lungs, ready to give in, need only a matter of time before it stops.
The air-hungry patient badly needs ‘intubation’. It is a transparent plastic tube that is attached to the patient’s throat down the windpipe. This connects the body to an outer source of life – air. The tube is then attached either to an football-shaped ‘ambubag’ (hand squeezer) or to a breathing machine (ventilator).
The patient was revived.
The Dark Side
Some patients are not as lucky. Some are dead on arrival (DOA) because no amount of advanced resuscitative skills could pull them back to life. Heartbeats may recur by CPR with ventilator-controlled breaths, but still, the oxygen-deprived brain is permanently damaged. Comatose patients, after several days or months, usually surrender to pneumonia and multiple organ failure before dying.
What Happens Inside
In most Acute Severe Asthma, the insides of the lungs and the air tubes are full of dirty materials along with mucus plugs (hard rubbery phlegm) that cause deadly obstruction. This is the result of basic asthma problems that went bad, like the swelling and increased phlegm production on the inside plus ‘muscle choking’ from the outside.
Why It Has Come To This
Asthma is considered a disease of ‘underestimation’. Patients usually answer, “I’m okay” when asked how they are feeling. This is dangerous because many had been so used to their breathlessness that they’ve lost touch of the exact severity. Asthmatics may feel good now, only to pant for breath the next minute.
‘Underestimation’ begets ‘under-medication’. They stop taking their prescribed maintenance drugs because they feel well. They riskily rely on quick acting relievers or ‘rescue meds’ instead.
The ‘Rescuers’
An asthma patient unwittingly inhales a trigger: like cockroach ‘dust’ (cockroaches do not ‘die’ or easily decay, they just pulverize). It is rice harvest time now with plenty of pollens for inhalation. Air-tube (bronchus) muscle reacts and ‘squeezes’ the hole into small opening causing airflow obstruction and breathlessness. This sudden ‘attack’ is called asthma ‘exacerbation’. A handy anti-asthma spray (Bricanyl, Asmalin, or Ventolin) is puffed. The tight airway muscle loosens, and relief is at hand. They are the ‘rescuers’.
Thought at first to be the miracle asthma drug because of the quick relief, today’s ‘rescuers’ are considered as short-term aids for short-lived relief. ‘Attacks’ keep coming back because the real hallmark problem is overlooked.
The ‘Preventers’
Inflammation of the airways is the hallmark problem of asthma. It is wise, therefore, to control the inflammation inside. Inflamed lining equals ‘bronchial hyper-reactivity’ (BHR). This means that even a very minimal ‘tickle’ of the air tube as minor as inhaling house dust mite can cause a severe asthma ‘attack’. Asthma may be absent for years but an asthmatic still harbors the BHR (with varying degrees of inflammation inside), waiting for the right moment and the right trigger to strike. This must be the reason why transferees to new jobs or locations suffer asthma recurrences after years of respite. Prevent inflammation, therefore, and you prevent worse asthma exacerbations.
Take Home Message
Rely on ‘preventers’ more, not on the ‘rescuers’. One good example of a preventer is the combination of anti-inflammatory drug (Fluticasone) and a long-acting airway opener (Salmeterol) or Seretide. Studies have shown that regular daily use of ‘preventers’, even on asthma-free days, lessened asthma exacerbations and improved quality of life. The GINA, Global Initiative for asthma guideline, recommends use of inhaled preventers even on early asthma stage. Consult your doctor first.
The Bottom Line
The best life saving measure is total knowledge of the disease. In my next column, we will discuss other asthma issues like: the other ‘tube of life’ (peak flow meter), the role of nebulizers at home — helpful or a threat, the ‘attack triggers, the telltale signs of impending Acute Severe Asthma, and more.
Meanwhile, stay alive. Keep on reading Health Line. (I apologize for the preceding two sentences for it seemed to have betrayed the bighead in me. I just felt proud when my wife, Denise, told me, “Oh my! My dear! Now you can write a good piece other than sex). Comments to dryapjr@yahoo.com.
(Our writer is a member of The Kapisanan ng Mga Brodkasters sa Pilipinas. You can catch Dr. Yap every Sunday morning at Bombo Good Morning Philippines 900 MHz, and Fridays at “Health Line” Wesfardell Budyong Kapihan TV Show simulcast with dyjj with Rexam Laguda. Saturdays at Pulso sang Banwa with Glenn Beup channel 5 Alto Cable 8 am. Dr. Yap’s book “Joyful Life & Sex? GO TO HEALTH!” is now available at all National Bookstore outlets nationwide.)
