During an asthma attack, the muscles surrounding the bronchi tighten, significantly reducing the size of the bronchi (8). This is referred to as acute (sudden) airway obstruction. Meanwhile, the mucous membrane that lines the bronchi and alveoli begins to swell and produce more mucus, further obstructing the bronchi. This inflammation can occur as a response to various stimuli; changes in the structure and function of this lining dramatically affect the severity of an asthma attack. When the airways become severely narrowed and obstructed, there is very limited air flow. The efforts for inhaling must increase to get the proper amount of air into the lung.
Due to the difficulty in moving the air in and out of the lungs, all the muscles connected to the respiratory system are involuntarily called
into action. It is common to see someone during an acute attack using “abdominal breathing,” in which abdominal muscles are used to suck in more air. The ribs and the abdominal muscles will become concave, and the neck muscles will rise and fall with each breath. During milder attacks, these signs may be more subtle, yet the sufferer is still literally fighting to take a breath.
The mucus clogging the bronchial tubes becomes thickened and infected, causing chronic cough and shortness of breath. The lungs will automatically begin to wheeze. The wheezing is the high-pitched sound of the air pushing through the bronchi as it tries to get to the lungs. In rare instances, asthma symptoms can also include chest pain, hyperventilation, and spitting blood.
An acute attack is literally exhausting, and the sufferer will quickly become tired and reduce his or her rate of respiration. If you are experiencing a severe asthma attack, you can feel as if you were suffocating. In fact, that is what is happening. When the breathing passageways clamp
down tight enough you can enter what we call status asthmaticus; and there is essentially no airflow. This can lead to a rapid buildup of high levels of carbon dioxide, and lower oxygen levels in the bloodstream. All it takes is a few moments of low oxygen levels for the brain and heart to stop functioning, causing irreversible stroke, brain damage, or coma.
There is a classic triad of symptoms seen with asthma:
■ Shortness of breath
These symptoms may occur simultaneously or only one may occur at a time. Often, these symptoms may be part of other illnesses. Even more confusing, an absence of wheezing does not exclude an acute asthma attack. When the airways become severely narrowed and obstructed, the air flow is so limited that wheezing does not occur. On the other hand, wheezing can be seen with other disorders. This can happen if there is a foreign body aspirated into the lung or with the presence of mucus in the airway by the vocal cords or in the nose. It is, therefore, very important for you to relay your symptoms to your doctor so that he or she can make an accurate diagnosis.