Asthma is characterized by periods of exacerbations and remission of symptoms, as mentioned briefly in Contemporary View Of Asthma. During a remission of asthma, symptoms are well controlled and measurements of lung function normalize. An exacerbation of asthma, on the other hand, refers to an increase in lung inflammation and rep-resents a period of increased asthma activity. It indicates a flare of the disease. An exacerbation of asthma manifests itself through the development of lung symptoms. Examples of exacerbation or flare symptoms include wheezing, coughing, nighttime lung symptoms, increased mucus production from the lungs, breathlessness or dyspnea, and chest pressure or discomfort.
During an exacerbation, measurement of lung function, as indicated by the FEV1 (and peak flow) will typically show decreasing values. An exacerbation usually develops gradually and begins with mild symptoms. If unchecked, that mild exacerbation will worsen and become more severe. Mild exacerbations, identified early and treated appropriately—perhaps with increased use of inhaled medication—can be nipped in the bud with minimal, if any, disruption of health and lifestyle. More advanced exacerbations, however, may require the use of addition-al medication, such as steroid tablets. Severe or rapidly progressive exacerbations require hospital-based or emergency department intervention and treatment. The term asthma exacerbation has supplanted the out-dated asthma attack in the scientific and medical literature.
Exacerbation more accurately describes the gradual nature of the buildup in lung inflammation during a disease flare. Some practicing pediatricians, internists, family physicians, and asthma and allergy specialists nonetheless still choose to use the term asthma attack in speaking with their patients about asthma. The word attack, with its allusion to defensiveness, implies unpredictability, violence, and vulnerability, whereas exacerbation emphasizes reversibility and potential transience. I prefer to use the term exacerbation throughout this book, just as I do with my patients; it is more accurate and is scientifically accepted. No matter which terminology you use, remember that an exacerbation of asthma, even of the mildest type, should never be ignored or dismissed as insignificant.
Treatment of an asthma exacerbation always includes a search for those factors underlying the loss of asthma control. Did wheezing emerge because of a respiratory infection? Were the several missed doses of inhaler medicine the culprit? Could the long wait at the bus stop in the morning in subzero temperature have been a factor? Correct identification of asthma triggers not only allows for a better understanding of your individual asthma but also leads to a more proactive approach to managing your asthma, with an emphasis on preventive measures.
Learning to increase asthma medicines when specific symptoms of an infection emerge, for instance, may help you prevent a flare or an exacerbation. Another example of proactive asthma treatment might include stepping up appropriate asthma medicine prior to the onset of spring weather if you’ve been diagnosed with tree pollen allergy and asthma and have had exacerbations in prior years related to blossoming trees.
Asthma Exacerbation: 10 Key Points
- An exacerbation of asthma is a sign of uncontrolled or poorly con-trolled asthma.
- An exacerbation of asthma reflects increasing and ongoing lung inflammation.
- An exacerbation of asthma is a significant flare of disease activity; some persons prefer to use the term “asthma attack.”
- Never ignore increasing or worsening symptoms such as wheezing, cough, nighttime awakenings, shortness of breath, or chest tightness or pain. Not all symptoms need to be present to define an exacerbation.
- Although asthma exacerbations tend to build up gradually, untreated (or ignored) symptoms can rapidly worsen and may lead to hospital-ization, respiratory failure, and even death.
- Lung function measurements including the FEV1 and PEF usually decrease during an asthma exacerbation.
- Timely and appropriate intervention and response to increasing asthma symptoms will limit their duration and lead to a return to normal baseline lung function.
- Most exacerbations will require the administration of a “burst” of oral corticosteroid anti-inflammatory medication. Some exacerbations may require treatment in hospital.
- Prevention of exacerbations is a major goal of modern asthma management.
- Remember that asthma and its symptoms are controllable with proper treatment.