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Australia has one of the highest rates of asthma in the world. Over 300 Australians die from asthma each year, and many of these deaths may be preventable.

Asthma sufferers have very sensitive airways, and when they are exposed to certain triggers, their airways narrow making it difficult for them to breathe.

An asthma attack can take anything from a few minutes to a few days to develop

There are three main factors that cause airways to become narrow:

1. The inside lining of the airways becomes red and swollen (inflamed)
2. The muscle around the airways constrict (tighten)
3. Extra mucus may be produced

Trigger factors for asthma may include:

• Colds and flu
• Exposure to known allergens, eg dust mite, pollens, animal dander, moulds
• Exposure to chemicals or other occupational sensitisers
• Exposure to irritants eg cigarette smoke, perfume
• Reflux
• Drugs eg aspirin and beta-blockers
• Foods eg nuts, seafood
• Food additives – colourings, monosodium glutamate (msg)
• Changes in weather, exposure to cool air
• Exercise
• Emotion

Asthma is usually considered in three classifications of severity.

• pale, cool, clammy skin
• coughing, especially at night
• shortness of breath – using all the chest and diaphragm muscles to breathe
• ‘sucking in’ of the throat and rib muscles
• Severe chest tightness
• wheezing – a high pitched raspy sound
• cyanosis around the lips (bluish colour)
• anxiety and distress
• exhaustion
• rapid, weak pulse
• little or no improvement after using reliever medication (Airomir, Asmol, Bricanyl, Epaq or Ventolin)
• severe asthma attack: collapse – leading to eventual respiratory arrest

• sit the casualty comfortably upright
• be calm and reassuring

Classifications of Asthma Severity
Severity	Mild	Moderate	Severe & Life-threatening
Symptoms
Physical exhaustion	No	No	Yes May have paradoxical chest wall movement
Talks in	Sentences	Phrases	Words
Pulse rate	<100/min	<100-120/min	>120/min
Central cyanosis	Absent	May be present	Likely ot be present
Wheeze intensity	Variable	Moderate - Loud	Often quiet

With spacer

• shake inhaler and insert mouthpiece into spacer
• place spacer mouthpiece in casualty’s mouth and give 4 separate puffs of a blue/grey reliever puffer
• give 1 puff at a time
• ask the casualty to breathe in and out normally 4 times after each puff
• wait 4 minutes. If there is little or no improvement, repeat the above sequence

Without spacer

• shake inhaler
• place mouthpiece in casualty’s mouth. Fire 1 puff as the person inhales slowly and steadily
• ask the casualty to hold that breath for 4 seconds, then take 4 normal breaths
• repeat until 4 puffs have been given
• wait 4 minutes. If there is little or no improvement, repeat the above sequence
• if still no improvement:
  • call ‘000’ for an ambulance
  • continuously repeat reliever medication every 4 minutes until the ambulance arrives

Collapsed Casualty

• call ‘000’ for an ambulance
• if possible, assist with 4 puffs of a reliever
• if little or no immediate improvement
  • repeat reliever medication every 4 minutes until the ambulance arrives
• be calm and reassuring
• if in respiratory arrest give rescue breaths
• if in cardiac arrest – cardiopulmonary resuscitation (CPR)
  

	No harm is likely to result from giving a reliever to someone who does not have asthma.
	In a severe asthma attack, rescue breaths will require much greater force to inflate the lungs.

Useful Resources The National Asthma Council Australia
1800 032 495
http://www.nationalasthma.org.au

Asthma Australia
1800 645 130
http://www.asthmaaustralia.org.au