In an asthma attack, external stimuli cause the airways to narrow, resulting in shortness of breath, breathing is visibly more difficult and exhalation (clinically called expiration) is often accompanied by a whistling sound that is clinically called expiratory stridor or wheezing. There is also a symptom of an extension of the breathing phases. While during normal breathing the inhalation (clinically called inspiration) lasts longer than the exhalation, this ratio is shifted during an acute asthma attack and may even reverse.
In order to facilitate breathing on his own, the asthmatic in an acute asthmatic bronchial attack usually involuntarily adopts a sitting position and supports his arms. This reverses the actual function of the muscles that start at the arm and move towards the chest and can raise and lower the chest (thorax) as respiratory support muscles, which makes breathing easier. In addition, the seizure is usually accompanied by a pronounced coughing stimulus and an increase in the beating frequency of the heart, which can be seen from an increased pulse rate.
Furthermore, symptoms of a blue discoloration of the lips, clinically called cyanosis, can occur, which indicates a reduced oxygenation of the blood. Above all, exhalation is more difficult in the case of a bronchial asthma attack. This is due to a fundamental difference in the sequence of inhalation and exhalation.
During resting breathing, the thorax expands with the help of the respiratory muscles and a negative pressure is created in the lungs by the diaphragm, which pulls the air into the lungs like suction. (see diagram below) Exhalation, on the other hand, is not supported by muscles, so it takes place passively through the restoring force of the lungs. There are also muscles that can support exhalation, but they only play a role in increased breathing and are therefore poorly developed.
However, asthmatics can train them and thus alleviate their shortness of breath during a bronchial asthma attack. With increasing duration of the attack, symptoms of exhaustion and confusion appear, caused by the great effort that has to be made to breathe and the increasing undersupply of oxygen to the brain. A bronchial asthma attack can last from a few seconds to hours and in extreme cases days.
If left untreated, a severe asthma attack can also be fatal, and this is known as asthmaticus status. What often goes unmentioned is the great fear that a patient develops during an asthma attack. It can go as far as a feeling of annihilation and should be considered as an additional factor, as it increases the patient’s suffering and can make the attack even worse.
In the interval between two attacks asthmatics are often free of symptoms, coughing can be the only asthma symptom for a long time and is often misinterpreted as chronic bronchitis! Asthma attacks are therefore only the tip of the iceberg!