Are you having an asthma flare-up? Let's talk about this asthma attack (Asthma Flare-Up)!

Are you someone who has asthma? Or does someone in your family, perhaps your child, a friend, suffer from asthma? When we look at such people, we see that some days they breathe very easily, without any difficulty. But, there are times when they suddenly have difficulty breathing, feel like their chest is constricted, and cough violently. That is when we say that asthma is aggravated, or an asthma attack , or an asthma flare-up has come. This can be a really disturbing experience. So, shall we talk about this in a little more detail today?

What exactly is asthma? Let's understand it simply.

Before we talk about asthma exacerbations, let's briefly review what asthma is. Simply put, asthma is a condition in which our airways , the tubes that carry air to the lungs, become sensitive . This sensitivity can cause these airways to become inflamed , meaning they swell, and narrow, for a variety of reasons.

Think of it like a water pipe. Normally, the pipe is wide open, so the water flows through easily. But in someone with asthma, the airways, which are tubes called airways, react to certain things and become swollen and narrow. Then, just like when the pipe becomes blocked, it becomes difficult for water to flow through, making it difficult to breathe in and out.

The most important thing is that asthma is a chronic condition. This means that it is not something that will get better in a day or two. However, if it is managed properly and the medication is used correctly, it is possible to live a normal life even with asthma.

So what is this asthma flare-up?

Now let's look at what an asthma flare-up, or asthma attack, is. A person with asthma can go about their daily activities even if they have minor discomfort during the day. However, an asthma flare-up is a sudden, severe episode of shortness of breath.

The main symptoms that can be seen at this time are:

• Severe coughing: Sometimes the coughing can be so severe that it is impossible to stop.
• Wheezing: A low, whistling sound coming from the chest when breathing. This is most often heard when exhaling.
• Severe shortness of breath: It can feel like you're suffocating and your chest is tight. Some people have difficulty breathing, making it difficult to even speak.

This condition can last for several hours, or even days, so this is something that should definitely be taken into account.

Why does asthma suddenly increase? Let's see what the main causes (Triggers) are.

Each person's asthma can be triggered by different things. We call these triggers . If you have asthma, it's important to identify what triggers make your asthma worse.

Here are some common triggers:

• Allergies:
• Dust mites: Small creatures that live indoors, in bedding, pillows, and mattresses.
• Pollen: The pollen that comes from tree flowers in the spring.
• Animal fur, hair, and skin flakes (Pet dander): From animals like dogs and cats.
• Types of Mold: Mold that grows in places with high humidity, such as bathrooms and kitchens.

When these things enter the body, the airways of a person with asthma react, swelling and becoming blocked. Just think, some people sneeze and feel like they're scratching themselves even when they touch a little dust, and people with asthma have difficulty breathing because of these things.

• Colds and other respiratory infections:
• Even a common cold or flu can worsen asthma. This is because these viral infections increase inflammation in the respiratory tract. That's why people with asthma need to be extra careful when they get a cold.

• Cigarette smoke and other fumes:
• Being around someone who smokes (secondhand smoke) and smoking (active smoking) can make asthma worse. The chemicals in cigarette smoke are very harmful to the respiratory tract.
• Also, things like wood stove smoke, vehicle exhaust, factory fumes, strong perfumes, and pesticides can also increase asthma.

• Exercise:
• Some people may experience an increase in asthma symptoms when they exercise, especially in cold, dry environments. This is called exercise-induced asthma .
• But this does not mean that people with asthma should not exercise. As per medical advice, it is appropriate to exercise, perhaps using an inhaler before exercise.

• Cold air:
• When suddenly exposed to cold air, for example when going outside from a cold room, or when drinking cold water, some people's airways may constrict and asthma may worsen.

• Other reasons:
• Stress and strong emotions: Some people's asthma can worsen when they are extremely angry, scared, or sad.
• Certain medications: Some pain relievers (e.g., NSAIDs such as aspirin and ibuprofen), and some heart medications such as beta-blockers can make asthma worse. If you have asthma, be sure to tell your doctor when you start taking any new medication.
• Air pollution: Things like vehicle exhaust and factory smoke in urban areas.
• Some substances in food and beverages (food additives): Things like sulphites can affect some people, but this is somewhat rare.

What happens inside our respiratory system when asthma flares up?

When asthma flares up, three main changes occur in our airways:

1. Inflammation and swelling of the inner lining of the airways: Due to the triggers we discussed earlier, the delicate tissues lining the airways begin to swell. Just like when we get injured, our bodies swell.

2. Muscle tightening / Bronchoconstriction: The small muscles around the airways tighten, causing the inflamed airways to narrow further.

3. Increased mucus production: The glands in the airways start producing more mucus than normal. This mucus thickens, further constricting the narrowed airways, making it more difficult for air to pass through.

Imagine a water pipe that is swollen from the inside, someone is squeezing it from the outside, and on top of that, dirt is also trapped inside. That's what happens inside the lungs when asthma flares up. So you can imagine how difficult it would be to breathe.

Can we accurately recognize the symptoms of an asthma exacerbation?

Symptoms of an asthma exacerbation can vary from person to person, and may not be the same for every person. However, the following are some of the common symptoms:

• Shortness of breath: This is the main symptom. It feels like you're short of breath and can't take a deep breath.
• Chest tightness or pain: It may feel like a belt is tightening around the chest, or like there is something heavy inside the chest.
• Persistent coughing: This cough may be worse at night, in the early morning, or during exercise. It can sometimes be a dry cough, or it can be a cough with mucus.
• Wheezing: A whistling sound from the chest, such as "soo... soo...", when breathing, especially when exhaling. Sometimes this sound can be heard not only by yourself, but also by those around you.
• Rapid breathing.
• Difficulty speaking: Difficulty breathing, making it difficult to speak in a continuous sentence. You have to speak two or three words and take a breath.
• Feeling very tired or weak.
• Difficulty sleeping: Due to coughing and difficulty breathing.
• Frequent use of your reliever inhaler: If you find yourself needing to use your blue inhaler (such as Salbutamol) more often than usual, it is a sign of an asthma exacerbation.

Serious symptoms that require emergency medical attention:

If you have these symptoms, you should go to the hospital or call an ambulance immediately . These can be life-threatening.

• Blue/purple lips or fingernails (Cyanosis): This means the body is not getting enough oxygen.
• Severe shortness of breath, suffocation.
• No relief or temporary relief even after using a quick-relief inhaler.
• Difficulty breathing to the point of being unable to talk or walk.
• Dizziness or confusion.
• In young children, rapid breathing with enlarged nostrils, abdominal breathing, refusal to eat or drink, and whining.

What to do if your asthma flares up? Prompt treatment is very important!

Taking action as soon as symptoms of an asthma exacerbation begin can prevent the condition from getting worse.

1. Stay calm: Getting anxious can make breathing more difficult.

2. Use your "Reliever Inhaler / Rescue Inhaler": This is usually a blue inhaler (e.g. `(Salbutamol)`, `(Ventolin)`). Take the prescribed dose as directed by your doctor. This inhaler works by quickly relaxing the muscles in your airways, making it easier to breathe.

3. Sit up straight: Sitting slightly forward makes it easier for air to enter the lungs.

4. Follow your "Asthma Action Plan": If your doctor has given you an asthma action plan, follow it. This plan clearly states what medications to take, how much to take, and when to see a doctor if your asthma flares up.

5. If symptoms persist or worsen: If you do not feel any relief within 5-10 minutes of using your quick-relief inhaler, or if your symptoms get worse, seek medical advice or go to a hospital immediately. If you have any of the serious symptoms mentioned above, do not delay for a second.

What can we do to prevent asthma exacerbations?

Asthma exacerbations are a very unpleasant experience, so it's best to try to avoid them as much as possible.

• Identify and avoid your asthma triggers: Try to figure out what triggers your asthma. It's a good idea to keep a diary. Then avoid those triggers as much as possible.
• Take your doctor's prescribed "Controller/Preventer medications" exactly, every day: These are the medications that control asthma long-term. They reduce inflammation in the airways and prevent asthma flare-ups. It is important to take these medications as prescribed, even on days when you are not having any symptoms. Stopping them can cause your asthma to flare up again.
• Learn the correct way to use your inhaler: In order for the medicine to reach your airways properly, you need to use it correctly. Ask your doctor or pharmacist for instructions on how to use it.
• See your doctor at regular intervals: Talk to your doctor about your asthma and decide whether you need to change your medication dosage.
• Get a yearly flu vaccine: Since things like colds and flu can aggravate asthma, getting this vaccine provides some protection.
• Avoid smoking completely and avoid hanging out in places where people smoke.
• Follow a healthy lifestyle: drink plenty of water, eat a balanced diet, and get enough sleep.

Finally, a few things to remember (Take-Home Message)

An asthma flare-up is something to be afraid of, but if we have the right understanding about it, we can cope with it and prevent it.

Remember:

* Identify exactly what your asthma triggers are.

* Use the preventer inhalers prescribed by your doctor every day, without fail.

* Always keep a reliever inhaler nearby and know how to use it properly.

* If you have an Asthma Action Plan, understand it well and work accordingly.

* If you experience serious symptoms of an asthma exacerbation, seek medical advice immediately. Don't delay!

Living with asthma can be challenging, but with proper management, you too can live a healthy, active life. You are not alone, and doctors and healthcare professionals are always there to help you.

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