HEALTH TALK: Signs of an Asthma attack

Dr. Victor Emanuel MD
Dr. Victor Emanuel MD

If you visit an Emergency Room at any given time on any given day in almost every part of the world, you’ll find someone or a few patients being treated for an asthma attack. So prevalent is this disease on a worldwide basis. I haven’t heard of it classified among the chronic non-communicable diseases (CNCD’s) about which we hear so much in Dominica. If it isn’t so classified, I think it definitely ought to be.


Asthma attacks rarely happen without warning. Knowing the signs of a pending attack could help you prevent an asthma emergency. In fact, acting quickly could save your life.


•    A lack of appetite, fatigue, headache, or coughing often comes before an asthma attack.
•    Trouble sleeping and feeling tired are other typical signs.
•    Dark circles under the eyes and less tolerance for exercise are also typical signs.


Signs of an asthma attack can change from one attack to the next. One time, there may be little or no coughing before an attack. The next time, there may be a persistent cough, especially at night.

As asthma cough is usually dry and hacking. A chronic or persistent cough that doesn’t disappear after cold symptoms are gone could point to asthma.

Avoid taking cough medicine (if it turns out to be an asthma attack). Cough medicines won’t help the asthma.


A peak flow meter can alert you to a pending attack. Be sure you always know your baseline measurement that reflects your best breathing.

•    If your peak flow meter shows numbers between 50% and 80% of your personal best, an asthma attack has probably started.
•    A number below 50% means an emergency that needs immediate attention.
•    Call the ambulance, or have someone do it, if you have trouble talking due to shortness of breath, of if your lips are blue or gray.


An action plan tells you how to deal with symptoms of an asthma attack.

Based on peak flow measures, an action plan shows you what medicines to take and when. It’s important to follow the plan and use the medications exactly as prescribed.
If the symptoms still get worse after following the plan, call your doctor. Also, follow the plan’s emergency instructions.


During an asthma attack, muscles around the airways tighten, and the airway linings swell.

•    Too much secretion is produced in the airways and can block the air tubes in the lungs.
•    Air is trapped in the lungs and breathing becomes difficult.

You might notice symptoms of wheezing at first. But as attacks get worse, there’s more chest tightness and shortness of breath. Eventually, you might feel like you can’t get enough air.


The effort to breathe may make someone with severe breathing difficulties lean forward, speak in words instead of sentences, and become noticeably agitated.

As the severity increases, an asthma sufferer may increasingly move into a hunched-over sitting position with their hands supporting their upper body. This is what is called the tripod position.


When it’s hard to breathe, the tissue in the chest and neck may sink in with each breath. This is called retraction.

Retractions mean that not enough air is getting into the lungs, and are signs of a medical emergency. Call the ambulance, or have someone do it, or see a doctor right away.

In children, other signs of deterioration in breathing are;

•    Poor appetite
•    Fatigue
•    Decreased activity


Blue or gray lips or fingernails are a sign of not enough oxygen in the blood. The condition is called cyanosis.

Cyanosis is an emergency situation. Call the ambulance, or have someone do it, as soon as possible.


If you notice any of the following, get emergency help at once.

•    Difficulty talking
•    Inability to exhale or inhale
•    Shortness of breath
•    Feelings of anxiety or panic
•    Coughing that won’t stop
•    Pale, sweaty face

A word of advice, perhaps even caution. Just as you have a plethora of weight loss, tooth whitening, skin therapy and other products being advertised on TV in few minute commercials or infomercials, so it is that people will prey on your ignorance and craving for help with your asthma, to promote themselves as what they really are not. Take care in saving yourselves money, your health, and even your lives.

As I write this, it is Carnival Monday in Dominica. It is my sincere hope that when this article will have been published on Wednesday when it’s all done, those who participated can say that they enjoyed good, clean, shameless celebrations devoid of violence and lawlessness.

See you next week.

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  1. February 14, 2013

    Very informative, but there was violence during carnival.

  2. Mrs B
    February 14, 2013

    Thanks Doc. As an asthma sufferer, this article was very helpful:)

    February 13, 2013

    This piece will surely be copy and paste. I hope you dont mind Doc

    February 13, 2013

    Thanks for this piece Doc, as an acute asthma sufferer for many years. The remedies such as ventolin(I consider as part of my equipment and life saver. aminophyllins and others could be explained in this pieve. this is a serious desease and and the patient must take the prescribed medication as a top priorityif not taken seriously can cause a painful death.

  5. ios
    February 13, 2013

    Thank you doctor. I always take time to read your article.

  6. Anonymous
    February 13, 2013

    excellent article Dr. Very informative. Alot was learnt

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