First Aid/Asthma & Hyperventilation

Introduction
Asthma is a medical condition which causes swelling of the airway, spasm of the smooth muscle of the bronchioles (smaller airways), and increased mucous production in the alveoli (the air sacs where oxygen from the air is exchanged for carbon dioxide from the blood) constricting airflow.

Asthma attacks can range from mild to life threatening & everything in between. They can come on gradually or very rapidly & can be triggered by allergic reactions, weather changes, respiratory infections, exercise and irritants in the air such as smoke or dust.

Hyperventilation is simply breathing at an inappropriately high rate. It can be caused by numerous conditions including anxiety; injuries that limit adequate intake or circulation of oxygen or cause a build-up of carbon dioxide; toxins that prevent adequate oxygen exchange such as carbon monoxide or paraquat poisoning; increased demands of the cells for more oxygen such as exercise, severe infection, pregnancy etc & many more.

Psychogenic hyperventilation (rapid breathing from psychological causes such as anxiety or fear) should be the last condition considered in first aid, once other, more life threatening or reversible causes have been ruled out. However, decreasing anxiety as much as possible can help decrease hyperventilation, physical demands for oxygen & improve oxygenation.

Recognition
Asthma is characterized by difficulty breathing, wheezing, increased secretions in the airway, coughing and a history of asthma. The sensation of not being able to breathe, as well as adrenaline released by the body in response to the anxiety & to help try to maximise oxygenation, will make people feel anxious & possibly become agitated & restless.

The wheeze in Asthma attacks is usually a high-pitched soft noise. During mild or early attacks, it usually presents first as a sound when breathing out, as the air is able to enter the lungs, but is restricted from getting out as easily. The spasm of the bronchioles, inflammation & increased mucous cause the airways to narrow & the air to create friction in the airways, creating the wheezing sound. If an attack progresses & it becomes harder to get air in & out, a wheeze will develop on inspiration as well. As it progresses further & air starts becoming trapped in the lungs, only an inspiratory wheeze will present. Eventually, if not treated effectively, the breathing will become silent. This is a late & extremely serious sign that will be accompanied by a decreasing level of consciousness & can rapidly progress to death as very little air will reach the bloodstream.

Although wheezing is a common symptom of asthma, it also occurs in other conditions that affect respiratory function like allergic reactions/anaphylaxis or respiratory infections. And it is sometimes mistaken for other noisy breathing like stridor, which is a more harsh, coarse, loud wheezing sound that is produced by obstruction of the upper airways.

Hyperventilation can be recognized as fast breathing which is inappropriate for the circumstances. It may be accompanied by a feeling of not being able to catch one's breath and, if excessive, it may cause lightheadedness, tingling in the hands & feet, progressing to muscle spasms in the hands & feet. The spasms are most likely to occur if the hyperventilation is psychogenic - caused by the mind rather than a disease process or injury.

Treatment
For Asthma
 * If the victim has a fast-acting inhaler for asthma attacks, encourage them to use it as directed by their doctor or Asthma Action Plan. You may assist with finding the inhaler. Be aware that the bronchodilators in the inhalers can increase a feeling of anxiety & cause shaking as a side effect.
 * Try to keep the victim as calm as possible and slow their breathing rate.
 * Assist the casualty to sit in a position which relieves pressure on the chest. The tripod position is ideal - sitting up, leaning slightly forward, supporting their weight with their hands either on their knees or on a table or the like in front of them.
 * Call EMS if the victim's condition does not improve or if the victim's level of consciousness is lowered.
 * If the person does start to lose consciousness, lie them on the floor (preferably their left side) with their head tilted back a bit to ensure their airway is open. Watch their breathing carefully & if they vomit, ensure their mouth & nose are kept clear. Keep reassuring them help is on the way - they may be able to hear you even if they can’t respond.

For Hyperventilation The aim is to calm the casualty down & to reduce their rate of breathing. Ensure the environment around them is as calm as possible - multiple worried friends/family/strangers all talking at once can make their anxiety/fear worse.

Have one, calm person talk to them in a low, soothing voice & help them feel safe.

Gradually try & get them to slow their breathing down, by matching your breathing & making their breaths out longer than their breaths in.

Ensure they’re sitting upright if they’re able to hold themselves up, preferably with their hands on their knees or arms resting on a table or chair.

Try asking them simple questions & distracting them from the cause of their anxiety. Something as simple as having them count out loud or name items around them or talk about their favourite things can help. Recognise their fear & reassure them. Even if they’re just having a psychogenic anxiety attack, the fear & symptoms feel extremely real to them. If they develop tingling & muscle cramps, assure them that this is normal & will go away once they have their breathing under control.

Don’t give them a paper bag to breathe into as, if the cause of their hyperventilation is an illness or injury that isn’t immediately obvious, this can worsen their oxygen demands & build-up of carbon dioxide in the body. Just focus on reassurance, calming them as much as possible & using distraction techniques. Music can help too. If there is an underlying cause to their hyperventilation, such as an asthma attack, recognising this early, getting help & frequently reassuring them that help is on the way is vital.

If the person is unable to hold themselves upright in a sitting position, place them on their side on the floor, a couch or bed & tilt their head back a little to help keep their airway open. Monitor their breathing & airway closely. A normal respiratory rate for an adult is between 12 and 20 breaths per minute.

It is possible for people hyperventilating solely due to an anxiety attack to lose consciousness. This will usually be brief & once their breathing returns to normal, they should fully recover. If they do not fully recover, they have recurrent hyperventilation/ anxiety attacks or their symptoms persist, ensure they get assessed medically to rule out any underlying problem or get appropriate treatment for the cause of their anxiety.