Asthma can turn deadly in no time


Watching a patient struggle to breathe is one of the most-disquieting sights.

In many cases, medications don’t work quickly enough, and I rarely feel comfortable leaving until I see some improvement.

That was the case with a patient who recently stumbled into the emergency department. He had a history of asthma and was suffering a particularly bad attack. None of his prescribed rescue medications worked.I placed a stethoscope on his back, hoping to hear the classic wheezing associated with asthma. Instead, I barely heard any breathing sounds over either lung.This was ominous. He was hardly moving any air in and out, and the bluish hue that had crept into his lips and his fingers told us his oxygen level was poor.

I placed him on high-flow oxygen, which helped a bit; and breathing treatments further eased him from blue to ghostly white.He still wasn’t out of the woods, and I was concerned that we needed to induce a coma and place him on a ventilator.But we still had a few options left.

We started an intravenous magnesium drip, which can relax smooth-muscle contractions that can choke off the alveoli, the tiny air sacs in the lungs that exchange oxygen and carbon dioxide.Magnesium is a serious medication. Too much can cause all the smooth muscle to relax, eventually weakening the respiratory muscles to the point of non-function.The other treatment we ordered was heliox, a combination of helium and oxygen.

The smaller, less-dense helium molecules can sneak past severely narrowed passageways.We continued the breathing treatments and added steroids to decrease swelling, too. That combination did the trick. My patient started to regain his color, and I could hear some air moving into his lungs.

My patient had severe asthma but had been able to identify over the years all of the things that can trigger attacks.He had been hospitalized twice in the past year, once in Hawaii after visiting Volcanoes National Park and breathing in hydrogen-sulfide gas from the volcanic vents, and once during a trip to Yellowstone about the time of the northern Colorado wildfires.Some reports say that such environmental exposures and air pollutants are responsible for a 50 percent increase in asthma incidence every decade.

My patient said he also suffered allergy-related flare-ups.

For example, cats, mold and tree pollen were particularly difficult. He also avoids aspirin and ibuprofen, both of which make his asthma worse. He had not suffered a recent cold or cough, which can also exacerbate his asthma.

The only thing he could identify that was out of the ordinary was that he had spent the past evening at a friend’s house. Before he went, he made sure his friend had no pets, that no one there smoked, that there weren’t a lot of plants in the house or chemicals used to clean.

The one thing he didn’t count on, however, was the carpets.We called his friend and learned that his wife was so concerned about my patient’s allergies that she had vacuumed with extra vigor right before his visit.Her vigilance made sure there was an extra dose of dust mites in the air — enough to cause a severe asthma reaction.In the end, he responded well to the treatments and required only an overnight stay.His friends visited him the next morning, and I believe that his friend’s wife was spared the news that her cleaning likely put him in the hospital.
