By Dr. Larry Chiaramonte
Asthma patients are understandably interested in lessening their reliance on drugs of all kinds. We hear this all the time in practice and see it on websites.
Unfortunately, there is no substitute for drugs for either control or rescue. A patient has to do what a patient has to do. But behavior does play a big part. As part of the control effort, you can avoid triggers of course, monitor your peak flows and adjust your medication accordingly. You can warm up for exercise in the ways we describe in our book. Over time, the requirement for a specific level of medication may decrease. This is called stepping down.
But what can you do during an asthma attack in addition to pulling on your albuterol?
Here’s a trick we teach:
The patient should sit on a chair backwards and set his arms high on the backrest.
Next, try to get control over hyperventilation—rapid, shallow involuntary breathing. Since most patients hyperventilate during an attack, which can irritate their airways, we have them place their hand in front so they can feel their breath coming out.
We tell them to concentrate on breathing slowly. By concentrating on the mechanics they can gain control over the process. This not only helps limit irritation, but it tends to curtail the panic that follows from losing control over breathing.
If a patient coughs repeatedly, it means they cannot raise mucus, so we have
them push with two clasped hands on their abdomen in time to their coughing, which should help bring up the mucus that’s limiting their breathing.
Why is this important? When mucus cannot be raised it blocks the airway so the outside air does not get to the lowest reaches of the lung. This is where oxygen enters the blood and CO2 is eliminated from it. Since there is no outside air present the exchange between the air and the blood arriving via the capillaries does not take place. This is called a ventilation[air] perfusion[blood] mismatch.
(Note: An illustrated video showing how mucus production can affect lung function can be found here.)