Main navigation

Draft Guidelines for Emergency Treatment of Asthma

For Comment

Asthma is a disorder of the airways of the lungs. People with asthma have sensitive airways which when exposed to certain triggers can narrow, leading to difficulty in breathing.

There are several types of asthma medications. Relievers, (usually in blue/grey containers) provide relief of asthma symptoms within minutes. Reliever medications relax the 'tight' muscles around the airways. Brand names include Airomir, Asmol, Bricanyl, Epaq and Ventolin.

Preventer medications (usually brown, orange, red or purple containers) are used for longer term prevention of attacks and are not very useful in an acute attack. However, one symptom controller, Oxis, may be useful in an emergency situation.

Recognition

If a person has obvious difficulty in breathing due to asthma, first aid should be initiated.
Severe asthma can be recognised when a patient’s asthma symptoms get worse very quickly and are not relieved by usual dose of bronchodilator.¹

Signs of severe asthma include some or all of the following:

• Loud wheezing (a whistling sound in the chest), although in very severe asthma the chest can be almost silent
• Chest tightness, and sometimes coughing
• Difficulty speaking more than a few words or inability to speak because of wheezing or breathlessness
• Rapid breathing with indrawing of neck and chest muscles.

First Aid: The 4 x 4 x 4 technique

Four puffs, four minutes, four puffs

• Sit the person comfortably upright. Be calm and reassuring. Try not to leave them alone
• Give 4 puffs of a blue Reliever inhaler (puffer) – Ventolin, Airomir or Asmol. Relievers in a puffer are best given through a spacer, if available. Spacers can be improvised using a paper or Styrofoam cup.² (If only a powder inhalant is available this may be used, provided it is properly primed according to manufacture's instructions³)
• Use 1 puff at a time and ask the person to take 4 breaths from the spacer after each puff
• Use the person's own inhaler if possible. If not, use the first aid kit inhaler or borrow one from someone else⁴
• If oxygen is available, it should be administered at 6-8 litres per minute through a face-mask, in between administration of the reliever by a person trained in its use⁵
• Wait 4 minutes. If there is no improvement, give another 4 puffs
• If little or no improvement, CALL AN AMBULANCE IMMEDIATELY (DIAL 000) and state that the person is having an asthma attack
• Keep giving 4 puffs every 4 minutes until the ambulance arrives or the patient improves significantly.

Collapsed victim⁶

• If the victim is unable to take the usual bronchodilator medication, call an ambulance immediately
• If oxygen is available, it should be administered at 5-8 litres per minute through a face-mask, by a person trained in its use
• If and ONLY if breathing stops, give resuscitation following the ARC Basic Life Support Flow Chart.⁷

What if this person has never had asthma diagnosed before?

If a person is in respiratory difficulty and it may be asthma, initiate asthma first aid and call an ambulance. No harm is likely to result from giving a Reliever in these recommended doses to someone who does not have asthma.⁴

Diagram for Use of Devices⁸

With Spacer	Without Spacer
Shake inhaler and place the mouthpiece into the spacer. Place spacer mouthpiece into person's mouth. Ask them to breathe in and out normally for 4 breaths. Repeat this promptly until 4 puffs have been given.	Shake inhaler. Place mouthpiece in the person's mouth. Fire one puff as the person inhales slowly and steadily. Ask the person to hold their breath for 4 seconds. Then take 4 normal breaths. Repeat until 4 puffs have been given.

If only a powder inhalant is available, this may be used if properly primed according to the manufacturer's instructions

Notes

The preferred form of bronchodilator administration is a puffer via spacer or improvised spacer.
A puffer alone will do but a powder inhaler is difficult for a novice to use and difficult to see if a dose has been administered. There are also several different types of powder inhaler.

References

1. www.asthma.org.au/asthma.htm
2. Willemse BW, Toelle BG, Li JS, Shah S, Peat JK. Use of a paper disposable cup as a spacer is effective for the first-aid management of asthma. Respir Med 2003;97(1):86-89.
3. Drblik S, Lapierre G, Thivierge R, et al. Comparative efficacy of terbutaline sulphate delivered by Turbuhaler dry powder inhaler or pressurised metered dose inhaler with Nebuhaler spacer in children during an acute asthmatic episode. Arch Dis Child 2003;88(4):319-323.
4. First Aid for Asthma: An Overview. Personal Correspondence prepared by National Asthma Council.
5. ARC Guideline 10.1.2 Use of Oxygen in Emergencies.
6. ARC Guideline Section 5 Breathing 5.1 to 5.4.
7. ARC Guideline 7.2 Basic Life Support Flow Chart.
8. www.nationalasthma.org.au/first_aid.html

Last Modified: 28 July 2004