An asthma attack is when, after a period of time when aperson has had only a few or no symptoms of asthma, the asthma gets worse all of a sudden, usually because of being exposed to one or more triggers. When the asthma attack happens, the tissue inside the airways swell because of inflammation – which is how the body tries to protect itself from harmful things, like germs and irritants. When the tissues swell the opening (called the lumen) in the airway gets very narrow.
The smooth muscles (which are the kind of muscles in the body that do not contract voluntarily, like the ones in the arm) around the bronchi and bronchioles begin to spasm or contract which makes the opening in the airway even narrower. This is called a bronchospasm.
Inside the lining of the airways are glands called, submucosal glands, and above them, closer to the opening in the airway are cells called goblet cells – because they are shaped kind of like a goblet, which is a type of cup. The submucosal glands and the goblet cells make mucous which helps protect the inside of the airways. The mucous in the airways of healthy lungs is a thin film which traps irritants such as dust particles and pollen so they do not damage the airways and keep them from entering the air sacs (alveoli).
There are tiny hairs lining the airway called cilia. The cilia wave back and forth like a liitle whips, and help push the mucous and the trapped particles up the airways to the “pharynx. From there the mucous, the trapped particles from the lower airways can be coughed up (this is called sputum).
During an asthma attack the submucosal glands and the goblet cells start making much more mucous than normal, and the mucous is also thicker than normal. This makes it very hard for the cilia to do their job, and bring the mucous up out of the airways. So now there is too much mucous being made, and not enough being brought up by the cilia. The airways are already to narrow to breathe properly because of the tissue swelling caused by inflammation and the constriction caused by the bronchospasms, so the extra mucous blocks the airway even more. This makes breathing very difficult. In fatal asthma attacks the airways can become so constricted and/or plugged with mucous that no air can get through at all.
There are other signs of breathing difficulty as in an asthma attack, which are important to learn, and knowing them can help tell if someone who cannot talk is having breathing problems. People who may not be able to let somebody know they are having breathing problems include babies and young children.
Some of the other signs of asthma include:
- Chest and neck retractions; which cause muscles within the chest and neck not normally used too much when breathing, to begin contracting as they try and help to take in more air. Retractions are how the body tries to get enough air because of the difficulty in breathing normally because of the asthma attack. These retractions cause the skin of the chest wall, the skin of the neck and or the breastbone (sternum) to move in when breathing. There are different types of retractions which depend on which muscles start contracting, and this depends on how much difficulty a person is having breathing during an attack.
- Nasal flaring is when the opening of the nostrils get larger than normal during breathing. It is often a sign that a person is having difficulty in breathing.
- Blue lips and fingertips: oxygen which is in the air we breathe, is what makes blood have a red color. Blood without oxygen has a blue color. Oxygen enters the body through the air sacs (alveoli) which are at the end of the airways. During an asthma attack it difficult for the body to get enough oxygen because it is difficult to get enough air. As less air with oxygen in it makes it to the air sacs and into the blood, there is less red blood (blood with oxygen in it) and more blue blood (blood without oxygen in it). The blue color of the lips and under the fingernails is because of the blue blood, which can be seen in the small blood vessels under the skin. More parts of the body start turning blue the longer the body goes without oxygen. When parts of the body turn blue because of lack of oxygen it is calledcyanosis.
- Sweating : sweating may be noticed especially on the forehead, but the skin does not feel warm, it may feel cool and clammy to touch.
- Rapid breathing (tachypnea); breathing in and out much faster than normal.
- Rapid heart beat: (tachycardia): the heart starts beating much faster than normal.