Thursday, August 09, 2007

• Attack!!!!

  Currently Listening Good Monsters By Jars of Clay Work see related

  Not to offend you if you’re of the majority of the general population, but the majority of the general population is clueless, insensitive, and naïve when it comes to asthma.  More and more recently, I’ve come to realize how many people would love to be understanding and helpful, but are so uninformed they do more harm than good.  So I figured that I may as well give those of you who would like to be more useful if you have a friend with asthma or if you encounter someone having an attack a few pointers as to 1) What is actually happening with an attack, 2) General guidelines for how to behave when someone has an attack, and 3) Some specific things you can do to be helpful.  Since this is a rather long post, I’ve bolded the important points.  And in case it isn’t clear from what follows, I do have asthma myself, so I’m speaking from experience.

  1)  What’s going on?

  The medical description of an asthma attack can be reduced to the words “bronchiospasms and inflammation.”  (I had to put that in there just ‘cause I think bronchiospasms is a cool word!)  Basically, some trigger such as a pungent smell, pollen, exercise, a cold, strong emotion, or whatnot causes the muscles controlling every single airway to spasm, constricting the airways, and the lining of the airways swells and begins to secret mucus.  The most common description of it is a “squeezing feeling in your chest,” or, more likely, “I CAN’T BREATHE!!!!”

  
  

  For those of you who have never experienced this, it can be very difficult to identify with, but imagine lying on your back with a seventy pound weight on your chest, breathing through a straw which is slowly being plugged up with gum, except said straw is inside you.  That’s what an asthma attack feels like.  Secondary effects of the attack can include throat muscles cramping (it hurts!), coughing up congestion (sometimes I’ve even coughed up blood if an attacks gone on a few days), and various things you would expect to happen when there’s not enough oxygen being processed – numbness in the extremities, dizziness, and passing out are just a few of them.

   The primary impact besides the physical on someone having an asthma attack is sheer terror.  It’s one thing when somebody else is attacking you and you can fight them; it’s another when your own body is doing its level best to kill you.  My brother once asked if it was like drowning.  My response:  “There’s no surface.”  I cannot describe the sensation when all the world seems to whirl slow-motion around one thing:  the next gasp of precious, precious oxygen.  This fear cycles into increasing and prolonging the intensity of the attack.

  2) General guidelines

  So what are some things to keep in mind when someone is having an asthma attack?

   a) You are dealing with someone on the verge of panic.  You must stay calm.  When we feel like we have to keep everyone around us calm our own stress level rises, and we waste precious air trying to help you when you should be helping us.

  b)  DON’T make me waste oxygen.  No matter how helpful you may be trying to be, if you make me do more than gasp out “asthma” and then respond with gestures to yes or no questions, I will be highly upset with you.  And give me space.  Otherwise, you are taking up space that could otherwise hold more oxygen for me.  While laughter is the best medicine for many ills, this is not one of them.  If you make me laugh, I am extremely likely to be thinking about murder, and it could quite literally kill me.

  c)  Having an attack is embarrassing enough already.  Please don’t draw attention to me, please don’t call 911 unless I tell you to or I pass out and stop breathing, please keep it low-key and understand that despite my near panic, I have dealt with this before and know far better than you do what I need at the moment – sometimes a reminder is helpful to get me thinking straight, but if I seem to be thinking clearly, let me have charge of the situation.

  3) Do’s and Don’ts

  a)  DON’T ask if I am okay or if I need help.  I’m obviously not, but if you’re stupid enough to ask, then as far as you are concerned, I am fine.  Yeah, I’m standing here in the random middle of the parking lot leaning against a planter wall coughing my lungs out because I think it looks cool!  Sure… Of course I’m not okay, don’t bug me with silly questions.  A much better one if you notice such odd behavior is something knowing, like “asthma?”

  b)  You have two main objectives:  deal with the triggers, deal with the fear.  Triggers first.

  Triggers:  Once an attack has gotten going, only one thing will stop it from progressing short of bringing in the paramedics (NOT fun). That is an inhaler; these are typically abuterol.  Ask if they have used their inhaler.  If no, ask if they need it.  Do they have it with them?  Can you get it for them?  If they need it desperately and it’s far away, do they mind if you call out a general “does anyone have an abuterol inhaler on them?”  Anyone with asthma will be happy to rush to the rescue.  Once the inhaler issue is taken care of, try to identify, and if possible remove, the trigger.  Ask only yes or no questions so they don’t have to talk to tell you.  Just too much physical activity?  Sick?  See if there are any pungent odors in the air.  If someone nearby is wearing perfume, see if the person having the attack is capable of moving away, or politely ask the perfume-wearer to go downwind.  You get the idea.

  (istockphoto.com)

  Fear:  One of the most helpful things you can do is to stay calm and just be there.  You have no idea how comforting it is knowing that if I pass out, someone who knows it’s asthma will be around to call the paramedics so they can pump me full of steroids and keep me alive.  If it’s unavoidable for the person having the attack to walk somewhere, walk with them.  It’s incredibly reassuring, and helps the fear to be manageable; relaxing can even help reduce the effects of the attack!

  c)  Probably the most common mistake:  “Can I get you water?”  NO!  All of us have made the mistake of accepting this offer at some point to let the helpful person feel like they’re doing something.  If they would just bring it and set it there ‘til we feel well enough to drink it, that’s fine, but when we’re pressured to drink, like most people do, it makes things worse.  For one, there’s so much effort involved in just breathing that stopping for an instant to swallow is scary.  Secondly, people seem obsessed with getting cold water… now would you dump ice water on someone who climbed out of the water with leg cramps?  Then why would I pour it down my throat when muscles around there are all spasming…?  Now what is helpful is something lukewarm – not steaming, but warm enough to help relax the muscles.  But specify what you’re going for or you’ll just get this “you silly idiot I don’t want ice water” look.

  There’s way more I could say, but this is already a very long post; hope it’ll help someone help a friend through an asthma attack at some point, or at least be ready for it.
  

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