Acute Bronchospasm

Overview

Acute bronchospasm is a sudden and severe constriction of the smooth muscles that surround the bronchial tubes, resulting in significant narrowing of the airways and causing immediate breathing difficulties. This condition represents a medical emergency that can develop rapidly and may be life-threatening if not promptly treated. The bronchial tubes, which are the air passages that carry oxygen to and from the lungs, become constricted due to muscle tightening, inflammation, and often excessive mucus production, creating a combination of factors that severely impede airflow.

The condition can occur as an isolated event or as part of underlying respiratory diseases such as asthma, chronic obstructive pulmonary disease (COPD), or allergic reactions. During an acute bronchospasm, the smooth muscles surrounding the airways contract involuntarily, similar to how muscles elsewhere in the body might cramp. This contraction, combined with swelling of the airway lining and increased mucus secretion, creates a significant obstruction to normal breathing. The severity can range from mild breathing difficulty to complete respiratory failure requiring emergency intervention.

Acute bronchospasm differs from chronic bronchospasm in its sudden onset and severity. While chronic bronchospasm develops gradually over time and may be managed with regular medications, acute bronchospasm occurs suddenly and requires immediate treatment to prevent serious complications. The condition can be triggered by various factors including allergens, infections, medications, environmental irritants, or physical exertion. Understanding these triggers is crucial for both prevention and management of the condition.

The pathophysiology involves complex interactions between the nervous system, immune system, and airway smooth muscle. When triggered, inflammatory mediators are released, causing direct muscle contraction and increased vascular permeability leading to airway swelling. This creates a vicious cycle where narrowed airways lead to increased work of breathing, which can further stimulate the inflammatory response. Prompt recognition and treatment are essential to break this cycle and restore normal breathing patterns before respiratory failure occurs.

Symptoms

Acute bronchospasm presents with characteristic symptoms that develop suddenly and can rapidly worsen without appropriate treatment.

Primary Respiratory Symptoms

Immediate Symptoms

• Sharp chest pain or pressure
• Persistent dry cough or productive cough
• Rapid, shallow breathing
• Inability to speak in full sentences
• Feeling of suffocation or drowning
• Panic or anxiety due to breathing difficulty

Physical Signs

Respiratory Distress

• Use of accessory muscles for breathing
• Retractions (pulling in of chest wall)
• Flared nostrils
• Pursed-lip breathing
• Tripod positioning (leaning forward)
• Increased respiratory rate (>20 breaths/minute)

Circulatory Signs

• Rapid heart rate (tachycardia)
• Elevated blood pressure initially
• Weak pulse if severe
• Cold, clammy skin
• Profuse sweating

Severity Indicators

Mild Bronchospasm

• Mild wheezing on exertion
• Slight shortness of breath
• Able to speak normally
• Normal oxygen saturation (>95%)
• Normal heart rate

Moderate Bronchospasm

• Audible wheezing at rest
• Moderate breathing difficulty
• Speaks in phrases, not full sentences
• Oxygen saturation 90-95%
• Increased heart rate
• Use of accessory muscles

Severe Bronchospasm (Medical Emergency)

• Severe wheezing or silent chest
• Extreme breathing difficulty
• Cannot speak or only single words
• Oxygen saturation <90%
• Cyanosis (blue lips, fingers)
• Altered mental status
• Exhaustion from breathing effort

Associated Symptoms

Systemic Symptoms

• Fever if infection-related
• Fatigue and weakness
• Dizziness or lightheadedness
• Nausea or vomiting
• Headache from hypoxia
• Confusion if severe

Upper Respiratory Symptoms

• Nasal congestion
• Sore throat
• Runny nose (coryza)
• Sneezing
• Postnasal drip

Warning Signs of Respiratory Failure

• Silent chest: Absence of breath sounds
• Cyanosis: Blue coloration of lips, face, or fingernails
• Altered consciousness: Confusion, agitation, or lethargy
• Paradoxical breathing: Chest and abdomen moving opposite directions
• Extreme fatigue: Too tired to continue breathing effort
• Cardiovascular collapse: Drop in blood pressure, weak pulse

Symptom Patterns

Allergic Bronchospasm

• Rapid onset after exposure
• Associated skin reactions (hives, itching)
• Nasal symptoms prominent
• May have gastrointestinal symptoms

Exercise-Induced Bronchospasm

• Onset during or after exercise
• Chest tightness and cough
• Wheeze more prominent than shortness of breath
• Usually resolves with rest

Medication-Induced Bronchospasm

• Onset minutes to hours after medication
• May be associated with other allergic symptoms
• Can be severe and prolonged
• May not respond to typical bronchodilators

Age-Related Differences

Children

• May present with feeding difficulty
• Increased fussiness or crying
• Changes in crying sound
• Decreased activity level
• Difficulty sleeping

Elderly

• May have subtle presentations
• Fatigue may be prominent
• Confusion may occur earlier
• Less obvious wheezing
• Higher risk of complications

Causes

Acute bronchospasm can be triggered by various factors that cause sudden constriction of airway smooth muscles and inflammation.

Allergic Triggers

Environmental Allergens

• Pollen: Tree, grass, and weed pollens
• Dust mites: House dust mite proteins
• Mold spores: Indoor and outdoor molds
• Animal dander: Cats, dogs, rodents, birds
• Cockroach allergens: Common in urban environments
• Latex: Natural rubber products

Food Allergens

• Nuts (peanuts, tree nuts)
• Shellfish and fish
• Milk and dairy products
• Eggs
• Soy products
• Wheat and gluten
• Food additives and preservatives

Infectious Causes

Viral Infections

• Respiratory syncytial virus (RSV): Common in children
• Influenza: Types A and B
• Rhinovirus: Common cold virus
• Parainfluenza: Multiple types
• Adenovirus: Upper and lower respiratory infection
• Human metapneumovirus: Similar to RSV

Bacterial Infections

• Mycoplasma pneumoniae
• Chlamydophila pneumoniae
• Streptococcus pneumoniae
• Haemophilus influenzae
• Staphylococcus aureus

Medication-Induced Bronchospasm

Common Medications

• Beta-blockers: Non-selective types (propranolol)
• ACE inhibitors: Cough-induced bronchospasm
• Aspirin and NSAIDs: Aspirin-exacerbated respiratory disease
• Contrast agents: Iodinated contrast media
• Antibiotics: Particularly in allergic individuals
• Local anesthetics: Lidocaine, procaine

Anesthesia-Related

• Neuromuscular blocking agents
• Induction agents
• Inhalational anesthetics
• Intubation and airway manipulation

Environmental and Occupational Triggers

Air Pollutants

• Ozone: Ground-level ozone pollution
• Particulate matter: PM2.5 and PM10
• Nitrogen dioxide: Vehicle exhaust
• Sulfur dioxide: Industrial emissions
• Smoke: Tobacco, wood, wildfires

Chemical Irritants

• Cleaning products and disinfectants
• Paint fumes and solvents
• Perfumes and fragrances
• Pesticides and herbicides
• Industrial chemicals
• Chlorine and pool chemicals

Occupational Exposures

• Healthcare workers: Latex, disinfectants
• Cleaners: Bleach, ammonia
• Hairdressers: Hair dyes, permanents
• Bakers: Flour dust
• Farmers: Organic dusts, animal proteins
• Woodworkers: Wood dusts

Physical Triggers

Weather and Climate

• Cold air: Sudden temperature changes
• Humidity changes: Very dry or humid air
• Barometric pressure: Weather front changes
• Wind: Carrying pollutants or allergens

Physical Exertion

• Exercise-induced bronchospasm
• Hyperventilation
• Laughing or crying intensely
• Singing or yelling

Underlying Medical Conditions

Respiratory Diseases

• Asthma: Most common underlying cause
• COPD: Chronic bronchitis and emphysema
• Bronchiectasis: Abnormal airway widening
• Vocal cord dysfunction: Paradoxical vocal cord motion

Cardiovascular Conditions

• Congestive heart failure
• Pulmonary edema
• Pulmonary embolism
• Cardiac asthma

Other Conditions

• Gastroesophageal reflux disease (GERD)
• Anxiety and panic disorders
• Thyrotoxicosis
• Carcinoid syndrome

Psychological and Emotional Triggers

• Severe stress or anxiety
• Panic attacks
• Strong emotional reactions
• Post-traumatic stress
• Depression-related breathing patterns

Pathophysiology

Immediate Response

• Smooth muscle contraction
• Inflammatory mediator release
• Increased mucus production
• Airway edema and swelling
• Neural reflex activation

Inflammatory Cascade

• Mast cell degranulation
• Histamine and leukotriene release
• Eosinophil activation
• Cytokine production
• Complement activation

Risk Factor Combinations

• Multiple allergen exposure
• Infection plus allergen trigger
• Medication plus underlying asthma
• Exercise plus cold air
• Stress plus environmental triggers
• Hormonal changes plus allergens

Risk Factors

Several factors increase the likelihood of developing acute bronchospasm and influence its severity and frequency:

Medical History Risk Factors

Respiratory Conditions

• Asthma: Highest risk factor, especially poorly controlled
• COPD: Chronic obstructive pulmonary disease
• Previous bronchospasm: History of prior episodes
• Allergic rhinitis: Hay fever and seasonal allergies
• Chronic bronchitis: Persistent airway inflammation
• Respiratory infections: Frequent or severe infections

Allergic Conditions

• Food allergies
• Drug allergies
• Atopic dermatitis (eczema)
• Allergic conjunctivitis
• Anaphylaxis history
• Multiple chemical sensitivities

Genetic and Family History

• Family history of asthma: First-degree relatives
• Genetic polymorphisms: Beta-2 receptor variants
• Atopic tendency: Family history of allergies
• Ethnic factors: Higher rates in certain populations
• Inherited immune disorders: Affecting respiratory system

Age-Related Risk Factors

Pediatric Risk Factors

• Premature birth
• Low birth weight
• Early viral infections
• Maternal smoking during pregnancy
• Lack of breastfeeding
• Daycare attendance
• Multiple siblings

Adult Risk Factors

• Adult-onset asthma
• Hormonal changes (pregnancy, menopause)
• Occupational exposures
• Chronic stress
• Smoking history

Elderly Risk Factors

• Multiple medications
• Decreased lung function
• Comorbid conditions
• Reduced immune function
• Frailty and decreased reserves

Environmental Risk Factors

Indoor Environment

• Poor indoor air quality
• Dust mite exposure
• Pet dander
• Mold and dampness
• Chemical cleaners
• Tobacco smoke exposure
• Poor ventilation

Outdoor Environment

• Air pollution levels
• Pollen exposure
• Industrial emissions
• Vehicle exhaust
• Wildfire smoke
• Weather patterns

Geographic Factors

• Urban vs. rural living
• Climate and humidity
• Altitude and barometric pressure
• Proximity to industrial areas
• Regional allergen patterns

Occupational Risk Factors

High-Risk Occupations

• Healthcare workers: Latex, chemicals, infections
• Cleaning staff: Chemical exposure
• Manufacturing workers: Industrial chemicals
• Agricultural workers: Organic dusts, pesticides
• Construction workers: Dust, chemicals
• Laboratory workers: Chemical and biological agents

Workplace Exposures

• Isocyanates (spray painting, foam)
• Flour and grain dust
• Wood dust
• Metal fumes
• Textile fibers
• Latex products

Lifestyle Risk Factors

Smoking

• Active smoking
• Secondhand smoke exposure
• Electronic cigarette use
• Marijuana smoking
• Past smoking history

Physical Activity

• Exercise-induced symptoms
• Poor physical conditioning
• Sudden intense exercise
• Cold air exercise
• Chlorinated pool swimming

Diet and Nutrition

• Food allergies and intolerances
• Sulfite sensitivity
• Low antioxidant intake
• Obesity
• Vitamin D deficiency

Medical Risk Factors

Medications

• Beta-blockers (especially non-selective)
• ACE inhibitors
• Aspirin and NSAIDs
• Contrast agents
• Certain antibiotics
• Multiple medications (polypharmacy)

Comorbid Conditions

• Gastroesophageal reflux disease (GERD)
• Obstructive sleep apnea
• Rhinosinusitis
• Vocal cord dysfunction
• Anxiety disorders
• Obesity

Psychological Risk Factors

• Chronic stress
• Anxiety and panic disorders
• Depression
• Poor coping mechanisms
• Social isolation
• Post-traumatic stress disorder

Seasonal and Temporal Factors

• Pollen seasons
• Cold weather months
• Humidity changes
• Viral infection seasons
• School year (children)
• Holiday periods (stress, foods)

Hormonal Risk Factors

Women-Specific

• Menstrual cycle variations
• Pregnancy
• Menopause
• Hormone replacement therapy
• Oral contraceptive use

Socioeconomic Risk Factors

• Lower socioeconomic status
• Poor access to healthcare
• Inadequate housing conditions
• Limited education about triggers
• Inability to avoid triggers
• Delayed medical care

Diagnosis

Diagnosis of acute bronchospasm is primarily clinical, based on characteristic symptoms and rapid response to bronchodilator therapy, with additional testing to confirm severity and identify underlying causes.

Clinical Assessment

History Taking

• Onset and duration: How quickly symptoms developed
• Trigger identification: Recent exposures or activities
• Severity assessment: Ability to speak, function
• Previous episodes: History of similar events
• Medication history: Current drugs, recent changes
• Allergies: Known allergens and reactions
• Family history: Asthma, allergies in relatives
• Response to treatment: Previous effective therapies

Physical Examination

• Vital signs: Respiratory rate, heart rate, blood pressure, oxygen saturation
• General appearance: Level of distress, positioning, ability to speak
• Chest inspection: Use of accessory muscles, retractions
• Lung auscultation: Wheezing, diminished breath sounds
• Cardiac examination: Heart rate, rhythm, murmurs
• Skin examination: Cyanosis, pallor, rash

Immediate Assessment Tools

Peak Flow Measurement

• Peak expiratory flow rate (PEFR)
• Comparison to patient's baseline or predicted
• Monitoring response to treatment
• May be difficult during severe episodes
• Useful for ongoing monitoring

Oxygen Saturation

• Pulse oximetry measurement
• Normal: >95% on room air
• Mild hypoxemia: 90-95%
• Severe hypoxemia: <90%
• May be normal in mild bronchospasm

Severity Classification

Mild Bronchospasm

• Speaks in sentences
• Prefers sitting to lying
• Not agitated
• Respiratory rate increased
• Accessory muscles not used
• Wheeze moderate, often only end-expiratory
• Pulse rate <100 bpm
• O2 saturation >95%

Moderate Bronchospasm

• Speaks in phrases
• Usually agitated
• Sits upright
• Accessory muscles commonly used
• Wheeze loud, throughout expiration ± inspiration
• Pulse rate 100-120 bpm
• O2 saturation 90-95%

Severe Bronchospasm

• Speaks in words
• Usually agitated
• Sits upright
• Accessory muscles usually used
• Wheeze usually loud
• Pulse rate >120 bpm
• O2 saturation <90%

Life-Threatening Bronchospasm

• Cannot speak
• Confused or drowsy
• Exhausted appearance
• Silent chest or minimal wheeze
• Weak respiratory effort
• Bradycardia or hypotension
• Cyanosis

Laboratory Tests

Blood Tests

• Arterial blood gas: If severe hypoxemia suspected
• Complete blood count: Check for eosinophilia
• IgE levels: Total and specific allergen testing
• Inflammatory markers: C-reactive protein, ESR
• Tryptase levels: If anaphylaxis suspected

Sputum Analysis

• Eosinophil count
• Bacterial culture if infection suspected
• Fungal elements
• Inflammatory cells

Pulmonary Function Tests

Spirometry

• FEV1: Forced expiratory volume in 1 second
• FVC: Forced vital capacity
• FEV1/FVC ratio: Obstruction indicator
• Peak flow: Maximum expiratory flow rate
• Bronchodilator response: Improvement with treatment

Methacholine Challenge

• Tests airway hyperresponsiveness
• Not performed during acute episodes
• Useful for asthma diagnosis
• Contraindicated if severe airway obstruction

Imaging Studies

Chest X-ray

• Rule out pneumonia or pneumothorax
• Assess for complications
• May show hyperinflation
• Usually normal in pure bronchospasm

CT Scan

• High-resolution CT if chronic disease suspected
• Identify structural abnormalities
• Assess for bronchiectasis
• Not typically needed for acute diagnosis

Allergy Testing

Skin Prick Tests

• Common environmental allergens
• Food allergens if indicated
• Immediate hypersensitivity reactions
• Cannot be done during acute episodes

Specific IgE Testing

• RAST or ImmunoCAP testing
• Specific allergen identification
• Can be done during acute episodes
• Helps guide avoidance strategies

Differential Diagnosis

Respiratory Conditions

• Vocal cord dysfunction: Stridor, normal spirometry
• Pneumonia: Fever, infiltrate on chest X-ray
• Pneumothorax: Sudden onset, decreased breath sounds
• Pulmonary embolism: Sudden onset, chest pain
• Foreign body aspiration: Sudden onset, history

Cardiovascular Conditions

• Congestive heart failure
• Pulmonary edema
• Cardiac asthma
• Myocardial infarction

Other Conditions

• Anxiety or panic attack
• Gastroesophageal reflux
• Anaphylaxis
• Drug reaction

Response to Treatment

Bronchodilator Response

• Improvement in symptoms within 15-30 minutes
• Increased peak flow or FEV1
• Decreased wheezing
• Improved oxygen saturation
• Supports diagnosis of bronchospasm

Lack of Response

• Consider alternative diagnoses
• Severe bronchospasm requiring multiple treatments
• Vocal cord dysfunction
• Non-reversible obstruction
• Medication-related bronchospasm

Treatment Options

Treatment of acute bronchospasm focuses on rapid relief of airway obstruction, addressing underlying triggers, and preventing future episodes.

Emergency Management

Immediate Assessment

• ABC assessment: Airway, breathing, circulation
• Oxygen saturation monitoring: Continuous pulse oximetry
• Severity assessment: Mild, moderate, severe, or life-threatening
• Vital signs: Blood pressure, heart rate, respiratory rate
• Position patient: Upright or semi-upright for comfort

Oxygen Therapy

• Supplemental oxygen if SpO2 <90%
• Target oxygen saturation 94-98%
• Nasal cannula or face mask
• Avoid high-flow oxygen unless severely hypoxemic
• Monitor response to oxygen therapy

Bronchodilator Therapy

Short-Acting Beta-2 Agonists (SABA)

• Albuterol (Salbutamol): 2.5-5 mg nebulized every 20 minutes
• Levalbuterol: 1.25-2.5 mg nebulized
• MDI with spacer: 4-8 puffs every 20 minutes
• Continuous nebulization: For severe cases
• Onset: 5-15 minutes, peak effect 30-60 minutes

Anticholinergic Agents

• Ipratropium bromide: 0.5 mg nebulized with albuterol
• Combination therapy: SABA + anticholinergic more effective
• Particularly useful: In COPD-related bronchospasm
• Onset: 15-30 minutes, peak 1-2 hours

Anti-Inflammatory Therapy

Systemic Corticosteroids

• Prednisolone/Prednisone: 1-2 mg/kg/day (max 60-80 mg)
• Methylprednisolone: 1-2 mg/kg IV every 6 hours
• Hydrocortisone: 4 mg/kg IV every 6 hours
• Early administration: Within 1 hour for best effect
• Duration: 3-10 days, tapering usually not needed

Inhaled Corticosteroids

• High-dose during acute episodes
• Budesonide nebulized solution
• Maintenance therapy for prevention
• Less effective than systemic steroids acutely

Severity-Based Treatment

Mild Bronchospasm

• SABA inhaler 2-4 puffs every 4-6 hours
• Spacer device recommended
• Monitor symptoms and peak flow
• Outpatient management appropriate
• Follow-up within 24-48 hours

Moderate Bronchospasm

• SABA nebulization every 20 minutes × 3
• Add ipratropium to nebulizer
• Oral prednisolone 40-60 mg
• Oxygen if SpO2 <90%
• Observation for 1-4 hours
• Discharge if good response

Severe Bronchospasm

• Continuous nebulization or frequent dosing
• IV corticosteroids
• Supplemental oxygen
• Consider IV magnesium sulfate
• Hospital admission often required
• Close monitoring in emergency department

Life-Threatening Bronchospasm

• Immediate intensive care assessment
• Continuous bronchodilator therapy
• IV corticosteroids high dose
• IV magnesium sulfate
• Consider mechanical ventilation
• Subspecialty consultation

Second-Line Therapies

Magnesium Sulfate

• IV dosing: 2 grams over 20 minutes
• Nebulized: 2.5 grams in 3 mL normal saline
• Mechanism: Smooth muscle relaxation
• Indications: Severe bronchospasm not responding to first-line
• Monitor: Blood pressure, deep tendon reflexes

Theophylline

• Loading dose: 5-6 mg/kg IV over 30 minutes
• Maintenance: 0.5-0.7 mg/kg/hour
• Monitor serum levels (therapeutic 10-20 mg/L)
• Multiple drug interactions
• Limited use due to side effects

Refractory Bronchospasm

Additional Therapies

• Epinephrine: Subcutaneous 0.3-0.5 mg
• Terbutaline: Subcutaneous 0.25 mg
• Ketamine: 1-2 mg/kg IV (anesthesia setting)
• Heliox: Helium-oxygen mixture
• ECMO: Extracorporeal support (extreme cases)

Mechanical Ventilation

• Last resort for respiratory failure
• Low tidal volumes to prevent barotrauma
• Permissive hypercapnia
• Sedation and paralysis often needed
• Risk of pneumothorax

Anaphylaxis-Related Bronchospasm

Epinephrine

• First-line treatment: IM epinephrine 0.3-0.5 mg
• Repeat doses: Every 5-15 minutes as needed
• IV epinephrine: For severe cases with hypotension
• Auto-injectors: EpiPen, Auvi-Q

Adjunctive Treatments

• H1 antihistamines (diphenhydramine)
• H2 antihistamines (ranitidine)
• Corticosteroids (prevent biphasic reaction)
• Aggressive fluid resuscitation
• Vasopressors if needed

Supportive Care

Monitoring

• Continuous oxygen saturation
• Frequent vital signs
• Peak flow measurements
• Arterial blood gas if severe
• Response to treatment

Comfort Measures

• Positioning for optimal breathing
• Calm, reassuring environment
• Minimize unnecessary procedures
• Family presence if appropriate
• Anxiety management

Discharge Planning

Criteria for Discharge

• SpO2 >94% on room air
• Peak flow >70% predicted or personal best
• Minimal or no wheezing
• Stable for 2-4 hours
• Able to walk without distress
• Adequate home support

Discharge Medications

• SABA inhaler with spacer
• Oral corticosteroids 3-10 days
• Controller medications if indicated
• Written action plan
• Follow-up arrangements

Follow-up Care

• Primary care within 24-48 hours
• Pulmonologist if severe or recurrent
• Allergy/immunology if indicated
• Trigger identification and avoidance
• Medication adherence counseling
• Emergency action plan review

Prevention

Prevention of acute bronchospasm involves identifying and avoiding triggers, optimizing treatment of underlying conditions, and having emergency management plans in place.

Trigger Identification and Avoidance

Allergen Avoidance

• Dust mites: Allergen-proof mattress and pillow covers, wash bedding in hot water weekly
• Pet dander: Remove pets from bedroom, use HEPA air purifiers
• Mold: Control humidity <50%, fix water leaks promptly
• Pollen: Monitor pollen counts, stay indoors during high pollen days
• Cockroaches: Seal cracks, eliminate food sources, professional extermination

Environmental Controls

• Air purifiers with HEPA filters
• Regular HVAC filter changes
• Maintain proper humidity levels
• Avoid strong scents and chemicals
• Use fragrance-free products
• Proper ventilation in work areas

Occupational Measures

• Personal protective equipment
• Proper ventilation systems
• Regular health monitoring
• Alternative work assignments if needed
• Education about workplace hazards
• Compliance with safety regulations

Lifestyle Modifications

Smoking Cessation

• Complete smoking cessation
• Avoid secondhand smoke
• E-cigarette avoidance
• Smoking cessation programs
• Nicotine replacement therapy
• Counseling and support groups

Exercise Management

• Pre-exercise bronchodilator use
• Proper warm-up and cool-down
• Avoid exercise in cold, dry air
• Choose appropriate activities
• Monitor symptoms during exercise
• Gradual fitness improvement

Dietary Considerations

• Identify and avoid food triggers
• Read food labels carefully
• Carry emergency medications
• Anti-inflammatory diet
• Adequate vitamin D levels
• Omega-3 fatty acid supplementation

Medical Management

Controller Medications

• Inhaled corticosteroids: Daily anti-inflammatory therapy
• Long-acting beta agonists: Combined with inhaled steroids
• Leukotriene modifiers: Montelukast, zafirlukast
• Mast cell stabilizers: Cromolyn sodium
• Biologics: For severe allergic asthma

Immunotherapy

• Subcutaneous allergen immunotherapy
• Sublingual immunotherapy tablets
• Gradual desensitization
• Long-term commitment required
• Effective for environmental allergens

Vaccination

• Annual influenza vaccination
• Pneumococcal vaccination
• COVID-19 vaccination
• Other respiratory virus vaccines
• Up-to-date immunization schedule

Emergency Preparedness

Action Plans

• Written asthma action plan
• Peak flow monitoring zones
• Medication instructions
• When to seek emergency care
• Emergency contact information
• Regular plan updates

Rescue Medications

• Always carry rescue inhaler
• Multiple inhalers (home, work, car)
• Check expiration dates regularly
• Proper inhaler technique
• Spacer device use
• Epinephrine auto-injectors if anaphylaxis risk

Monitoring and Self-Management

Peak Flow Monitoring

• Daily peak flow measurements
• Establish personal best values
• Recognize early warning signs
• Adjust medications based on readings
• Track patterns and triggers

Symptom Tracking

• Daily symptom diary
• Trigger identification
• Medication use tracking
• Activity limitations
• Sleep quality assessment
• Mobile apps for tracking

Education and Training

Patient Education

• Understanding of condition
• Trigger recognition
• Proper medication technique
• When to seek help
• Lifestyle modifications
• Emergency procedures

Family and Caregiver Training

• Recognition of emergency signs
• How to assist with medications
• When to call for help
• Environmental trigger control
• Support for lifestyle changes

Psychological Support

Stress Management

• Relaxation techniques
• Breathing exercises
• Meditation and mindfulness
• Regular physical activity
• Adequate sleep
• Professional counseling if needed

Anxiety Management

• Recognition of anxiety triggers
• Coping strategies
• Support groups
• Cognitive behavioral therapy
• Medication for anxiety if appropriate

Special Populations

Children

• School action plans
• Teacher and staff education
• Age-appropriate inhaler devices
• Regular pediatric follow-up
• Growth monitoring with steroid use

Elderly

• Simplified medication regimens
• Large-print action plans
• Caregiver involvement
• Regular medication reviews
• Fall prevention considerations

Pregnant Women

• Pregnancy-safe medications
• Close obstetric and pulmonary follow-up
• Fetal monitoring if severe episodes
• Delivery planning
• Postpartum medication adjustments

Regular Medical Care

• Regular follow-up appointments
• Medication adherence assessment
• Inhaler technique review
• Trigger assessment
• Action plan updates
• Pulmonary function monitoring
• Specialist referrals when appropriate

When to See a Doctor

Acute bronchospasm can be a medical emergency requiring immediate attention. Knowing when to seek care can be life-saving.

Call 911 or Seek Emergency Care Immediately

Severe Breathing Difficulty

• Cannot speak: Only able to say single words
• Extreme shortness of breath: Gasping for air
• Silent chest: Little or no wheezing despite severe distress
• Oxygen saturation <90%: If you have a pulse oximeter
• Peak flow <50%: Of personal best or predicted

Signs of Respiratory Failure

• Blue lips or fingernails: Cyanosis indicating severe hypoxia
• Confusion or altered consciousness: Due to lack of oxygen
• Exhaustion: Too tired to continue breathing effort
• Sweating profusely: From extreme effort to breathe
• Pale or gray skin color: Especially around face

Cardiovascular Compromise

• Rapid heart rate >120 bpm
• Very slow heart rate <60 bpm
• Weak pulse
• Dizziness or fainting
• Chest pain

Poor Response to Treatment

• No improvement after rescue inhaler
• Worsening symptoms despite treatment
• Need for rescue inhaler more than every 4 hours
• Unable to perform normal activities

Seek Urgent Medical Care (Same Day)

Moderate Bronchospasm

• Difficulty speaking in full sentences
• Wheezing audible without stethoscope
• Peak flow 50-80% of personal best
• Oxygen saturation 90-95%
• Frequent use of rescue inhaler
• Inability to lie flat

Concerning Symptoms

• Persistent cough with wheezing
• Chest tightness not relieved by inhaler
• Shortness of breath interfering with daily activities
• Sleep disruption due to breathing problems
• Recurrent episodes within short period

Schedule Appointment Within 24-48 Hours

Mild Bronchospasm

• Mild wheezing
• Slight shortness of breath
• Peak flow >80% of personal best
• Good response to rescue inhaler
• Able to speak normally
• Minimal activity limitation

Follow-up Needed

• Recent emergency department visit
• Increased frequency of symptoms
• New triggers identified
• Medication side effects
• Concerns about current treatment

Special Circumstances

Anaphylaxis Signs

• Call 911 immediately: Do not wait
• Rapid onset after exposure
• Skin reactions (hives, swelling)
• Gastrointestinal symptoms
• Drop in blood pressure
• Use epinephrine auto-injector if available

High-Risk Patients

Seek care sooner if you have:

• Previous severe episodes: History of intubation or ICU
• Heart disease: Additional cardiac stress
• Multiple medical conditions: Complex medical history
• Taking multiple medications: Drug interaction risks
• Age >65 or <5 years: Higher complication risk
• Pregnancy: Risk to mother and baby

Medication-Related Episodes

• Bronchospasm after new medication
• Reaction to contrast agents
• Anesthesia-related bronchospasm
• Aspirin or NSAID reaction
• Beta-blocker induced

When to Call Your Doctor

Routine Follow-up

• Scheduled asthma follow-up appointments
• Medication refill needs
• Action plan updates
• Peak flow zone questions
• Trigger identification help
• Inhaler technique review

Preventive Care

• Increasing frequency of episodes
• Poor asthma control
• Need for rescue inhaler >2 times/week
• Night symptoms >2 times/month
• Activity limitations
• Declining peak flow values

Information to Provide

When Calling for Help

• Current symptoms and severity
• Peak flow reading if available
• Medications already taken
• Response to treatment
• Possible triggers
• Medical history
• Current medications

Emergency Information

• Known allergies and triggers
• Regular medications
• Emergency contact information
• Primary care physician
• Insurance information
• Advance directives if applicable

What to Expect

Emergency Department

• Immediate assessment of breathing
• Oxygen therapy if needed
• Nebulizer treatments
• Chest X-ray
• Blood tests if severe
• IV medications if necessary
• Observation period

Hospital Admission

• Continuous monitoring
• Regular nebulizer treatments
• IV corticosteroids
• Oxygen therapy
• Gradual medication weaning
• Discharge planning and education

After Emergency Care

• Follow-up with primary care within 24-48 hours
• Pulmonologist appointment if severe
• Allergy testing if indicated
• Action plan review and update
• Trigger identification
• Medication adherence counseling
• Return to normal activities gradually

Related Conditions

Frequently Asked Questions