Asthma attacks are mostly BS?

LanceCorpsman

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I was attending some CE training and a flight RT mentioned how most (he said up to 70%) of asthma attacks that EMS gets dispatched to can be treated without any more medical interventions. He said it was because these patients having are having an anxiety attack secondary to the asthma and that their inhalers are doing the job.

I'd say there is definitely some truth behind this. But are there any actual studies to confirm this number? I've done some research, I couldn't really find anything on it. It would be interesting to see what the number actually is.
 

Summit

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People dial 911 when they feel things are beyond their control... someone feels like they can't breath in an asthma attack and they dial 911 with a low threshold... lower for kids. Maybe they solve the medical component. I don't blame them for calling.

I remember being dispatched to an anaphylaxis/can't breath tripoding patient that was having a pure panic attack.

It's not BS, it just isn't that magical TV AIRWAY! BREATHING! moment... now breath with me... look at me... breath... wait.... breath...

Never seen any numbers specifically.
 

rescue1

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Technically, the guidelines for asthma suggest patients try 4-8 puffs every twenty minutes for one hour during an acute attack--4 MDI puffs is approximately 1 neb treatment (though the actual dosing is not identical--which is confusing) before seeking medical attention, unless they have no response at all to the initial puffs. That's upwards of 6 whole neb treatments before calling 911 (how often do you give that many nebs to a semi stable patient?).

I can see how coaching yourself through an hour of vague breathlessness would be fairly anxiety provoking though, plus these patients have the potential to get sick quickly/may need steroids to prevent a relapse. I don't really think it's an issue that can be solved, and of all the non urgent things we go to, coaching someone through a disease that could definitely kill them seems like a reasonable use of resources.
 

Carlos Danger

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I was attending some CE training and a flight RT mentioned how most (he said up to 70%) of asthma attacks that EMS gets dispatched to can be treated without any more medical interventions. He said it was because these patients having are having an anxiety attack secondary to the asthma and that their inhalers are doing the job.

I don't think most asthma attacks are BS, but I think the statement that I bolded most definitely is. In fact I think it's an irresponsible and unprofessional claim to make.

Is anxiety a factor in asthma attacks? Most certainly. It turns out that when you feel like you are suffocating, it tends to make you anxious. So that should be built in to our approach to asthma attacks. But I know personally, most of the asthmatics that I've dealt with in the field didn't call until they were puffing on their inhalers for a while and felt as though the bronchodilators were not only not working, but that they were actually getting worse. And most of them were plenty wheezy with a low Sp02 to substantiate their concerns. Are there exceptions? Most certainly. Do they make up 70% of asthma calls?

Given that asthma kills twice as many people per year (250,000) as car accidents, gun violence, and drug overdoses (about 40k each) combined, I'd say it's not something that we should be minimizing, especially when you consider than many of the victims are relatively young and otherwise healthy.
 

medichopeful

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I don't think most asthma attacks are BS, but I think the statement that I bolded most definitely is. In fact I think it's an irresponsible and unprofessional claim to make.

Is anxiety a factor in asthma attacks? Most certainly. It turns out that when you feel like you are suffocating, it tends to make you anxious. So that should be built in to our approach to asthma attacks. But I know personally, most of the asthmatics that I've dealt with in the field didn't call until they were puffing on their inhalers for a while and felt as though the bronchodilators were not only not working, but that they were actually getting worse. And most of them were plenty wheezy with a low Sp02 to substantiate their concerns. Are there exceptions? Most certainly. Do they make up 70% of asthma calls?

Given that asthma kills twice as many people per year (250,000) as car accidents, gun violence, and drug overdoses (about 40k each) combined, I'd say it's not something that we should be minimizing, especially when you consider than many of the victims are relatively young and otherwise healthy.

End of thread.
 

DrParasite

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Given that asthma kills twice as many people per year (250,000) as car accidents, gun violence, and drug overdoses (about 40k each) combined, I'd say it's not something that we should be minimizing, especially when you consider than many of the victims are relatively young and otherwise healthy.
Can you provide a source for that statement?

I know of areas that get one fatal shooting a shift. others that get fatal ODs. I haven't heard of many places that get more status asthmaticus calls per shift than fatal crashes or shootings.

Not saying you're wrong, just looking for where you found that information, because it runs contrary to what I have experienced.
 

EpiEMS

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@DrParasite
Some CDC data is available here. Asthma has a death rate of 10.3 per million, or 1.03 per 100,000.

I found more recent CDC data classified by ICD code (asthma is ICD code J45) here.

ICD J45 coded deaths for 2015 of 1.03 per 100,000 versus opioid ODs (also here page 168) crude death rate of 16.3...well, let's just say I'll take asthma over an opioid addiction.

You can get all the death data you want from the CDC:)

@Remi, if we're talking about premature deaths or something, that's a different story, but I'd wager that drugs/violence/transportation are more dangerous than asthma.
 

Carlos Danger

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Can you provide a source for that statement?

I know of areas that get one fatal shooting a shift. others that get fatal ODs. I haven't heard of many places that get more status asthmaticus calls per shift than fatal crashes or shootings.

Not saying you're wrong, just looking for where you found that information, because it runs contrary to what I have experienced.

Yeah, it looks like I was mistaken. I thought the numbers were much higher than what most people realized so when a quick google search returned some stats that appeared to confirm it, I didn't notice that that 250k number was international. http://www.aaaai.org/about-aaaai/newsroom/asthma-statistics

I think my point still stands. Asthma kills otherwise young and healthy people and would kill many more if it weren't for aggressive treatment. To suggest that asthma presentations are primarily anxiety is really irresponsible.
 

RocketMedic

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Asthma severely limits a lot of people and kills a lot of good, healthy, productive, useful people; often far younger than their expected expiration date. It's also one of the more 'treatable' things we can run across. Pretty much everyone likes breathing easily.

Addictions/psych/violence, on the other hand, although most definitely lethal, are often killing people who are not quite as "sympathetic" or receptive to assistance as asthmatics. Should EMS help them? Absolutely, but given a choice, I'd much rather spend the time and resources on making sure Little Tanisha gets to breathe air well instead of babysitting Ms. "He Shows Me His Love With His Fists Every Week" or "This isn't enough valium to get me high" or "I like to smoke and shoot up". Everyone gets care, but given the necessity, I'll prioritize a respiratory distress over the other ones.
 

DrParasite

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I think my point still stands. Asthma kills otherwise young and healthy people and would kill many more if it weren't for aggressive treatment. To suggest that asthma presentations are primarily anxiety is really irresponsible.
So using the website you provided in the US, there were 3,615 asthma-related deaths in 2015. Children under 18 years old made up 219 of those deaths (and that was per the Centers for Disease Control and Prevention, National Vital Statistics Reports, Vol. 61, No. 4, May 8, 2013). So it's not like it's a major killer, at least compared to other causes of death in the US.

I don't think we should minimize asthma calls. Even if your all knowing flight RT was right, and 70% of all asthma patients don't need any additional pharmacological intervention from EMS, that means 30% need more medications or interventions or else they might end up on the asthma related deaths. In many cases, we can get there "just in case the worst case scenario happens" and should that happen, i'd want as many meds as possible available to me.

Yes, statistically, many/most asthma cases COULD be handled with just the patient's inhaler, but if it's can't, well, how long can you hold your breath for until help arrives?
 

Gurby

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A friend of mine had an asthma attack, tried to uber to the hospital but halfway there decided he wasn't going to make it, bailed from the uber and called an ambulance. He told the paramedics, "I'm having an asthma attack, my inhaler isn't working, I've been intubated before". They thought he was having an anxiety attack and tried to coach his breathing. The next thing he remembers is waking up in the hospital, staring up at a doc with laryngoscope at the ready.

This mindset makes me really angry. That RT is an idiot. They have asthma, are wheezy, have a prescription for albuterol/etc? Just give them the damn duo-neb. Maybe a little more finesse is required in patients with cardiac concerns.
 

Tigger

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A friend of mine had an asthma attack, tried to uber to the hospital but halfway there decided he wasn't going to make it, bailed from the uber and called an ambulance. He told the paramedics, "I'm having an asthma attack, my inhaler isn't working, I've been intubated before". They thought he was having an anxiety attack and tried to coach his breathing. The next thing he remembers is waking up in the hospital, staring up at a doc with laryngoscope at the ready.

This mindset makes me really angry. That RT is an idiot. They have asthma, are wheezy, have a prescription for albuterol/etc? Just give them the damn duo-neb. Maybe a little more finesse is required in patients with cardiac concerns.
Also, put the capnography on.
 

medichopeful

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Also, put the capnography on.

Agreed.

That being said, even if you don't have capnography, treating an anxiety attack as an asthma attack is probably a lot less dangerous than treating an asthma attack as an anxiety attack.
 

rescue1

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Lets also not forget, there are plenty of stab wounds or shootings that will only require a shot of antibiotics and a bandage, but you'll never see people try and leave them on scene. In my experience, the same medics who would want to BLS an asthma "anxiety attack" are the first to try and fly the helicopter for a through and through leg GSW without significant bleeding.
 

RocketMedic

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"It's just air"
 

StCEMT

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Had asthmatic today...was wheezy...was breathing too fast... I did things....they helped....not anxiety attack, although I did have one of those too. He was none of the above and had an associated history.
 

MSDeltaFlt

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Holy dear mother of God!!! All that wheezes is NOT ASTHMA!!! If you have a patient, ESPECIALLY AN ADULT PATIENT, complaining of shortness of breath and it appears they are wheezing, put your stethoscope on them. For an adult, it's been my experience that 99 times out of 100 (I realize some on here is liable to toss out empirical data but humor me, will you?) it's not asthma. It's usually not going to be asthma or anxiety attack. It's usually going to congestive heart failure and morbidly obese patients who have an undiagnosed Obese Hypoventilation Syndrome (Pickwickian Syndrome).

CHF will need NTG, Lasix, CPAP/BiPAP. Why? Rales, not bronchospasm.

Pickwick's will need either the above and/or a neb IF they have a wheeze due to bronchitis/pneumonia.

Not only do you need to put capno on them as stated already, but for God's sakes PUT YOUR SCOPE ON THEM!!!

LISTEN to them.

This in not rocket science. Neither is it brain surgery. This is patient assessment, plain and simple. You listen to all five lobes anterior, posterior, and axillary, that alone can tell you which algorhythm you need to take on your protocols.

It appears that your Flight RT has a misdiagnosis of "potpourri-gastritis" - Basically he has forgotten that his @#$% still stinks.

Granted, I may be misinformed. Opinions are like buttholes. Everyone's got one and most of them stink. And this one is mine.
 

Tigger

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Holy dear mother of God!!! All that wheezes is NOT ASTHMA!!! If you have a patient, ESPECIALLY AN ADULT PATIENT, complaining of shortness of breath and it appears they are wheezing, put your stethoscope on them. For an adult, it's been my experience that 99 times out of 100 (I realize some on here is liable to toss out empirical data but humor me, will you?) it's not asthma. It's usually not going to be asthma or anxiety attack. It's usually going to congestive heart failure and morbidly obese patients who have an undiagnosed Obese Hypoventilation Syndrome (Pickwickian Syndrome).

CHF will need NTG, Lasix, CPAP/BiPAP. Why? Rales, not bronchospasm.

Pickwick's will need either the above and/or a neb IF they have a wheeze due to bronchitis/pneumonia.

Not only do you need to put capno on them as stated already, but for God's sakes PUT YOUR SCOPE ON THEM!!!

LISTEN to them.

This in not rocket science. Neither is it brain surgery. This is patient assessment, plain and simple. You listen to all five lobes anterior, posterior, and axillary, that alone can tell you which algorhythm you need to take on your protocols.

It appears that your Flight RT has a misdiagnosis of "potpourri-gastritis" - Basically he has forgotten that his @#$% still stinks.

Granted, I may be misinformed. Opinions are like buttholes. Everyone's got one and most of them stink. And this one is mine.
I get what you're saying, but sometimes it is asthma. Or some other sort of reactive pathology, but all probably need some degree of treatment. Listen, capno, history. Maybe it's just where I live, but we run lots of "I have asthma, this is an asthma attack like the last one." Sure enough they're hypoxic, have a constricted waveform, tachypneic, and wheezy. Maybe they have COPD too, but it isn't like we aren't going to treat them.
 
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