First Aid In ASTHMA: by Manual External Chest Compression
Dr Rex Harrison B.A. M.B. B.Chir.(Cantab) D.L.O. D.R.C.O.G.
Despite huge improvements in the managment of asthma over the last 20 years approximately 1600 people die each year from asthma, in England and Wales alone, and most of these deaths occur outside hospital.(1,2) Many of these are particularly tragic as they occur in otherwise fit young people. The purpose of this website is to stimulate interest in a simple, first aid treatment for asthmatic attacks and in particular life-threatening asthmatic attacks. I used the technique successfully during my time as a General Practitioner in Lancashire. I have tried to interest the medical journals in it without success so am hoping that posting the details of my experience on the internet will stimulate interest from healthcare professionals and patients so that trials might be set up that could eventually save lives. It is based on the fact that in severe asthma the patient's one desire is to breathe air in and this becomes harder and more exhausting as the chest wall reaches its maximum capacity. Less air is breathed in despite using more and more effort causing eventual exhaustion of the respiratory muscles and in the most extreme cases respiratory arrest. Using simple chest compression to aid expiration emptying the chest (as one would a bellows) allows the next inspiration to be easier and much more rewarding. The method is easy to use.
The hands are placed on either side of the lower chest and a firm but continuous pressure is exerted while the patient is breathing out. Timing of the chest compressions is made easier because respiration in asthmatic attacks is very noisy. The method should be used in conjunction with all the standard treatments for asthma and could easily be used by relatives and first-aiders before medical help arrives. For a more detailed explanation, click here.
This method came from my experience with three extremely unusual and dramatic cases, which occurred within a relatively short time. For further details see the Navigation Bar (left). All the patients had used Salbutamol aerosol inhalers and discarded them prior to my arrival. The cases occurred before modern nebulisers were available.
It is rare for respiratory arrest to occur in asthma; for a Doctor to arrive at the moment when a patient stops breathing in an asthmatic attack is extremely rare and not well documented. It happened to me twice in a short space of time. Despite the extreme rarity of these events they directed me to an important principle which requires further debate and assessment.
1. Molfino NA, Nannini LJ, Martelli AN, Slutsky AS. Respiratory arrest in near-fatal asthma. N Engl J Med 1991; 324: 285-288
2. Inwald, D., Roland, M., Kuitert, L., McKenzie, S. A, Petros, A. (2001). Oxygen treatment for acute severe asthma. BMJ 323: 98-100
Since 2003 (when this webpage was originally written) Dr Michele Alzetta, Director. Pronto Soccorso (SUEM) Venezia describes a similar rescue after failure of passing an endotracheal tube and attempted ventilation failure produced an immediate response with chest compression after removal of the tube in an E-Letter to EMJ in response to my paper in the EMJ Chest compression first aid for respiratory arrest due to acute asphyxic asthma (EMJ January 2010 Volume 27 issue 1)
UPDATE 7 June 2014
As already described there was a case of asphyxic asthma treated by endotracheal tube and attempted ventilation described by Fisher MM, Whaley AP, Pye RR, having failed but after the tube was withdrawn chest compression produced rescue dramatically quickly.