1) Patient still breathing and inhalers no longer providing any relief
Place your hands on the side of the chest over the lowest ribs with the thumbs towards the mid line and force the ribs inwards at the end of their inspiration (breath in) helping the patient to breathe out. This should be a short sharp movement initially as breathing will be rapid. You should remember that the ribs have been forced higher and higher and you are trying to get them back to their normal resting position. This can only be achieved over the next few breaths (timing your compressions to coincide with the patient’s breathing out.) As soon as it is achieved the patient will be able to take a full inspiration with great relief.
2) Patient stopped breathing and unconscious
There can be a problem with using mouth to mouth resuscitation in these patients as the lungs are already overdistended so trying to force more air in just won’t work until the lungs have been emptied.
Roll the patient to face down on the floor with the head turned to one side. Kneel at the patient’s side, place your hands over the lower ribs with your thumbs pointing towards the mid line and lean forwards so that the weight of your body compresses the lower chest against the floor and if possible at the same time push the lower ribs inwards. Because the ribs are fully raised there is a rush of air from the chest. Release the pressure to enable the elasticity in the rib cage to take air into the lungs and repeat until the patient starts to breath normally. This is Schafer’s method of artificial respiration. The advantage of the prone position is that the abdomen and therefore the diaphragm is supported by the floor when pressure is applied.
This simple safe procedure described above can be performed by anyone without any training and should be widely known and discussed by relatives and friends of all asthmatics because death can occur in Asphyxic Asthma before medical help let alone getting to a hospital is possible.
Chest compression can also relieve the panic of not being able to breathe in
children or adults with severe asthma.
In less severe asthma the patient can even easily perform the compression themselves with the thumbs behind and the fingers spread over the lower ribs
Schafer's method must not be confused with the mid line sternal compression used in CPR for cardiac arrest which has little effect on lung ventilation. Patients dying because of asthma die from interruption of breathing not cardiac arrest. At present they all receive mouth to mouth resuscitation which does not work!
Any one wishing to learn more about this method and its background should see other pages on this site and http://pdm.medicine.wisc.edu/Fischer.pdf