Often asthma attacks begin suddenly, with no warning. They may begin even when a person is at rest. Although symptoms may follow heavy exertion, exposure to allergens or emotional extremes, in a typical attack the person suddenly becomes short of breath. Because asthma is a condition that can afflict able-bodied as well as disabled children, all school bus drivers should be taught how to recognize the symptoms of an asthma attack and how to respond properly. Signs of an asthma attack

• The person having the attack may feel as if he or she is drowning or suffocating. To obtain relief the person may sit up straight, stand up or lean forward.

• Breathing is difficult.When the person breathes out, it is usually prolonged, and wheezing is very pronounced.

• The person will appear pale and may even be blue (especially around the mouth and hands) if the attack is severe. Skin may be cool and moist.

• During a severe attack the chest may be distended and the neck veins may bulge.

• Sternal retraction — when breathing is difficult, the shape of a person's chest may look different than normal when they attempt to breathe. (For example, sternal retraction looks like the breast bone is being pulled.)

• The symptoms may last a few minutes or persist for hours to days. They are exhausting, serious and frightening. The most severe type of asthma attack is called status asthmaticus. This is a true medical emergency. In this distressful type of episode, the asthma attack is not relieved by use of local bronchodilators, such as inhalers (medications that relax and enlarge the diameter of the person's airway). Seek immediate emergency medical treatment. In addition, if someone is unable to take fluids orally during an asthma attack, this is another indication that medical help is needed immediately. What to do during an episode
  Sit or stand the person so that he or she is leaning slightly forward with the back straight and chest upright. For a non-ambulatory person in a wheelchair, make sure he or she has an adequate support for trunk elongation and good body alignment. Or align the person's body lying on his or her side with support to the head and trunk. This position should elevate the head and trunk, leaning the person's body slightly forward. Be supportive, calm and reassuring. Calm and relax the person as much as possible throughout your intervention. Panic tenses muscles and aggravates the symptoms. If this is a first attack or breathing difficulties worsen, call the doctor or emergency medical services at once. Special considerations
  Those who are immobile, have physical deformities and/or have oral motor deficits are most at risk for "silent aspirations." Silent aspiration of small amounts of food, fluids, saliva or partially digested food, which may have come back up from the stomach into the esophagus, can result in the above described "asthma-like attack" symptoms. The person will wheeze as the muscles in the airway tighten in an attempt to keep out further invasion or in response to chemical irritation of the food or stomach acid. This results in increased mucus production, and swelling may occur. This causes breathing difficulty and may be mistakenly diagnosed as an allergic reaction or asthma attack, leaving the real problem undiagnosed. Ellen Johnson is a registered nurse who has been teaching at Oklahoma State University in Sweetwater, Okla., for the past eight years.