The Douglass Report November 2001

November 2001 PDF

Asthma: Attacking back with the Heimlich maneuver

Rashidi Wheeler was a starting safety on the Northwestern University football team. He was good. He started all games last year and helped the Wildcats win the Big 10 title. Rashidi also had severe asthma. But he'd learned to live-and play-with his condition, frequently using an inhaler during practice. During his three years at Northwestern, he'd had more than 30 asthma attacks. One of them proved fatal.

One day during football practice, Wheeler's inhaler stopped working: He simply could not get any air into his lungs. He fell to his knees and quit breathing. The coaching staff administered CPR, as did paramedics when they arrived on the scene, but despite these efforts, Wheeler died at the hospital an hour later, apparently without taking a single breath.

If he didn't die until an hour later, then his heart was still beating. But because he was asphyxiating, the blood his heart was pumping around his body and brain was inexorably lessening in oxygen content.

The paramedics left out a lifesaving step

It's easy to second-guess an emergency response to a patient in distress, but this case needs to be reported.

Henry Heimlich, with the help of his wife Jane, has made an enormous difference in the effectiveness of cardiopulmonary resuscitation (CPR) with the Heimlich maneuver. Hundreds of people, especially children, have been saved from drowning because paramedics have learned to perform the Heimlich maneuver before CPR in order to get the water out of the lungs before trying to get air into the lungs. Otherwise, CPR will kill rather than cure.

Jane Heimlich recently reported on the importance of the Heimlich maneuver in severe asthma attacks. She pointed out that asthmatics die suddenly, usually because of a mucous plug obstructing the airway. The surest way to kill them is to institute mouth-to-mouth respiration before performing the Heimlich maneuver to expel the mucous plug.

Even the coroner got it wrong

"The Northwestern safety was never able to catch his breath and later died," said the Associated Press report. According to the Cook County coroner's office, the cause of death was bronchial asthma. But I'd be willing to bet that the reason Wheeler couldn't "catch his breath" is that his airway was obstructed by a mucous plug. The most likely cause of death was not bronchial asthma but an obstructed airway blocked by mucous formation. He died of asphyxiation.

Mucous formation is an ever-present danger in acute asthma, made worse by the "clamping down" action of the muscles around the bronchial tubes. This is why so many asthmatics "mysteriously" and suddenly die, almost all of them unnecessarily.

This treatment oversight is even more tragic than drowning deaths. More people die of asthma than from drowning every year-so the potential for saving lives is immense. According to the National Institute of Allergy and Infectious Diseases-a subdivision of the National Institutes of Health (NIH)-more than 15 million Americans suffer from asthma. Fourteen Americans die during asthma attacks every day, which adds up to more than 5,000 deaths each year.

Since I wasn't there, and I haven't seen the autopsy report, my conclusions on Wheeler's death are conjectures, though educated ones.

Action to take:

If you are ever in the presence of someone who is having a severe asthma attack and appears to require CPR, be sure to administer the Heimlich maneuver first.

To perform the maneuver, stand behind the person and wrap your arms around his or her waist. Make a fist and place the thumb side of that fist against the victim's upper abdomen, below the rib cage and above the navel. Grasp your fist with your other hand and press into the victim's upper abdomen with a quick upward thrust. Do not squeeze the rib cage; confine the force of the thrust to your hands. Repeat if necessary.

If you are performing the maneuver on yourself, lean over a fixed horizontal object (table edge, chair, railing, etc.) and press your upper abdomen against the edge to produce a quick upward thrust. Repeat if necessary. RH

Armour, Nancy. "Asthma cause of Northwestern player's death." Associated Press, 8/4/01