You're hiking up the seventh of 10 steep switchbacks one cool, spring morning when your hiking partner suddenly begins wheezing, coughing, and complaining of tightness in her chest and difficulty breathing.
Chances are, your partner is aware of her condition (17 million Americans are currently diagnosed with asthma) and has brought an inhaler prescribed by her physician. Taking a break and inhaling the medication should stop the attack so you can resume your hike. But what if this is her first attack, or she didn't pack the inhaler?
In these cases, try to determine what triggered the attack and remove the respiratory irritant. In exercise-induced bronchospasm (EIB), the cause is vigorous exercise. Working up a sweat, especially in cold weather, makes the muscles constrict around the bronchial tubes in the lungs, restricting airflow. Have your friend rest until her breathing returns to normal. If the air is cold, have her breathe through a bandanna or some other thin material to give the air a chance to warm, which helps relax the bronchioles.
With chronic asthma, exercise may be a trigger, but more often allergies, a virus, air pollutants, or dust particles are responsible. If the victim is allergic to the pollen from cottonwood trees, for example, get her as far away as possible from the vegetation.
In all instances, try to calm the victim. Relaxing will help open the airway and ease the asthmatic reaction. Encourage her to breathe through pursed lips, as if she's blowing out a candle 3 feet away. This can create pressure in her lungs that enables the airway to open and let trapped air out. The dilemma in serious asthma attacks is not so much one of breathing in, but of exhaling so the victim can take her next breath.
If these procedures don't work and the victim is in serious respiratory distress, inject her with epinephrine in the form of an EpiPen or Ana-Kit from your first-aid kit (see Body Language, August 2001) and evacuate. Do not give antihistamines; these can further constrict the airway. You may also be able to help restore breathing by performing the Heimlich maneuver-thrusting in and up four times at the bottom of the victim's rib cage to expel trapped air and mucus.
See a doctor before hitting the trail if you notice any changes in your breathing. If you've been diagnosed as having asthma, keep an inhaler handy when backpacking regardless of how long it's been since your last attack. And give a backup inhaler to your hiking partner. The few measly ounces it will add to your pack weight could mean the difference between life and death.