( updated 8-1 -2010)
1)Monitor peak flows 4 times a day and/or whenever feeling short of breath.
2)If dipping into yellow zone for more than 24 hours, bolus with 60 mg prednisone, increase neb treatments accordingly.
3)If remaining in yellow zone for more than 24 hours after taking prednisone….go to ER.
4)If dipping into red zone, even briefly,….. Don’t wait , go directly to ER!
5)If experiencing rapid chest tightness, inspiratory wheezing, or rapid drop in peak flows or FEV1s….. go directly to ER.
6)Regardless of the other steps, if requiring neb treatments more often than every 2 hours, go directly to ER.
Since I’m what they call a “poor perceiver” ( meaning I don’t always sense when my breathing is getting bad), it’s important that I use objective data when assessing my symptoms, ie..PFs, FEV1s, breath sounds, O2 sats, etc. Because I don’t have much lung reserve, and because I tend to decompensate rather quickly when a severe exacerbation is underway, it’s generally better for me to seek hospital treatment sooner, rather than later. I admit though, that I’m not very compliant with this rule.
Finally, while a solid asthma action plan is a must for any asthmatic, choosing the right hospital and or/doctors to manage your asthma if you get sick, is especially important if you have severe chronic asthma. While severe persistent asthma isn’t that rare ( 5-10% of asthmatics), finding a doctor who truly understands the more severe form of this disease is exceedingly rare. Patients with severe asthma are often misdiagnosed and/or mismanaged when hospitalized. It’s essential that you develop a good relationship with an experienced Pulmonologist BEFORE you get sick, who will oversee your care should ever need hospitalization.