Foremost on my mind during one of these really bad flares is the question….how bad will it get? Is this exacerbation going to escalate to the point where I need hospital care? If I don’t go in, will this be the one that kills me? After all, 4,000 people in this country alone still die every year from asthma. Many of them before they get to a hospital.
Like most severe asthmatics, I tend to downplay or ignore the severity of my symptoms for as long as possible, because I know the unpleasantries in store for me if I end up in the slammer, ie blood gas sticks, IV insertions, bipap masks, etc. But in doing so, am I playing asthma Russian roulette? Should I go in at the first sign of trouble, or should I try to tough it out and hope it gets better on it’s own? Should I call my doctor or an advise Nurse? Should I check the web? Without any type of standardized guideline in place, it can be a tough decision to make, especially at a time when you’re struggling to breath or think clearly.
For me, assuming that my flare isn’t too severe or sudden, I’ll try to use objective criteria, such as my peak flows, FEV1s and sats, as well subjective observations, such as my dyspnea level, to try and assess whether I need a higher level of treatment and monitoring. I say monitoring, because that’s essentially what happens when you go to hospital to be treated for asthma. Most of the drugs they give you in the hospital are the same exact ones you take at home, only in much higher concentrations. Of course they also have oxygen and assistive breathing devices available if needed.
Obviously the main benefit and probably the most important reason of being in hospital or emergency room during a severe flare, is that you have Doctors, Nurses and RTs in close proximity if things get out of control, which they can easily do with asthma. If you’re sick enough where you actually need to be admitted to the hospital and are at risk for death and/or need to be intubated (having a breathing tube inserted in your airway), they’ll most likely put you in the intensive care unit where they can keep a really close eye on you. More times than not though, if you’re stable but not improving fast enough, they’ll usually put you in a regular hospital room and check on you every few hours. Another benefit of being in the hospital is that they can perform diagnostic tests, give you IV medications, etc. But the hospital’s basic function for asthmatics is to monitor you until you’re over the hump and considered clinically stable, which btw, is totally different than feeling better. Your asthma flare is going to break when its darn good and ready, and nothing the Doctors, Nurses or “Hospital” can do, is really going to speed that process up. Most of the time your asthma exacerbation won’t burn itself out completely until you’ve already been discharged from the hospital.
Other than the recommendations in your asthma action plan, there are really no hard fast rules or guidelines to tell you if and when you should go to the ER for your asthma. You just need to apply some common sense and go with your gut feeling. If your exacerbation is not getting better despite doing everything you’re supposed to, and/or your exacerbation has been brewing for more than a few days, or if you have a history of severe asthma and have been intubated and spent time in the ICU, or things just don’t feel right to you, then you should get yourself to the hospital pronto!
As far as children go, they can’t speak for themselves. Learn to recognize the danger signs, which are often much different in children than adults. And by all means take them in right away if their symptoms don’t improve or if you’re not sure.
On a semi related topic, have any of you frequently flyers experienced the following scenario……
You’ve had an exacerbation brewing for a couple days and you’re getting progressively tighter and tighter. You decide it’s finally time to head to the ER. They triage you to a room and suddenly,and almost miraculously, you don’t feel quite as tight as you did 15 minutes early. Then you start 2nd guessing yourself, thinking that perhaps you’re not as sick as you originally thought? Or maybe it’s anxiety that’s making you feel worse than you actually are? You feel a little embarrassed and are actually considering leaving, but it turns out that you are indeed sick and you made the right choice by going in?
To demonstrate just how complicated ones perception of ones own breathing can be, a couple years back this very same thing happened to me . I felt sick as a dog, tight as can be. I reluctantly headed to the ER as above, and miraculous started feeling better the moment I entered the building. I was even telling the doc that this was a relatively minor flare up that I probably should have waited a little longer to come in. Well, 2 hours later I went into full blown respiratory failure, had a respiratory arrest that required CPR and woke up on a ventilator 2 days later.
Again I can’t stress just how important it is to go with your gut instinct. If you’re an asthmatic and you feel like crap, blame your breathlessness on the asthma first, and then consider the possibility of anxiety, but always in that order. No doubt that anxiety can add fuel to the fire, but asthma can actually kill you all by itself, so don’t mess around.
So, what criteria do YOU use to determine if, or when, you should go to the hospital ? And how high do you set the proverbial ER bar? Do you wait until you’re at the brink of respiratory failure, or do you go in at the first sign of trouble? Studies have shown that the sooner you come in for treatment, the better chance you have of slowing or reversing an attack and preventing a possible hospitalization. Not to mention, it could save your life.