Foremost on my mind during an asthma excerbation,is the question….how bad will it get? Is this flare going to escalate to the point where I need hospital care? If I don’t go in, will I end up on a ventilator, will this be the one that kills me? After all, 4,000 people in this country alone still die of this stupid disease every year, most of them before they make it to a hospital.
Like most chronic 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 procrastinating, 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 to see what other people do?
Other than pre-agreed upon instructions in your asthma action plan ( hopefully you have one), there are really no hard fast rules or standardized guidelines in determining when a flaring asthmatic should seek emergency medical care.
Obviously, if your symptoms come on suddenly and they’re severe, or you’re starting to turn blue, you you should call 911 or have someone drive you to the hospital right away. Same holds true if you’ve been dealing with a flare that’s lasted more than a week,but doesn’t seem to be getting any better. But if you’re not quite to that stage, what should you do? This can be a tough decision to make, especially at a time when you’re struggling to breath and basically feeling like crap.
For me, assuming that my flare didnt come on suddenly or I was recently discharged from a hospital, I’ll try to use objective criteria, such as my peak flows numbers, my FEV1s and my sats readings, as well subjective observations, such as my dyspnea level, to try and assess whether I need a higher level of treatment or 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, such as bipap or a ventilator if needed.
Probably the most important reason for going to the ER for a severe asthma flare, is that you’ll have Doctors, Nurses and Respiratory Therapists (in the US and Canada) in close proximity if things get out of control, which they can easily do during a bad asthma attack. Once you’re stable, the ER doctors will determine if you should be admitted to hospital for further treatment or monitoring. If you’re flare is really severe and you’re not improving and/or you have a history of intubations (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.
Another benefit of being in a hospital during a bad exacerbation is that they can perform diagnostic tests, give you IV medications, etc. But again, the hospital’s primary role in treating 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.
The bottom line here, is that you need to apply common sense and go with your gut feeling in determining whether you should seek medical care for an asthma attack. If your exacerbation is not getting better despite doing everything you’re supposed to, and/or it’s 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. Don’t try to second guess yourself….err on the side of caution and just go! You’ve probably already done this, but it’s also a good idea to discuss with family and friends in advance, about what to do in the event of an asthma emergency.
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.
Now, on a semi related topic, how many of you frequently flyers have 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 distorted ones perception of ones own breathing can become during a bad flare, here’s an example of what happened to me a couple years back. I had been feeling sick as a dog, tight as can be. I reluctantly headed to the ER as above, but the moment they wheeled me back to one of the treatment rooms I started to feel better. I was even telling the doctor 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, possibly saving your life.