New asthma action plan

After a record number of admissions to the intensive care unit this year, (5 so far), it was pretty evident that my current asthma action wasn’t working anymore. So, at last weeks pulmonary clinic follow-up visit, we (they) came up with a new asthma action plan that will hopefully reduce that high number of ICU admissions.

For those of you who don’t know what I’m talking about; an asthma action plan is basically a set of instructions agreed upon by the patient (me) and the physician (my lung docs), on how to best manage one’s asthma on a daily basis. It includes such things as, how to interpret peak flow readings, when to increase or take certain medicines, what to do if your symptoms get worse, when to contact the your doctor…that sort of thing. The goal for most people of course, is to keep your asthma under control so that it will never escalate to the point where you have a crisis and need to seek emergency medical care.
Well, with very brittle asthmatics, things are a little trickier. The primary goal of the action plan often becomes not one of avoiding the ER, but rather, of going to the ER right away.

The way it worked before, was at the first sign of increased symptoms (ie. my yellow zone) , I would take a loading dose of prednisone (60-80mg) and then wait at least 24 hours for the steroids to take effect. If after that period I felt better…fine. If not , I would call my doctor for further instructions or go to the ER for treatment depending how I felt.

This new action plan eliminates that 24 hour waiting period altogether.
Now , they want me to go to the emergency room immediately after taking the first dose of prednisone and regardless of whether I think it’s necessary or how I feel.
In other words, no more waiting to see if things will get better.

The rationale for all this is ? In their words (not mine):
#1 ) I’m a poor judge when it comes to recognizing the severity of my own symptoms.
#2) Sometime I like to push the envelop.
# 3) It’s better and much safer for someone like me to spend maybe one day in the emergency room, than to spend a week in the intensive care unit….or worse.

Let’s hope I don’t have to put this new plan to the test for a long..long time.
I have a marathon to train for, and even a single day in the hospital is going to screw things up.

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4 Comments

  1. Amy says:

    “Well with severe or brittle asthmatics, things are a apparently a little more tricky. The primary goal of the action plan often becomes not one of avoiding the ER, but rather, of going to the ER much sooner ,than later.”

    I think I need to print this out and frame it, for the times when I’m complaining too much. (read: everyday) I need to remember that my daughter could be struggling so much more than she is. You have such an awesome attitude, Steven.

    Good luck with the new plan! I hope you won’t need to implement it and can keep training.

    Asthma Mom

  2. rick says:

    I agree, good luck with the new plan. I like the new aggressive plan to keep you healthy. Like they said one day in the emergency room is better than a week in intensive care or worse…

  3. runliarun says:

    Oh, they’re right. You ARE pushing the envelope all the time. Then, we all know you are crazy, how can we expect anything different?

  4. Brooklyn says:

    I think “they” are right. Good luck on the new plan, Steve.

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While it's a little unusual to see a person with a perfect O2 sat of a 100% during a severe exacerbation, its pretty typical to see sats in the 94-97% range. The reason for this, is that asthma is a disease of the airways , not the alveoli where gas exchange takes place. Most asthmatics dont desaturate during the early stages of an attack,unless theres a secondary problem such as pneumonia. You have to be extremely ill with asthma if your sats are low.

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