The Recovery phases of a severe asthma exacerbation

Suffice it to say, I wasn’t exactly a happy camper when I wrote that last post about my little prison stint. I apologize for that. At the time, I was roided out of my mind and was still very sick. Dr W helped me get through this awful time by reassuring me that what anguish I was experiencing was a normal response after suffering such a severe flare up, and that my complaints were not really unique.

But what a difference a few extra days can make. I think it was Thursday that I finally turned the proverbial corner. As happens so many times when I think I’ll never recover from a severe attack, I just woke up one morning and all of sudden…Wham! I was breathing better and feeling better. It’s as if whatever was causing my lungs to act up in the first place, just burned itself out and left my body.

It’s astonishing how fast the transformation can happen too. One minute you’re feeling crappy, the next you’re feeling fine. This probably sounds strange, but for a while there it actually felt kinda weird to be breathing easy. All day yesterday I caught myself conscientiously trying to analyze my own breathing to see if indeed I was breathing normal…or I was imagining it. No wheeze, no difficulty exhaling, no discomfort…just normal breathing! So weird, but so appreciated. Id give anything to be able to breath like this all the time. Healthy people take their breathing for granted.

So with this most recent revelation, and after having survived literally dozens of these types of exacerbations, I put all my observations together and made a list. So far, Ive been able to identify 6 distinct phases that I go through during the recovery phase of a severe asthma exacerbation that required a hospital admission.

Just for fun I call it ” The Recovery phases of a severe asthma exacerbation” . The word hospitalization is important here, because the recovery phase from a severe exacerbation that did not require hospitalization, doesn’t seem to follow the same pattern.

Here’s the list in the order of occurrence. Can anyone else relate or add to this?

1)The Honeymoon phase: This is usually the period immediately following discharge from the hospital and usually lasts 24-36 hours. During this period you’re basically in a daze trying to adjust to familiar surroundings again. You’re breathing remarkably well and it seems like you’re getting better.
2)The Rebound phase: This phase usually starts on the 2nd or 3rd day out of the hospital and is characterized by a general worsening of all asthma symptoms. (So much for feeling better..huh). Now all of a sudden you actually feel like you are re-flaring and might need to go back into the hospital ( many do end up going back in). I think this phase is brought on primarily by the body trying to adjust to the lower levels of circulating systemic steroids (steroid withdrawals), and by other drugs and treatments that your body was used to getting while in the hospital.( ie cont or frequent nebs, bipap, oxygen etc.) There’s also the possibility that you were discharged from the hospital too soon.
3)The Zombie phase: Most of us know this phase well. Sleep deprived,unable to breath and body physically and mentally mangled, the steroids make you temporarily insane. Feelings of despair, guilt, blame and depression rear their ugly heads.
You’re riding an emotional roller coaster. You can’t turn your brain off. You’re body is rebelling too; You feel bloated, your muscles are cramping and you want to eat everything in sight. The intensity of these symptoms are usually steroid dose dependent and can last from a couple of days to a couple of weeks.
4)The Turning the corner phase: This phase mercifully begins usually around the 7-10th day out of the hospital, and can occur subtly without your awareness, or if you’re lucky, can happen with an abrupt onset, literally overnight. In either case, this is a welcome phase that signals you are finally getting better.
5)The Fatigue phase: Pretty self explanatory. You’re body is exhausted from working so hard, and now that you’re breathing easier and have less steroids in your system, you feel weak and sleepy. You’re coming down hard from a not so pleasant high.
6)The Amnesia phase: I’m not sure this happens to everyone, but certainly if you’ve been hospitalized multiple times, you’ve experienced this phenomena. This phase usually begins 1-2 weeks after the “Turning the corner”phase, or about 5-6 weeks after the initial exacerbation began. All of a sudden, it’s as if you were never sick, never hospitalized and never went through the living hell of a severe asthma exacerbation or recovery. I think it’s the brains way of blanking out the bad stuff, so that you can cope better with future attacks.

So that’s my asthma recovery theory/ check list. I think every physician and/or RT or Nurse who takes care of severe asthmatic patients should familiarize themselves with this list to get a better insight as to what we actually go through AFTER we get out of the hospital.

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54 Comments

  1. Jeanne says:

    Thank you so much, Stephen. Am home after a few days in the hospital with the worst exacerbation I’ve ever had. Am so totally wiped and it’s making me crazy. This post assures me greatly!

  2. Dawn says:

    Thanks for creating these phases. I was feeling very down and frustrated because I am still feeling absolutely exhausted six days post hospitalization. I’m still taking 50 mg of prednisone daily and feeling the effects. I have another full week to go at this dose before tapering down. The doc at the hospital said I should be good to go back to work in just two days. This after needing to be airlifted to the hospital and spending time in ICU. Your phases let me know that what I’m going through is normal. I no longer feel guilty about needing more recovery time.

    • Sorry to hear that you’re having a rough time with your asthma. Most physicians dont understand just how difficult it is to recover fro a bad flare. Going back to work after only 2 days out of the hospital is ridiculous.

      Take care

      • Dawn says:

        Hello again, well I ended up back in hospital for eight days. I have an awesome asthma doc and he admitted me within 15 min of seeing me. Am home now and still sitting between phase 2 and 3 depending on the day however I seem to be finally moving forward. My doc warned me that it would likely be a longer recovery than what I am used to. This time I have been encouraged to take it easy rather than overtaxing myself. My biggest challenge is trying to balance resting and at the same time ensure I am pushing my lungs enough to regain my strength. Do you have any articles or info on this topic? Or maybe you could share how you decide on how much exercise is appropriate?

  3. Mary says:

    Great post. Very useful and good to know I’m not alone

  4. Alice says:

    I find that the fatigue hits almost immediately after the attack, while the depression and despair hit during the attack.
    In the ER today, I could feel the despair/ helplessness/hopelessness hit like a wave, and had to fight mentally to overcome it and stay calm. My attack took place out of town, and I had to walk 15 minutes to the ER, as I couldn’t talk on the phone (in my hand!!) nor would anyone respond to my attempts to flag down help. I truly didn’t think I would make it–inhaler didn’t even make a dent.

    At this ER they did things backwards from at home. Home gives nebulizer first, asks questions and sets up tests while the neb is working. Here they did all the extras and THEN (about 7-8 minutes later) did the nebulizer–over 35 minutes from the start of the attack. (Gee, why would I get depressed?)
    I was breathing so loud people were coming into the hall to look. AND I had typed into my phone that it was an attack, and that the inhaler (also with me still) didn’t help.
    Now I’m home and so drained. I have just done an extra home neb treatment as I was starting to feel twitchy. And the really depressing thing? We still haven’t figured out what sets it off!

    • Sounds awful. In the future if I were you, I’d carry a mini medical record with you the that briefly describes what I kind of asthma you have, what makes it better and who to contact during flare, I call it the intro letter and I use mine all the time. I use one similar to this one

  5. JANICE WEIR says:

    This is so Apt.

    Not hospitalised but Asthma Exacerbation and Anxiety had made me so ill. It mainly started after eating some Almonds late one night after watching a movie. Not normally allergic but as my cuz mentioned, it may have been a bad batch from the processing and Toxin content.

    Whatever the reason or rhyme (Asthma doesn’t need one normally), I am so glad for your posts. Made me laugh at myself too.

    Prednisolone 8 x 5mg was my recommended dose. I could only do 6 and even that was hard. Felt like all the things you mentioned. Crazy this medication. Now stopped that. But I did make a mistake the day after receiving Meds of taking everything… My body was in a battle.. Steroids then Ceterizine Hydrochloride and Lansoprazole for the Acid and inhalers (I felt like a Lab RAT). Never did that again! Still got this lump like feeling so not eating all the mixtures and everything in sight as the Steroids makes you do. I am on Water, water, water and may have some ginger tea, cucumbers later and grapefruit throughout the day. Bread and biscuits and all sorts are just sending my whole body into a discomboobalated state!!! Resting but wanna Dance, Lying down but can only sit up. I know it will all end with WHAT WAS THAT ALL ABOUT! Only happens once every one or two years but I am grieving the loss of my grandmother recently so maybe the late grief triggered the stress levels. Love my Grandmother and I thank you Stephen for all your Posts. Its funny and also very very helpful. God bless your health. J

    • Sorry to hear that you’re battling the side effects of prednisone ( or in your country, “prednisolone”). For sure, the drug does strange things to your body and to your emotions, but also helps you breath easier. It’s a love-hate relationship.

      Hope you feel better soon.

  6. Anita says:

    Thank you for your explanation of asthma attack recovery. I was hospitalized on 9/8/14 with a severe asthma attack. I am 65 years old and ended up calling 911. I was admitted and given medication and nebulizer treatments. I was discharged 2 days later. Since then, I still use my controller inhaler and have not had any other attacks. However, even now, I don’t feel 100%. I feel tired and short of breath after walking maybe 300 feet. I am not taking any other asthma meds. I feel anxious and somewhat depressed still. I will be glad to feel good again.

  7. Anita, It can takes weeks to fully recover and feel normal again, but you will get there. :-)

  8. amanee williams says:

    thank you so much for explaining your phases of the asthma exacerbation I know exactly what you’re talking about. you have basically explained me for the past few weeks after my hospitalization to the exact. now if I can only figure out the best time for me to go back to work on graveyard shift as a nurse and be able to maintain.

    • Sorry to hear that you were hospitalized for asthma. I hope your gradually feeling better. Sometimes getting back into the swing of things can actually speed your recovery, just dont over do it :]

  9. David Burnside says:

    Hello Stephen reading your account was the first reassuring thing I have seen in weeks..
    In June of this year I was in a asthma study and had a flare up but was told for several it was not my asthma. I have gone to cardiologist, an allergist and a puminologist and I thought I was crazy because they all could not believe I was not feeling 100% after a 10 day taper on prednisone. I went on a second course of prednisone two weeks ago but have never felt recovered. I am off now and get a pretty significant attack twice a day. I not sure what to do? I feel a hospital stay might help but docs don’t feel it is severe enough? I feeling fairly depressed and not sure what to do. This is worse my asthma has ever been. Right now my chest is tight and I have already done combivent and 6 puffs of abutorol.

    • Hi David,

      Sorry to hear that you’re not feeling well and that you seem to be getting the run around from your doctors. You mentioned an asthma study, may I ask what the name of it is and where you did it?

      Im not sure why they would tell you it’s not an asthma flare, if you indeed have asthma and they are giving you steroids to treat it. Could it be that you have VCD or something other than asthma? They’re are a lot of mimic diseases. Have you had a PFT done recently?

      Im not sure where you live, but if you can get to Pittsburgh PA , I can refer you to a wonderful asthma specialist. You probably saw her name on my blog, Sally Wenzel.

      In the meantime, if your breathing gets really bad ..screw the doctors….GO TO THE ER! They have to treat to you.

      Wish I could be of more help, but it’s difficult assessing someones situation via email

      Good luck

      Steve

  10. Rebecca cook says:

    This has been so helpful and informative and so spot on!!!
    On Sunday I was taken in to A&E as couldn’t breath well. Had a terrible cold and chesty cough but then my asthma was so bad they put me in a nebuliser and send me home at 4pm (I went in 11.30am). At 6pm at home I lost it just couldn’t breath so returned to A&E and was taken straight away to the rests part of the department. I was given salbutamol,hydrocortisone and antibiotics. I then had a doc do my arterial gases twice ouch that hurt!!! At this point I thought I’d go home as my sats read 95-97 one under was 16-24 and heart one kept going 110-126 I know nothing about med stuff just looked a lot at it. I was told I had a heart murmur so was scanned and x rayed then Echo (?) scanned again don’t know results of this.

    I was the sent to the most hellish ward on earth where no one would try and communicate with me (I’m deaf) I was given oxygen, prenisipole steroids,anti biotics, co amoxilav and lots of nebuliser treatments,all through Monday and Monday night. Everything I got up for toilet I nearly passed out as breathless. But ok and better in bed. On Tuesday morning doc came round and said as my oxygen levels now good I can go. (Hello I’m on oxygen that’s why they are good???). Anyway I’ve been slung out on my notes its says was a pneumonia related acute asthma excarbation (sorry can’t spell it). I feel like pants. My chest feels like it’s got a rock on it and I’m so knackered walkin just round the bed. I have GP this morning and my husband I’m sure thanks I’m a hypochondriac :(. I need a sick note and don’t know what to say??? Also is feeling like I may die normal or am I being neurotic?? Be honest.

    So from a very confused girl from across the pond thanks to reading. I’m 38 by the way. :)

  11. Lorna M says:

    Thanks so much for this- I thought it was just me who suffers in recovery. I’ve just had my 1st asthma attack for 25 years. I’m gutted as I thought this was all well behind me. I’m experiencing the phases you mentioned, but would add something about the trembling phase, which I am currently becoming re-acquainted with! I realise from reading your blog that I am very lucky that my symptoms have been well controlled for so long, so thanks for getting me over the self pity phase & really hope that you are doing as well as possible.

  12. Mark says:

    After several days of looking up forum posts and articles, I finally found experiences and comments similar to my own. I started to get sick earlier this Christmas which caused shortness of breath. I was given a few rounds of antibiotics and felt no much difference. I finally went to a pulmonologist and was told that it was probably untreated asthma since I had to symptoms of infection.

    I’m on day 7 of taking 10 mg of prednisone for 10 days, along with a long acting inhaler (seretide diskus) once a day, and rescue inhaler (combivent) three three times a day. Does the treatment sound right? Should the prednisone be in a higher dose? I’m afraid of my symptoms getting worse after finishing the prednisone.

    Thanks for your article!

    • Hi, Sorry to hear that you’re having problems with your breathing. You didnt mention in your comment whether you had a history of asthma, and if so, how long ago and how severe. Assuming that you were experiencing actual asthma symptoms, 10 mg of pred per day usually isnt enough to treat an acute flare. The typical starting dose is 40-80 mg per day with gradual taper. Also, combivent at only 3 times time per day is on the low side if you’re using it strictly as a rescue med. Unless these kinds of meds make your heart race, youd probably be better off taking albuterol as needed.

      Take care!

      • mark says:

        Thank you for replying Stephen! Wish I could donate to your site for the service you do for the community…

        I had asthma that was trigger by allergy for years now. It was controlled by staying away from dust mites and pets. My symptoms usually got better after using my rescue inhaler. I also had a few episodes of bronchitis which went away after a few days of antibiotics.

        This Christmas I got the same symptoms of bronchitis (shortness of breath that wouldn’t get better with my inhaler) but this time the antibiotics didn’t take care of it. This is why my pulmonologist thinks is just asthma that wasn’t properly treated.

        I just finished my ten days of 10mg of prednisone, and my symptoms haven’t disappeared yet. I read that it can take weeks for asthma to go away. Based on your experience, what should do next? I’m worried about having another acute attack now that I’m off the prednisone… Currently I’m only on seretide diskus, combivent , allergy medicine(cetirizine), and omeprazole.

        • Could be a virus that set you off. It’s a really common trigger for asthma flares. If it is a virus, it could easily take months for your system to return to normal.

          It’s tough to give advise from what little I know about you, but If your symptoms are tolerable, Id say keep doing what you’re doing. You might want to try nebulized albuterol/atrovent instead of the combivent inhaler. If you feel you’re not getting better and you’re getting more short of breath, you probably should bolus with a much higher dose of steroids. Again though, you really need to run that by your doctor.

          Hope you feel better soon!

          • mark says:

            You’re an amazing man, Stephen. Not many people care about others while suffering as much as you have.

            My symptoms are uncomfortable and persistent but so far they are tolerable. My last dose of prednisone was 3 nights ago which was the reason of me freaking out about getting another flare.

            I will continue my treatment as prescribed and I will let you know in a few weeks how it went.

            Thanks again!

  13. Jenny Cattell says:

    Thank you for this breakdown of phases Stephen. It is spot on. I was ill for ages from Sept 2012 and didn’t get properly better until after Christmas, and due to the failings of the NHS I got turned away from A&E. Currently off work with another flare up after catching the first cold I’ve had in 2 years. No admission but the GP wanted me in hospital and the hospital said I wasn’t ill enough. Luckily my GP is great, and I’d rather be at home unless really desperate, but it is only yesterday, after a 5 day course of prednisolone 40mg and a 2nd 10 day course due to end tomorrow that I feel I have turned the corner. Today breathing is good and I feel well, but I’m just SO tired! I just hope that I don’t dip again when the prednisolone finishes again. Still on symbicort 200/6 8 puffs a day and montelukast (Singulair in USA I think?) at night. I need to start building up my strength so I can reclaim my waistline – what is with the above the waist weight gain? I look deformed! Many thanks for your insight Stephen. I’m glad I’ve come across you.

  14. Sorry to hear that you’re struggling, but it DOES get better.
    The weight gain is probably just water retention, it happens to all of us. The trick is not to go crazy with salty or sugary foods, though that’s usually what we crave while on the pred.
    Take care!

  15. Debra Douglas says:

    Hi, my name is Debra. I was diagnosed with asthma when I was 24. Would get severe fast hitting attacks and spend a week or two in hospital. I am not 44 yrs and have had only minor issues with asthma. A bad cold or pregnancy I would need puffers.

    This past Dec 9th I had a quick but nasty cold/flu for a few days. No asthma attack but breathing got more difficult. I was on 50mg Prednisone, Symbicort and Ventolin. I developed a dry constant cough. Walking or talking triggered it. I kept trudging along but tired trying to breath. Kept going back to doctor and we tried a round of antibiotics. Nothing worked. Kept pushing and got through Christmas and New Years with difficulty. By now for weeks I had only done what I had to. I was taxed out. I have a 7 and 9 year old who have busy schedules.

    For 3 days I developed a productive cough but clear mucous. I never felt sick through all this except the beginning. Never a full blown attack. Jan 9 I ended up in ER in respiratory distress. The RT and nurses were hopping around me. The doctor was a complete idiot and said I’m doing everything at home so I could go. Forgot I had switched to neb sat home 2 days before this. The nurse begged me to come back at midnight when this idiot dr left. I was too tired. I was shutting down. I left and thought I wouldn’t make it the night. My sister was crying on the phone listening to me and her and my Dad begged me to go to another hospital. My husband had never seen me suffer with asthma. He thought I could tough it out and it would pass.

    Dec 10 back to hospital again with the respiratory distress. Again RT and nurses hopping but 2 drs came quickly. I was admitted. Now on IV prednisone and nebs. Added PPI for reflux although I’d had surgery ( Nissen Fundoplication in Feb due to severe reflux). Had to be on oxygen. I was not responding to treatment for days, even a week later. Tests they ran were EKG, Echocardiogram, CT scan, VQ scan ( they thought I had a clot in my lungs), chest x rays ( all normal). Bloodwork skewed. Blood gases showed hyperventilation. I’d been breathing fast for a month now. One blood test showed indications of a clot. I developed some calf pain. Had ultrasound and found a clot but in a superficial vein in my leg. Had a Broncoscopy 4 days ago. Will get results Tues. They did a Brinchial Lavage and Brush and took a biopsies. A reddened area in my right lung showed then. I had Atelectasis of both lungs. Otherwise it looked ok. Dr ran 2 blood tests for autoimmune and Eosinophils along with another disease that attacks lungs and kidneys. Again find out results Tues.

    I was stable and off oxygen but low o2sats. Sat at 92-93% room air. Dr ok if I was 88% or above. Not sure why. Went onto puffers. My bed was needed so because I could make it to the bathroom and no one knew what was wrong I got discharged in day 10, 2 days ago. I have o2 at home which I use once or twice a day for about 20 mins. Clears my head and decreases the dizziness. On all meds except one for lung as I developed an allergic reaction. Got a sinus infection so been on antibiotics but today was extended 5 more days as pain worse.

    I’m a prisoner in my home. Can’t go up to bed so I sleep on the couch so I can incline. Everyone else caring for my kids. I’m very active and this is killing me. I’m terrified. I didn’t sleep for over 2 weeks until I dosed for cat naps only. Drs were desperately trying to get me some sleep. I am doing better but struggling. Legs are like lead to walk. Hoping for answers Tues but scared too. What if it’s something really bad? What if I never recover? I will go to a larger more advanced hospital if no answers and no better Tues. I’ve never gone through this. They say I don’t have COPD, which I have no risk factors for, but terrified. I watched my Mom die from this. She smoked.

    Sorry this is so long. Tried to just put highlights in. Anyone go through such an ordeal or for so long? They say I pushed and compensated so long that I could have died. I kept thinking tomorrow has to be better. It can’t go on like this. I was wrong. Thanks for reading if you made it this far.

    Debra

    • Hi Debra, What an ordeal. Sorry you had to go through all of that. For sure you should go to a bigger hospital, and if you havent already, get hooked up with a good pulmonologist. You mentioned having your eosin count checked, if it was high , you might find this video interesting. My lung doc, Sally Wenzel is doing research in this area. Hope you feel better and can get some answers soon.

    • Madel says:

      Hi Ms. Debra,

      I’m so sorry about what happened to you, I hope you will no longer have a severe asthma flare-up. I know how it feels to have a severe asthma attack. I was diagnosed as early as 3 years old with an asthma and I am now 23. I just had my severe attack just last month. I am on seretide maintenance & just shifted to symbicort a month ago.

      My 1st attack this 2015 was fine I am able to control it with my inhaler rescuer, I was given mepresone-steroids for 5 days and I am totally fine. I thought I was then okay, I do my normal activities like walking but I observe some breathless. I feel discomfort.

      After several days I had my endoscopy test. I was diagnosed with GERD/Heartburn. After 3 days I had my severe asthma flare-up that I never experienced it before. I had 4 doses of nebulization every 30 mins & every 2 hours round the clock for 3 days and every 4 hrs for 3 days. I also had medrol 16 mg. twice a day for 5 days. I was not rushed to the E.R. because my family members thought it was just an acute asthma attack. I was really grasping for an air and hyperventilating my mom was just asking me to relax while giving me salbutamol through a neb. On my 7th day i was fine, but I have chest pain lasted for 1 week again and I’m still feeling breathless, but i was okay again. I went back to the doctor and I was told that i am fine and I can do the walking.

      Days after I had heart burn for 3 hrs. at night time. It really hurts. After 5 days I had an acute asthma attack again, this was just last Saturday and until now I can still feel the tightness of my chest and still having a little difficulty in breathing. I just went back to the doctor yesterday and had my pft test & it turned to be normal and i was told again that I will be okay and that i am undergoing with an asthma anxiety.

      Does asthma really lasted for a week or two? Does Asthma Anxiety affects a fast recovery? Does asthmatic patients has always a possibility to have a severe asthma flare-up even under maintenance/steroid inhalers?
      I will be glad if anyone could help me answer this questions.
      Thanks in advance.

      Madel

      • Hello Madel,
        Sorry to hear that youve been sick. GERD is a very common trigger for asthma flare ups and can make the exacerbation more severe.

        *It can take several weeks, sometimes months to fully recover from a bad asthma exacerbation. During the recovery period
        *Yes, anxiety can certainly intensify symptoms, but inflammation in your airways can also make you feel short of breath, even if your PFTs are normal.
        *Yes, you can be on maintenance medications and still experience symptoms. Again, it can take a long time to completely recover from an exacerbation.

        Good luck to you and thank you for writing!

    • Hello Debra,

      Sorry for the delay in responding and Im sorry that you had such a rough time with your exacerbation.
      What you describe is not out of the of the ordinary for someone hospitalized with asthma and/or unexplained shortness of breath and hypoxia. Im glad you’re tests were negative. It can take weeks, sometimes months to recover from a bad exacerbation. Hopefully you’re feeling better now:]

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