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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63 Comments

  1. 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:]

  2. Christy says:

    This blog is amazing ! I just had my first asthma attack that I couldn’t rebound from without hospitalization . I have been going through the stages and it is so helpful to see that I am not alone and that this is normal. I am an emotional roller coaster the last 24 -36 hours and it sounds like we all do it.,,, thank you thank you thank you

    • Hi and thanks for the kind words.

      Sorry to hear about your hospitalization. Yeah, unfortunately recovering from a bad flare is often very difficult, but thankfully things do eventually get back to normal. It’s hard to understand just how tough it can be unless you’ve been through it.

      Here’s to a speedy recovery!

  3. JC says:

    Thank you for sharing your experience! I’m recovering from my first hospital stay due to asthma exacerbation. I’m on day 7 home and still can’t walk far without getting winded or lightheaded. I’m so glad I found your blog, and especially appreciate the recovery phases.

    I was diagnosed with asthma 9 years ago, though I know I had symptoms prior. The condition worsened when I moved to the CA Central Valley – not a good place for healthy breathing. I’ve been amazed at how little is known about asthma. Doctors know how to treat it, but there are so many possible triggers. I know my symptoms increase when I’m sick. I was recovering from bronchitis and a sinus infection when exacerbation took over. When I asked the doctors why it happened, they said that sometimes it just does. Not a very scientific answer, or a comforting one.

    With this episode, I’ve committed to make better choices to eat cleaner and strengthen my body. I’ll also continue to read your blog. Again, thank you.

    • Hi and thanks for writing.

      I’m so sorry to hear that you’re sick. What you’re experiencing is totally normal for someone who is recovering from a severe flare. Bronchitis and sinus problems are huge triggers and are super common in asthmatics.

      I know what you mean about the lack of knowledge about this disease, I’m trying to do my part to change that. Educate yourself as much as you can about this disease and be proactive. If you don’t already, you really should see a pulmonologist who specializes in the treatment of asthma.

      I hope your recovery is speedy!

      All the best to you,
      Steve G

  4. Brian Pettrie says:

    Thank you for this site. Like others have said, it is comforting to find others that can relate to what I go through.

    I’ve had asthma since birth. The last few years, its really flared back up. I’ve been to the ER 6 times in the last 2-3 years and I should have gone probably another 5-10 times. I haven’t had health insurance in a few years. In Indiana, its hard to get on health insurance. So I also haven’t had a rescue inhaler for who knows how long. Its nothing for me to make it through a 24 hour asthma attack or even longer. I feel like I will die every time but I’ve done it so much, I know I’ll always make it.

    I also experience the fatigue after the attack where I can’t even make it to the bathroom without having to sit down and gasp for air. I’m at that stage today. I’m trying to get my credit better and I just can’t afford to keep racking up ER bills between $600-$800 so this latest attack, I didn’t go and it was hell.

    Without an inhaler, I usually drink either black coffee, green tea, I have a salt inhaler which helps sometimes, other times it does nothing. I mainly use the Primatene Tablets which do work most of the time if I can take them before the symptoms really hit. They don’t really work when I wake up in a full blown asthma attack. I am experimenting with Ginger as I heard it works wonders. For now all I can afford is Ginger Ale which I’ve been told, the main brands, don’t even have real Ginger in them so I’m not sure how effective it will be. Right now its not really helping.

    I ordered some Magnesium Oil from Amazon which I just learned today, works wonder. I never realized Magnesium was so important and why don’t doctors mention this? Do they just not know about it?

    Ironically, I work for Indiana Medicaid, have been there about 13 months but I’m still a temp because the company is cheap so I still have no health insurance.

    I also live with family members who smoke, light incense, use bleach and whatever else so I realize, I’ll never fully be able to control my asthma until I move.

    For now, I’m going to buy an air purifier to help filter out the cig smoke, dust, etc.

    When my magnesium oil comes, I’ll rub that on my chest for a few days and come back and report. I read thats the best way to get the magnesium in you, versus taking it orally. If anyone else has tried it, let me know how it works out for you. The forum I found that on, everyone basically said its helped them a great deal. They just use it everyday and put it right on their chest.

    Again, thank you for this great blog and all that you do.

  5. Elke says:

    What a breath of fresh air (can’t resist a cheesy pun!) to discover and read your blog! Fantastic stuff! I had a few giggles in the sheer sense of relief that i was somewhat normal in this abnormal state! Forgive the following novella, but tired wired and can’t shut up!

    Just got released yesterday on bail after 15 days in prison (the wheezy lung ward, just barely escaped IC after a backslide after 5 days!) and feeling a little loopy and disorientated, as well as still SOB and wheezing like a pinwheel. While i have had asthma since childhood, this was my first “big one” that required 2xIV instead of oral steroids, wasn’t responding to standard treatment and went quickly downhill instead of upwards like it should (asthma not playing fair!) Having had a parent who died from asthma when i was young, i never saw myself as that bad – even though i have been to an ER numerous times and have had past attacks that were somewhat stubborn. However, most of my adult life my asthma has been so well controlled, i forgot it ever needs anything more than an extra symbicort or albuterol. How easily we fall into denial!

    Naturally, there were those signs that are easily talked away “the pollen must be bad today”‘, “bit of smog in the air”, or whatever other excuse i could think of. I swim middle distance and needing to stop and leap out of the pool for an inhaler… Apart from an aside mention to my doctor when i saw him for something else, i didn’t see those signs infront of me until i was breathlessly telling my rather concerned partner that i “didn’t need to go to hospital yet, just another puff should settle it down…”

    I am also rather calm in an attack, because i always thought panicking is a really quick way for things to deteriorate to the point you can’t get the help you need. And i never like to worry those around me AGAIN, especially if it’s nothing… And hey, those o2 sats are fine, nothing to worry about!

    It was rather disconcerting then, when all of a sudden it went down south, not just the initial warm up attack, but the unexpected later big one. I don’t remember much, but confusion and lots of activity around me and not understanding what was happening. But all the same, i still had enough of me present when they told me “we’re not going to let you die” to think “i should hope not – this is a hospital, isn’t it?” 🙂

    I am still quite sick, but well enough to be able to piece together what happened on those confusing days. In and out of some major ‘roid mood swings and emotional times, but reading your blog has really helped me understand it all and see it all from a better place. Knowing what is going on helps me process it all, and that helps me feel much better about feeling still uncontrolled. Battle scarred, bruised and moon faced; with timetable nebs, inhalers and pills, catching up on the latest asthma stuff while still not sleeping. But on the positive side – it’s nice to not have to discuss my bathroom habits with the rest of the world!

    Deciding when it’s time to go to hospital is always hard, especially if you have had asthma over the years. Sometimes your judgement goes out, or you second guess yourself. Having had years between attacks and being fairly well controlled can make it even more a challenge. But i was lucky to have been where i was when it did, so i hope next time i will not hesitate on my gut and try to tough it out (until morning, or whatever). Complacency is more dangerous to me than panic, it would seem.

    So, i’m somewhere in the rebound/zombie phase right now. Food is just coming back though still tastes like cardboard, the inflated ballooning of my body, laughing and crying at the same time, making inappropriate jokes and picking arguments with family… and chest and back muscles feel like they’ve been run over by a truck! It’s good to know that these are all normal and will end… Soon!

    Thank you once again!

    • Hello, Wow…what an ordeal. Sorry you’re having to deal with all the fun steroid side effects. ( I just weaned off a round myself.) Im glad you made the decision to go to the ER. Hopefully the worst is behind you now, though I can totally appreciate how you probably still “feel” sick.
      Most people, unless the’re impacted by the disease ( physicians included) have no idea how severe and devastating asthma can be. I’m on a mission to change that.

      If you need someone to communicate with while you’re dealing with these steroids crazies, feel free to write. I can’t guarantee I’ll be able to respond right away, but I do my best to read all of my mail as it comes in.

      Stay positive and focus on getting back to your normal routine. And remember, you’re not alone! There are thousands of us who live through this same scenario every single day.

      Best,
      Steve

      PS.. Are you in the US?

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