The Recovery

A lot of attention is focused on what goes on during a severe asthma exacerbation, but very little about what occurs after. What a lot of people ( and even some physicians ) don’t often realize, is that once the initial asthma crisis is over, the party has only just begun. There’s a perception that once you get past the acute phase of an asthma exacerbation, that your breathing rapidly returns to normal and everything is fine again. Well, that may be true in a very small percentage of asthmatics, but for severe chronic lungers like myself, the reality is much different. No matter how many of these severe exacerbations I go through, (and believe me, Ive been through a lot of them), it’s always the post hospital recovery period that’s the most difficult for me.

When you suffer an asthma attack that is severe enough to warrant hospitalization, once that critical acute phase is over , there’s also a recovery phase that you have to deal with. Though not as dramatic, can nevertheless make you feel just as miserable as the initial attack and can last twice as long!
You just don’t walk out of the hospital after a bad exacerbation and go about your business as if nothing ever happening. A severe asthma exacerbation and all the medications and interventions used to treat it, can reek all kinds of other havoc on your body, leaving you weak and breathless for days and weeks after the initial assault.There’s also an accumulative effect, whereby each subsequent exacerbation takes that much longer to recover from.

The length and severity of this recovery phase varies for everybody. For me, it’s usually determined by how severe the initial attack was, how many days I spent in the hospital,and how many steroids they had me on at the time of discharge. Generally, the longer the hospitalization and the higher the steroid dose, the longer it will take me to fully recover. Age and overall health play a role as well I’m sure, but in general it takes anywhere from 3-6 weeks to get back to normal.

Of course I’m grateful for the medical care I receive in that big building on the hill, but if you think about it, all they really do for you in the hospital, is stabilize you enough so that hopefully you won’t die. There’s no actual concern about “how you’re feeling” as long as your numbers are survivable. Once you’re over the hump clinically, you’re booted out and basically left to fend for yourself. There are no Nurses, Doctors or Respiratory Therapists to hold your hands or monitor your progress after you leave the hospital (unless of course, you live with one). At best, you might have a follow-up a appointment with your doctor a couple weeks down the road , but by then you’ll probably be back to normal ,which kind of negates the whole purpose of such an appointment.

Still, after going through this a million times, I consider myself lucky. There are some poor souls out there who’s asthma is so severe, that they never fully recover from their exacerbations. They are in a state of perpetual exacerbation and recovery. They are never symptom free. These are the people I feel for the most.

Maybe I’m asking too much, but I really think its important to have some kind of ” immediate” post hospital follow-up care for severe asthmatics. Even a phone call to see how you’re doing would help. Some of the Kaiser hospitals, to their credit, already do this.

Addendum : 4 hours after publishing this post, I actually received a phone call to see how I was doing. Not by the hospital personnel as you would expect, but from an understanding case worker from the insurance company . Needless to say, I was pleasantly surprised. The folks at Brown and Toland have their act together.

I’m not slamming any particular health organization or hospital for the lack of follow up care options for severe asthmatics, I’m just trying to bring attention to the fact, that there is often a prolonged and difficult recovery phase following an asthma hospitalization.
I have a pretty strong support network ( ie..this blog) , but many severe asthmatics don’t.

If this topic interests you, here are a few other posts Ive written in the past.

  • “Day 2″
  • “The First few days are the worst”
  • “A taper of a different kind “
  • Recuperative Phases of a Severe Asthma Excerbation
  • Related Posts:

    9 Comments

    1. Danielle says:

      This gets me too, people really don't understand what we go through to get back to "normal" after a severe exacerbation. Once the visible panic stage is over, it's easy for outsiders to forget what we are up against. Luckily I haven't had to climb that mountain in awhile now. I'm really rooting for a smooth recovery from here on in!

      Danielle

    2. Heather says:

      I think this happens in a lot of situations. I don't know about the United States, but here in Canada the system is so bogged down in every area, it's all workers can do to just keep people alive. Don't get me wrong..I am thankful every day for our "godless communist healthcare" but people aren't making the connection between good follow-up and better long-term outcomes. I also know another part of it is that here, doctors don't get paid unless they physically see you…so phone calls are out of the question. I recently had to drive five hours both ways to have a doctor read my mri and bone scan for 2 minutes.

      This post also reminded me….what do you think about allotment of resources for swine flu? There has already been talk that there are just not enough ventilators and ecmo for those that will need them.. Do you think that having asthma will be a point against us versus a young healthy-but-sick with h1n1?

    3. Susannah says:

      Well written, Steve. By all accounts let those who ought to see this see it-your Team, physios, shrinks, you name it. I always think that we get patched up enough to abort or fix the certain crisis scenario, then are discharged to start the rocky real recovery. From personal experience the length of time spent in a hospital bed prolongs the length of the recovery at home, so coupled with the fact that if you've been pretty darn sick whilst you were in that hospital bed, then you're looking at a pretty uphill recovery patch.
      It's a whole other 'kettle of fish' , isn't it, and one a lot of the medical bods don't really know about. It tends to be those closest to me who pick up the pieces at home following a difficult admission, plus my local GP.

      Oh yes, your US style discharge notes are far above what we get given here-there have been plenty of times that J and I have had to try and remember what happened to me during the course of an admission, drugs, IVs tubes you name it-this is something the UK is currently trying to rectify!

      Gentle healing hugs,

      Sus xx

    4. GayleMyrna says:

      Hi: Glad you are on the recovery road. Though I have had numerous ER, Urgent Care, same day doctor visits, etc., etc. due to the multiple exacerbations I've experienced, I've only had two hospital stays (I am adult-onset, with my condition worsened since 03). I am fortunate that my current family practice doctor of last 3 plus years has been very diligent on following up on me with multiple visits during my l-o-n-g recovery periods of time. Yes, you are absolutely right that once the initial acute phase of the attack has been dealt with (in my case, with lots and lots of prednisone, IV steriods, IV antibiotics, nebs, oral antibiotics, etc, etc.) there is a prolonged recovery period. In my case, inbetween exacerbations (and mine usually involve bacterial bronchitis) I still have dypsnea with walking faster than a strolling pace, and irritant hypersensitivity, etc….but at least I can function pretty well. I am currently at my "baseline", so optimistic, but vigilant. Take good care of yourself and keep on keeping on!
      GayleMyrna

    5. Olive says:

      hi stephen. Im glad your out of hospital and on the road to recovery. reading you post I can relate to it so much and you are so right. there is not much after care once you ahve had the attack and got stable. as you say drs jsut look at your numbers but dont actually know how you are doing. its not only physically draining but also psychologically as well. I am lucky that I ahve a great psychlogist who works with me now for after attack and works with me to make sure i pace myself and not go back to things too quickly. i find that the worse the attack the worse the recovery and the more frsutrating it is. i think the more attacks i ahve the longer it takes to recover jsut with more damage that is being done.
      take care and hope your recovery goes smoothly
      olive x

    6. LabPixie says:

      Hi. I found your post through some random googling. Although I've had asthma all my life, I haven't had a severe attack since I was a child. I had one recently that I needed to go to the ER for treatment. It was scary stuff. However, what shocked me was my slow recovery time. I was absolutely zapped of all energy for days. Moving on the couch exhausted me. Stairs and steps still leave my heart thumping and me breathless. My peak flow is still down. Despite the plethora of information available for dealing with an asthma attack, or controlling asmtha, there is very little about the aftereffects of such an attack. I was worried that I should have been bounching back alot quicker, and eventually phoned my doctor.
      I appreciate your post, and knowing that this is a pain for other people too :)

      • Stephen says:

        THanks for the comments. Sorry you’re having such a rough recovery. Don’t you just love this disease.! Are you a severe asthmatic? You should contact Sally Wenzel at the University of Pittsburgh . She’s looking for severe asthmatics for research. They’re doing some fascinating stuff there. She’s an awesome doctor who can totally related to the hell we go through.

        Breath easy!

    7. Kim says:

      Hi,
      I just wanted to write to say thanks for posting this blog. 4 weeks ago I was hospitalised for the first time with my asthma (I’ve had it for 28 years). I had a severe attack linked to an infection (high fever etc…). I left hospital after 1.5 days and rested at home for nearly two weeks before I felt well enough to get outside. I am still struggling after 4 weeks, but had a follow up with my doctor yesterday and all the signs are I’m getting better, but it will be at least another month before I’m back to normal. I’m now back at work, and everyone thinks I’m okay.
      Your blog has been a great help, as there is nothing written about the recovery stage. Thanks, Kim

      • Hi Kim,

        Thank you for the kind words.

        Im glad to hear that you are starting to feel better. Most people don’t realize how debilitating a severe asthma flare can be, unless they’ve experienced one.

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    "Can you have an asthma attack with a normal sat reading"?
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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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