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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  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


  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. :)

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