Foremost on my mind during an asthma excerbation is the question….how bad will it get? Is this flare going to escalate to the point where I need hospital care? If I don’t go in, will I end up on a ventilator, will this be the one that kills me? After all, 4,000 people in this country alone still die of this stupid disease every year, most of them before they make it to a hospital.
Like most chronic asthmatics, I tend to downplay or even ignore the severity of my symptoms for as long as possible, because I know the unpleasantries in store for me if I end up in the slammer(ie blood gas sticks, IV insertions, bipap masks, etc.) But in procrastinating, am I playing asthma Russian roulette? Should I go in at the first sign of trouble, or should I try to tough it out and hope it gets better on it’s own? Should I call my doctor or an advise Nurse? Should I check the web to see what other people do?
On the flip side of that dilemma, there are those of us who are in and out of the hospital so often that we might be asked, what did they do for you in the hospital that helped your asthma, that you could not have done at home? In other words, is there something similar I could be doing at home to avoid having to go to the hospital in the first place? Some of my own doctors have asked me that very same question, and quite honestly it was difficult for me to come up with a quick response. It made me feel like I did something wrong.Im also more than aware of just how incredibly expensive it is to treat asthmatic in the hospital, which just adds to the stress of coping with this disease.
So when exactly does an asthma flare warrant an escalation in care? There are really no hard fast rules or standardized guidelines in determining when a flaring asthmatic should seek emergency medical care. It’s a total judgement call on your part. Obviously, if your symptoms come on suddenly and they’re severe and you’re gasping for air you should probably call 911 or have someone drive you to the hospital right away. Or, if you’ve been dealing with an exacerbation that’s lasted more than a few days, but doesn’t seem to be getting any better despite taking medication, you should seek help right away as well. But what if you’re not quite to that stage, what should you do? This can be a tough decision to make, especially at a time when you’re struggling to breath and basically feeling like crap.
Most of who have had this disease for a long time are more than capable of treating are bad flares at home, but even for us there has to a line in the sand that should never be crossed, and that line should be clearly spelled out in your asthma action plan. ( Hopefully you have one). Above all though, it really boils down to a matter of safety. If you’re exceeding the recommended doses of your asthma meds, then you’ve already crossed that line. Sure, you can give yourself a large bolus of steroids at home, which is what they would do in the hospital, but doses of prednisone pills exceeding 60mg have not shown to be anymore effective , and the oral route can take many hours to kick in. Same goes with high doses of nebulized bronchodilators. Although it’s pretty safe to take a few extra Albuterol neb treatments at home, sometimes that’s still not enough to open tight airways. Sometimes it requires Mega doses, or the equivalent of 4 to 8 neb treatments per hour, for several hours to have any affect. Because of potential cardiac issues associated with high dose bronchodilators, it’s simply not safe to do at home. You need to be monitored both visually and electronically with a heart monitor. There are treatments you simply can’t do at home, including IV steroids, magnesium, Bipap and mechanical ventilation, in case you tire out or stop breathing all together.
The bottom line here, is that you need to apply common sense and go with your gut feeling in determining whether you should seek medical care for an asthma attack. If your exacerbation is not getting better despite doing everything you’re supposed to, and/or it’s been brewing for more than a day or two or if you have a history of severe asthma and have been intubated and spent time in the ICU, or things just don’t feel right to you, then you should get yourself to the hospital pronto. Don’t try to second guess yourself or worry about what he doctors or nurses might think….err on the side of caution and just go! You might also want to discuss with your family and friends in advance, about what to do in the event of an asthma emergency. Here’s one of the best articles Ive come across regarding status asthmatic ( an asthma flare that doesn’t improve despite taking maximal amounts of medication) from the perspective of an EMT and paramedic. These particular medics really know their stuff.
As far as children go, they can’t speak for themselves. Learn to recognize the danger signs, which are often much different in children than adults. And by all means take them in right away if their symptoms don’t improve or if you’re not sure.
Now, on a semi related topic, how many of you frequent flyers have experienced the following scenario?……
You’ve had an exacerbation brewing for a couple days and you’re getting progressively tighter and tighter. You decide it’s finally time to head to the ER. They triage you to a room and suddenly, and almost miraculously, you don’t feel quite as tight as you did 15 minutes earlier. Then you start 2nd guessing yourself, thinking that perhaps you’re not as sick as you originally thought? Or maybe it’s anxiety that’s making you feel worse than you actually are? You feel a little embarrassed and are actually considering leaving, but it turns out that you are indeed sick and you made the right choice by going in?
To demonstrate just how distorted ones perception of ones own breathing can become during a bad flare, here’s an example of what happened to me a couple years back….
I had been feeling sick as a dog, tight as can be. I reluctantly headed to the ER as above, but the moment they wheeled me back to one of the treatment rooms I started to feel better. I was even telling the doctor that this was a relatively minor flare up that I probably should have waited a little longer to come in. Well, 2 hours later I went into full blown respiratory failure, had a respiratory arrest that required CPR and woke up on a ventilator 2 days later!
Again I can’t stress just how important it is to go with your gut instinct. If you’re an asthmatic and you feel like crap, blame your breathlessness on the asthma first, and then consider the possibility of anxiety, but always in that order. No doubt that anxiety can add fuel to the fire, but asthma can actually kill you all by itself, so don’t mess around.
So, what criteria do YOU use to determine if, or when, you should go to the hospital ? And how high do you set the proverbial ER bar? Do you wait until you’re at the brink of respiratory failure, or do you go in at the first sign of trouble? Studies have shown that the sooner you come in for treatment, the better chance you have of slowing or reversing an attack and preventing a possible hospitalization. Not to mention, possibly saving your life.