Gemma’s comment: Emergencies can be scary. During a vacation at a popular seaside resort in the northeast, I was caught on the beach as a squall came up, blowing sand in my face and mouth.
Because my children were playing happily, I delayed leaving the beach, and by the time I did, I was gasping for breath, almost unable to climb up the dunes. By the time I got to an emergency room later that evening, my breathing was very labored. The treatment was scary, too. I was given a shot of adrenaline, which made breathing easy, and sent home. The adrenaline kept me wired (i.e., extremely tense and unable to sleep) for more than a day. I should add that this emergency occurred 20 years ago, and that I was treated in a small regional hospital, better prepared to deal with boating accidents than breathing problems. I’m sure the treatment would be better today.
The inability to gain control of an asthma exacerbation is the major reason for proceeding to the nearest hospital for emergency treatment . The simple fact that your asthma is more active might not in itself war-rant an emergency room visit. If your asthma responds to increased treatment as advocated in the NAEPP’s guidelines, or as outlined in your asthma care plan, then you might simply need to check in with your asthma provider. If your asthma symptoms do not respond to the increased treatment, or if your symptoms worsen despite such treatment, then a visit to the emergency room is indicated. The decision to proceed to the emergency room is based on medical considerations as well as common sense. Keep in mind that each individual’s asthma is unique. Some individuals may experience rap-idly worsening exacerbations, for example, and the rate of how rapidly your asthma tends to progress should certainly be taken into account as well. I always remind my patients that emergency rooms are open and staffed 24 hours a day for a reason—because they are needed!
Asthma unresponsive to stepped-up home treatment is exactly the type of condition that emergency rooms are designed to treat. The key is not to hesitate to proceed to the emergency room if your asthma specialist advises you to, or if the protocol you’re following as part of your asthma action plan calls for it. Every asthma action plan must include clear criteria for when you must obtain emergency care. A red-zone peak expiratory flow (PEF) less than 50% of your personal best is a clear-cut indicator of worsening asthma and warrants transportation to the emergency room. Don’t delay! Trying to tough it out will only make it harder to control your exacerbation. It is better to intervene early and quickly. Consider, as part of your routine asthma care, discussing ahead of time with your asthma doctor how best to handle increased asthma symptoms, when to start steroid therapy, when to telephone for advice, and when to go to the emergency room.
Kerrin’s comment: When my son had his first respiratory episode, we didn’t know what was happening. He had a cold, he had a very productive-sounding cough, and he was wheezing. We had the nebulizer from an earlier illness he had during which his doctor heard wheezes, although nothing as extreme as what we were hearing this time. We used the nebulizer, which worked for a short time, but only a couple of hours. We had to re-treat him within 2 hours. We put him to bed after one of the treatments and he seemed to be doing better, but after checking on him an hour later we thought he might be having trouble again.
It was hard to tell, though, because he was asleep; we couldn’t really see the retractions in his chest, and we thought perhaps his deep breathing was just from the fact that he was asleep. When we called the doctor, she asked us to hold the phone up to his mouth so she could hear him, and she told us to look at his neck to see if retractions were occurring there; they were, and they were very obvious. Hearing this, combined with the fact that we were having to readminister treatments within 4 hours, she told us to take him straight to the hospital. He ended up having to stay for 2 days.