The actual treatment you receive in the emergency department of the hospital depends on the individual characteristics of your asthma, other health conditions you may have, as well as the severity of your symptoms when you arrive in the emergency room. In general, you can expect three components to your emergency care. The first will consist of immediate treatment with supple-mental oxygen, bronchodilators, and anti-inflammatory medicines to gain control of the asthma exacerbation. The second component to your care will consist of careful assessment of the degree of asthma severity, along with close monitoring of your condition and overall response to treatment.
The third component will determine whether any other superimposed conditions are present and how they might affect your asthma. You can expect to be given supplemental oxygen to breathe, via either nasal prongs or a mask. You will likely be given repeated doses of short-acting β2 inhaled bronchodilator therapy in succession by a nebulizer or MDI (metered-dose inhaler) with a valved holding chamber (VHC). A temporary intravenous catheter (IV) may be inserted into a vein in your arm to allow for rapid administration of fluids to counter any dehydration. Steroids in pill form or via the IV (if already placed) will be prescribed to reduce airway inflammation.
Other inhaled treatments and intra-venous medicine may be prescribed on a case-by-case basis. As your treatment gets under way, you will be examined with close attention to vital signs and the lung exam. Your pulse and oxygen level will likely be monitored by a special sensor called a pulse oximeterThe pulse oximeter clips onto your fingertip and is painless. You may be asked to wear a heart monitor, which is made up of thin wires attached to electrodes stuck to the skin of the chest on one end and connected to a monitor screen on the other. The emergency room doctor and nurse assigned to your care will keep watch on you as you receive the prescribed treatments.
Some hospitals also have respiratory therapists on duty in the emergency room, and they will certainly play a role in your care as well. You will be asked to perform serial peak-flow measurements to help gauge your response to treatment. You can expect to spend at least 4 hours undergoing emergency treatment of asthma. You may undergo a chest X-ray and blood tests if an infection is suspected. You may be asked if you know what triggered your asthma.
Under the ideal circumstances, your exacerbation will become controlled in the emergency room, and your asthma will be stabilized. Your symptoms will lessen, and your peak flow will rise into a safe zone and remain there during your emergency room stay.
You will be given specific instructions for stepped-up asthma care, and you will need to contact and see your regular asthma doctor for a visit within a few days of the emergency room visit. If, on the other hand, your exacerbation cannot be controlled within 6–12 hours of aggressive management, you will likely be admitted to the hospital for continued care. If the physicians treating you in the emergency setting advise hospitalization, then agree.
You must take their best medical advice, no matter how inconvenient it may seem! The worst case scenario consists of an individual who misjudges the severity of an exacerbation and waits too long for treatment, or who doesn’t follow recommendations and ends up with out-of-control asthma that can lead to respiratory failure, and tragically, albeit rarely, even death.