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Silent Asthma Attacks

In light of a recent experience, I'm looking for some help from others who have been there before me. How do you address it when you're in a bad attack and a doctor or nurse tells you "your pulse ox is fine" or "you're not wheezing". Sometimes these are followed by other statements "you just need to calm down" or "you're not trying hard enough to breath". I've had some great dr's and nurses in the ERs and while I've been hospitalized previously, but I've also had those that dismiss me, try to tell me it's just anxiety, and in general, do not have a good understanding of the different ways asthma can present.

I'm an asthmatic, and I don't wheeze, I breath stack, air trap, and manage to keep a generally stable pulse ox level. What do you do when medical personnel use these things as signs that it's not so bad or that it's not asthma at all?

I already have a synopsis of my asthma and history in an app on my phone, connected to a medical alert bracelet I wear. Yet, I'm almost always worried about seeking care in an emergency because I've had enough bad experiences of being dismissed by medical personnel and then having my condition deteriorate.

  1. As a healthcare provider, I hate hearing that people such as you have these kinds of experiences when going to the emergency department, seaturtle08! It's so frustrating from my standpoint, so I can only imagine how it must make you feel. There is nothing worse than being told to calm down when you can't breathe.

    One of things I remember well from my years of clinical training was, "always look at your patient, not the numbers". Doing that has served me well over the years and prevented me from making this kind of mistake with someone such as yourself. That should always be a basic clinical practice, especially in a situation such as you're describing. However, that's not always the case.

    I'm hoping others that have experienced this will chime in with some suggestions. I've had people tell me they carry a note/lette from their primary care provider that states how they present when having an exacerbation of asthma. You could try that. You might also try calling your PCP as you're headed to the ED and ask him/her to call ahead and tell them you're coming and how you may present.

    Also, I would hope the providers are looking at other indicators such as your peak flow - which I'm assuming during an attack is fairly low.

    It's great that you have the app you do to show the ER team. Technology can really be our friend in a case like this!

    I hope if you have to make anothe trip to the ED, it's a better experience.

    Lyn (moderator)

    1. I updated my asthma information in my myid app today, based on some research I've done and articles I've found on here. I can't attach a screen shot, but here is what first responders and medical personal can see (along with my med list, emergency contacts, other medical conditions, etc) if they scan my bracelet:

      Asthma Attack presentation:
      -Pulse O2 stays stable, until in impending respiratory failure. (Due to unimpaired oxygen exchange in the lungs and hyperventilation)
      -Silent chest: minimal wheeling during attacks.
      -Peak flow drops to 300-400 (normal 680-700)

      PLEASE: don't look at the numbers and dismiss me. I can usually fight to breath and keep myself stable for many hours, but when you say I'm fine because my pulse ox is stable or that I'm not working hard enough to breath, my anxiety spikes because I worry that I won't get the care I need.

      History of intubation for asthma (2/14/17, 2/20/17), and 12/1/17). Typically need high levels of sedation during intubation to prevent awareness and waking up.

      NO SYSTEMIC STEROIDS! History of steroid myopathy. Treat severe asthma attack with epinephrine, magnesium, and inhaled steroids.

      Is there anything else that people have found helpful to share with medical personnel (or that you would want to know if you were treating me)? I didn't think to add the part about difficulty with sedation during intubation until after last weekend when I woke up multiple times- even though the doctors told me after my previous intubation that it took almost double the normal amount of medication to keep me under.

      1. Thanks. While I've had difficulty in the ER before, my recent terrible experience was after I was admitted- the ER was awesome about everything. And the smaller ER where I've wound up a couple of times has also been good- the last time I was there the doctor and 2 nurses recognized me and got treatment started within 3 minutes. Even though everything went well in the ER, I still get nervous about seeking treatment when it's bad, because I'm worried that someone won't believe me.

      2. Hi Seaturtle and that is perfectly understandable, too. It's good to hear you were taken care of so well in the ER's you described. Things do seem to go well when the (ER) staff are familiar with you personally and your condition.
        Until the care is going in the right direction, it's easy to understand your apprehension.
        All the best,
        Leon (site moderator)

    2. Wow, this looks pretty comprehensive seaturtle08. Hopefully others will chime in if they think of anything you may be missing. It certainly seems that this should be more than adequate to get medical personnel started with treatment and to let them know that you are knowledgeable about your condition. Best, Richard ( Team)

      1. I was once advised that the best treatment for an acute asthma attack is a brown paper bag (in the old days when such things existed)...

        The argument was that often the problem for the asthmatic was remembering to breathe OUT. If your lungs are already full, it is really hard to breathe IN, which is what people who are panicking often try to do.

        The bag helps the asthmatic to remember to breathe out before breathing in again and so helps them to calm down.

        Having said this... I think it is only a part of the solution. I miss Primatene Mist because, for me, it works MUCH faster and more reliably than Albuterol - I can feel the difference immediately with the Primatene - The first puff gets enough in that it allows the second puff to get deep into my lungs and do the job properly. With Albuterol, it does not feel like it has any impact and, while it is probably a bit better 5 minutes later, that may just be my optimism. Yes, I still have part of my stash of 6 PM refills from before they were banned, which shows how rarely I use them - I only get asthma when I exercise and when I am sick (and from dogs, but I can mostly avoid those). On the rare occasions when I have a serious attack, I need to be able to resume breathing NOW, not in five minutes (especially since I'm not sure that enough Albuterol gets into my lungs to help - breathing in is not easy when having an asthma attack, pretty much by definition). I have never needed to go to the ER due to an attack, which is a good thing since I live 30 minutes away from the nearest one.

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