Hi again, Rose, and thanks for your response and further explanation. I appreciate it! I am glad to hear that you have a good relationship with your pulmonologist, That relationship can go a long way towards successfully managing this disease. Adjusting the medication regimen sounds like the most prudent approach at this time.
It's understandable for you to be anxious about presenting to the emergency department (ED) again. One suggestion would be to have your pulmonologist provide you with a written asthma action plan. That way, whatever ED physician is on duty the next time you arrive, will be properly informed of how your attending physician (the pulmonologist) and you manage your particular level of disease. That should take care of the concern, too, about presenting with no wheezing present. Alternatively, the ED physician can be advised to call your pulmonologist directly to discuss your case first-hand. This works for any number of patients I provide care to on a regular basis and the arrangement is well accepted by all concerned. Perhaps this would work for you as well.
Generally speaking, the initial phases of an exacerbation of asthma may result in respiratory alkalosis (high pH and low CO2), with a normal oxygenation level. As the episode progresses, the alkalosis may transition to a respiratory acidosis (low pH and rising CO2), with a normal or decreasing oxygenation level. Should the episode progress untreated, the acidosis can rise further and the oxygenation level can continue to decrease. This is the generalized 'mapping' of an asthma exacerbation and does not necessarily affect all patients. However, rather than worry needlessly, my suggestion would be to stay calm and follow the asthma action plan. If the condition starts to worsen, the idea would be to seek out medical intervention and reach out for your private medical doctor. There is no reason to delay treatment when the episode is persisting or worsening even.
What are your thoughts?
Leon (site moderator asthma.net)