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Expert Level Compensator

Last updated: August 2022

I was recently having a conversation with a friend about what it means to be an “expert level compensator” when it comes to having a chronic disease. This is a non-official term that my medical team has used to describe me for over two decades. So I wanted to take a few minutes and talk about what this all means and how it pertains to me personally. For those of us with asthma, this might sound all too familiar, but it is a great talking point for those around us without any breathing difficulties.

Examples of being an expert level compensator with asthma

Breathing and talking

For example, think about when you breathe and talk. This is probably something non-asthmatics have never really thought about because it is not an issue for them. Are you able to take an average size breath and get a few sentences out in that breath? For me, when my asthma is flaring, I have to take in as deep of a breath as I can, and then I will either talk very fast or not let out too much air with each word to stretch it to try and get as many of the words out as I can and then pause to take another big deep breath, and repeat. Otherwise, I’d only get a couple of words in before taking another breath. I do not have the lung capacity to breathe and speak and do things as “normal” people do all of the time. Same goes for singing. I am a musician and I have mastered the ability to sneak in extra breaths when I am up on stage singing while playing my guitar. Most people would not notice that I sometimes do this, but there are a few that can tell, including my doctors.

Let’s talk about breath sounds. I rarely wheeze. I’m a silent asthmatic which is known in the medical world as the scary kind. My lungs skip the wheezing step and get very tight, and you cannot hear much of anything with a stethoscope. A silent chest is what gets a respiratory therapist in panic mode.

Preserving oxygen saturations

Another part of being an expert level compensator is my ability to preserve my Oxygen saturations (or SPO2.) Many asthmatics have this “superpower” where we will work really hard to stay oxygenated as long as we can. So we can be in the middle of a severe asthma attack in the ER and have a normal oxygen reading. I have personally intubated many asthmatics in the emergency room who were struggling and tiring out but had a “normal” SPO2. The moment it starts to drop is when it’s time to act very fast to avoid potential impending respiratory arrest.

Always tell people if you are having trouble with your asthma

So why am I telling you this? As with many different chronic diseases, the signs and symptoms aren’t always as outward as one would think. Asthma is one of those tricky diseases that have both visible and invisible components to it, and it is not a one size fits all disease. Even though I have been referred to as an expert level compensator, I still let people know when I am having trouble with my asthma. Asthma is one of those diseases where we can decline very rapidly and suddenly and being a “hider” can only make things worse. I could be having a bad asthma day and you might not even know it. I know I am not alone in this and other asthmatics can relate.

Are you an expert level compensator too?

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