Asthma

Being on the right asthma treatment and avoiding known triggers greatly reduces the chances of an asthma attack. An attack may come on suddenly (for example in severe brittle asthma) but often there will be warning signs for a few days before. People we talked to told us that warning signs included having to use the blue reliever inhaler more often; changes in peak flow meter readings, and increased symptoms, such as waking up coughing in the night. Warning signs should be taken seriously because they indicate that the asthma control is poor which increases the risk of having a severe attack. As Dee said, "You can manage to do an awful lot not to let it escalate into a really serious attack, and a serious attack is a big chunk out of your life…So it really motivates you to try to do everything you can not to let it happen."

Many people have a personal asthma action plan to help them to know what to do when symptoms escalate, but if they continue to get worse further help may be needed.

Often using the reliever inhaler will be enough to calm things down but sometimes symptoms may become more severe and the person may need to take further action and call for help, or go to an emergency department. In the event of a severe asthma attack current advice (Asthma UK 2016) recommends that you;

1. Sit up straight - don't lie down. Try to keep calm.
2. Take one puff of your reliever inhaler (usually blue) every 30-60 seconds, up to a maximum of 10 puffs.
3. If you feel worse at any point while you're using your inhaler or you don't feel better after 10 puffs or you're worried at any time, call 999 for an ambulance.

If the ambulance is taking longer than 15 minutes you can repeat step 2.

We talked to people about asthma attacks, which were sometimes frightening (see ‘What asthma feels like’). Struggling or ‘fighting’ for air could make people feel panicky but, as Dee and Philip explained, an asthma attack is not the same as a panic attack. Not everyone who has an asthma attack needs hospital treatment and it largely depends on the severity. Many people with asthma never need hospital care. Some may need it only once or twice in their lives and have managed attacks on their own, or with advice from their GP or asthma nurse. Susan remembered a couple of times when she had gone out without her inhaler and was at the point of feeling unable to cope, but she wasn’t far from home and managed to get back and use it in time. Jane has had asthma for many years and keeps a supply of the oral steroid prednisolone at home to use when her asthma flares up, although she usually phones her GP for advice before she begins taking them. ‘I would take it when my asthma is bad and I’m vulnerable’. A few people said they had misjudged the warnings, or not recognised the severity of their symptoms, had ended up having a bad attack. Those who had a written action plan, or had discussed what they should do in the event of an attack with the GP or asthma nurse, were aware of how to keep control of their asthma.

Dee, and others, described finding it hard to make proper decisions during an attack, feeling ‘in a fog’, ‘detached’, not wanting to move, and ‘feeling or being’ past caring what happened to them. Having written details of the medicines and emergency information could also be very useful for other people – especially if the attack means that it is hard for the person to speak. If another person witnesses the attack they may be able to help take action on the person’s behalf. People we talked to suggested that it can be a good idea to warn friends, family and colleagues what to look out for and what to do, for example, just knowing where an inhaler is kept could be very helpful to someone who is struggling with an attack. Mary was hospitalised quite often when she was younger, but these days if she has an attack it can usually be dealt with at A&E and she can generally go home the same day. However, Mary, like Ann above, said she sometimes worried about being alone and not being able to get help. Faisil remembers his mother calling for the doctor in the middle of the night when he was a child and he would be given an injection to calm things down, or she would take him to A&E where he’d be given oxygen. As an adult he has largely been able to control his asthma but there have been times when he’s gone to A&E and been given medication through a nebuliser which usually works more quickly than using an inhaler.

Andreane said that when things are getting out of control it can be reassuring to have people around you who help you to stay calm. ‘Any form of kindness from a colleague or friend or a family member just you know, shows that they care and you know, they want to help you, helps a lot’. Belinda remember a time when she had been taken to hospital with severe breathing problems and the nurse had given her a nebuliser and stroked her back which she found helped her to calm down. Some people said that they made a point of making sure that other people such as airline staff or employers would know what to do in case of emergency.

Dee always uses her peak flow meter to keep a check on her lung function and when it‘s low knows that she needs to step up her medication. She has only had to go to hospital for emergency help twice and says the best piece of advice she was given when she was first diagnosed was to be ‘an organised asthmatic’, which for her means keeping a note of her medication in a place where others would be able to find it, keeping inhalers in places like the car and the office drawer, and most importantly, using a peak flow meter regularly so that if your reading goes below a certain level you know it’s time to get help. The time when she had to go to hospital for help she said ‘I misjudged how far down into breathing difficulties I was because I didn’t have a peak flow meter’. (At the time she was away on holiday and out of her normal routine. Being away from home in an unfamiliar environment (especially abroad) can be worrying for people with asthma, so planning ahead can be useful). (See ‘Managing asthma – reviews and action plans’). For some people with severe or brittle type asthma, hospital admissions are a more regular occurrence and difficult to avoid. Jenny has a type of asthma that is very unstable and she says she can have very little warning before an asthma attack. "I don’t have simple asthma, I have what’s called severe brittle asthma, which means I go from being perfectly well to terrible in a matter of hours….or I can do… but that’s not what all asthmatics do and so I don’t, I don’t want to frighten all asthmatics and say, you know, you’re all going to end up going blue round the edges because you’re not, but it’s just what I do." Jenny is often given aminophylline in hospital. This is a bronchodilator which is given in injection form, but it can have unpleasant side effects including vomiting. Mary is now able to get aminophylline at her GP surgery, which is much more convenient.

Jenny’s local ambulance service has a ‘red flag’ on her mobile so that if she rings they know it’s her and she does not need to speak much. Her care is normally very efficient, but just occasionally she has had to wait in and A&E when staff have not been so well-informed about asthma. Others said their experiences had been mixed, with some excellent and immediate attention in A&E, but also some encounters with junior staff with limited experience and training who did not realise the need for urgency. Jane (above) carries an emergency admission card to ensure she gets seen quickly, and the only time her care has been less good was when she was admitted for another condition. The nurses had no training in respiratory care and did not understand that she needed medication immediately in an attack.

(Also see ‘Medication and treatments – other treatments’, ‘Relationships, friends and family’, ‘What asthma feels like’, ‘Changing symptoms over time’ and ‘Emotions and coping’).