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Controlling Severe Asthma

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When Adult Asthma Sends You to the Emergency Room

Medically Reviewed By William C. Lloyd III, MD, FACS
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Severe asthma symptoms can require treatment in an emergency room. Know which symptoms to watch for, and what to expect if you have to seek emergency treatment.

young woman reaching desperately for asthma inhaler

Imagine this scenario: You’ve been having asthma symptoms for the last three days and using your rescue inhaler to manage them. You haven’t had time to call your doctor, but the inhaler has helped each time you have used it. Today, you are having trouble talking without feeling breathless. You use your rescue inhaler, but you still feel winded after 15 minutes. This is just one scenario that should be a red flag to an adult with asthma. It means you’re having an adult asthma emergency and you need to go the emergency room for the right care.

Signs and symptoms of a dangerous adult asthma flare-up

Having frequent asthma symptoms means the disease is not well controlled. If you have symptoms more than twice a week, you need to call your doctor. It may be necessary to change your treatment for better control. However, there are certain symptoms that mean you are in danger and need immediate help. A severe adult asthma attack can progress quickly and be fatal. Signs and symptoms of a potentially deadly asthma attack include:

  • Agitation or anxiety that gets worse with time or a sense of fear or impending doom
  • Bluish skin, lips or nails
  • Confusion or altered consciousness
  • Fast heart rate and breathing rate
  • Progressive breathlessness or what people may describe as hungering for air
  • Sweating
  • Trouble talking due to shortness of breath or an inability to lie down due to breathing difficulty
  • Use of chest and neck muscles to help with breathing

Seek immediate medical care (call 911) if you, or someone you are with, have any of these signs or symptoms.

What to expect in the emergency room

When you get to the emergency room, the staff will evaluate your symptoms and risk factors. This gives them information about the likelihood of a life-threatening situation. Risk factors can help them in this process even if you appear stable.

The strongest risk factor for a potentially fatal asthma attack is having been admitted to the hospital for an asthma attack in the past. You will need extremely close monitoring in this case. Other risk factors include having a history of poorly controlled asthma or recently needing oral corticosteroids to manage your disease.

Adult asthma emergencies require aggressive treatment. This will include supplemental oxygen and inhaled medicines to relax and open your airways. The staff may give you medicines through a nebulizer or with an inhaler. The inhaler doses will be very frequent, sometimes every 30 seconds. They will continue until you improve or can’t tolerate the side effects. You will also get corticosteroids either by mouth or through an IV (intravenous) line. These medicines will help stop the asthma attack. A nurse will remain with you and monitor your condition until you show signs of improvement. Monitoring will include continuously measuring your oxygen levels and checking peak flow rates periodically.

Sometimes, an asthma attack does not respond to the standard treatment. When attacks are this severe, doctors may give magnesium through an IV. This medicine relaxes the airway muscles. They may also need to use a mechanical ventilator to help you breathe. You will need care in an ICU (intensive care unit) if this is necessary. The doctor may also decide to admit you to the hospital if your symptoms persist after 2 to 3 hours of aggressive treatment.

What to expect when you go home

Doctors may send you home if your peak flow rates and symptoms improve with treatment in the emergency room. Or, you may go home after a hospital stay. Before you leave, the staff will spend some time with you to make sure you have the tools you need to stay healthy. This includes explaining the criteria for asthma control and what it looks like when the disease is under control:

  • Being able to do all normal activities
  • Having a peak flow rate greater than or equal to 80% of your best rate
  • Having no more than one asthma attack per year that requires oral corticosteroids
  • Having symptoms no more than twice a week
  • Using rescue medicines no more than twice a week
  • Waking from sleep due to symptoms no more than twice a month

You will likely leave with prescriptions for both inhaled corticosteroids and a course of oral corticosteroids. The staff will review the purpose of each of your asthma medicines and how to properly use your inhalers. If you struggle to use inhalers, ask the staff about nebulizer treatments.

Asthma action plan

If you didn’t have an asthma action plan when you arrived, the staff will give you one before you leave. They may update your plan if you had one. The plan will cover how to avoid asthma triggers and check peak flow rates. Most importantly, it will spell out what medicines and actions to take in each asthma zone. Some general guidelines for asthma zones are as follows:

  • Green zone: You don’t have symptoms and can do all your normal activities. Your peak flow rate is 80% or better. This zone is your daily goal. You take your long-term control or maintenance medicines in this zone.
  • Yellow zone: You are having symptoms, may be waking at night, and can’t do some of your normal activities. Your peak flow is 50 to 79% of your best. This zone is a warning. You need to add your rescue medicines to your maintenance medicines. If your symptoms don’t improve within an hour, you need to contact your doctor.
  • Red zone: You are having severe symptoms and can’t do any of your normal activities. Your peak flow rate is less than 50%. This is the danger zone. You need to use your rescue medicines right away. Seek emergency medical care if symptoms do not improve within 15 minutes.

When you follow up with your regular doctor, you may need to change your asthma action plan to meet your individual needs.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Sep 22
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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