Wednesday, October 22, 2014

Wednesday, June 16, 2010 Hazel, Community Member, asks

Q: How do I best recover from an asthma attack after the immediate crisis is over?

My breathing started worsening about a week ago.  Despite adding in bronchodilators and such, I needed to seek urgent care four days ago.  My question is about what happens next.  


I'm currently on Advair (new, I had gone off of it with my GPs permission, something I will not try again), prednisone, and augmentin for an underlying sinus infection.  I was given a shot of steroids at urgent care as well.  I'm supposed to be nebulizing atrovent as needed, using albuterol inhaler as needed.  


I still am very easily fatigued.  I was able to go to my pulmonologist appointment this morning and then to the pharmacy without extreme fatigue.  That was the first time I have done much of anything without feeling exhausted.  I've been getting leg and hip pain, the kind I get when I run too many miles in a week, just feels like extreme exhaustion.  Today, I have mostly been able to talk normally again, although my voice is still weak and I'm still coughing a little.  I actually ended up in the ER the night after I was initially treated because I felt so low I was afraid of a medication reaction or potassium problem or similar, but it turned out to have been mostly dehydration.  I was cautioned at that time also to be cautious, get extra fluids, not skip meals, etc.


I'm self-employed and have young children, so it's not like I can easily "take a day off"; each skipped activity has consequences later.  I have been resting, but I'm not sure what is normal in asthma attack recovery.  How much pain/discomfort is normal from steroids/prednisone?  If my legs hurt and I'm exhausted and dehydrated, is that from over-using or under-using bronchodilators?  What does "every four hours, as needed" mean, anyway?  Does that every four hours, unless I'm feeling great, or every four hours, if I'm feeling really breathless?  Am I fatigued because I'm recovering from the attack, or because I'm still fighting it, and is there a difference?


And when can I start to push myself again?  I would love to (slowly) run a 5k this weekend.  I had one planned for last weekend, but I was too sick, and it would have precipitated a crisis.  Is six days after a moderate attack too soon, for someone used to that sort of exercise?  


I guess it's about mindset.  At what point do I stop thinking "sick day, recovery time--do I have the energy to do a small task?" and start thinking "I'm fine, but I'll take a break if I need one?" And do I need one?  Is extra fatigue following an attack perfectly ok to ignore?


There seems to not be a lot of resource on recovering from moderate attacks.  I have found some articles written by people with severe asthma, but for people with occasional moderate attacks, what should recovery look like? 

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Answers (5)
John Bottrell, Health Pro
6/17/10 3:42am

I wish I had all the answers for you, but asthma is a unique illness in that it effects every asthmatic different.  Likewise, what medicine(s) work for one patient may not necessarily work for another, which is why you'll need to continue to work with your doctor to determine the best medicine regime for you


Yet, ideally, you should be able to obtain good control of your asthma.  I wrote a post about this recently that might help you out.  Just click here


I'll try to answer your other questions too:


1.  How much pain/discomfort is normal from steroids/prednisone? This medicine effects everyone different.  While I have heard some who take this complain of leg discomfort, I never experienced this when I was on the stuff.  Usually it makes me hungry and that's it.  Actually, it gives me an unsatiable apetite.


2.  If my legs hurt and I'm exhausted and dehydrated, is that from over-using or under-using bronchodilators? No.  At least I have never observed this when I've overused my rescue medicine, and I've never had my patients note this.  The main side effect of bronchodilators is nervousness, shakiness and, in some cases if used way too much, increased heart rate.


3.  What does "every four hours, as needed" mean, anyway?  Does that every four hours, unless I'm feeling great, or every four hours, if I'm feeling really breathless?  It means if you're feeling short of breath, go ahead and use it. If you think you need it and you are not short of braeth, go ahead and use it anyway.  It's a good medicine, and it's safe, so don't worry about using it too much.  Now, every 4 hours as needed also means that if you need it more often than every 4 hours, your asthma is getting worse and you should call your doctor or go back to the ER.


4.  Am I fatigued because I'm recovering from the attack, or because I'm still fighting it, and is there a difference?  Good question. This one is not so easy to answer.  Obviously if your having trouble breathing you may be using accessory muscles to breath, and your body might be working overtime to fight an infection, or to fight allergens, and this might cause you to feel tired.  Plus if you're having lots of trouble breathing, you may not be getting adequate sleep even while you're lying down at night.  All or some or none of this might figure into your fatique-ness.


5. And when can I start to push myself again?  I would love to (slowly) run a 5k this weekend.  I think it's great you have your mind set on running again.  You might want to start by walking at first.  At least then you'll be doing something.  Yet don't push yourself too hard or too fast.  You'll know when you're ready to push yourself again.  You may also want to discuss this with your doctor, as he may want you to fully rest until your body has a chance to recover.


I hope this help.  Feel free to ask if you have further questions, no matter how silly you think they might be.  Always remember you are not alone in what you are going through, as there are many asthmatics on this site (like myself) who have been there, done that, and are willing to help if we can.


Good luck!!!

Nakia, Community Member
1/ 2/13 12:10pm
I would just like to say that I have the same unexplained leg pain an weakness after an attack. My body will often feel like I have been in a heavy weight fight. I have been asthmatic sine I was 5 years old I am now 38 and it hasn't gotten better. My attacks are now tied to food allergies and sleep apnea . Good luck to you. Reply
nscangal, Community Member
6/17/10 8:29am

This is what works for me when I'm flaring: First, I sleep as needed. This means that I may nap up to sixteen hours a day. However, because my breathing is bad, my quality of sleep is poor. I've noticed that exhaustion is a trigger for me, so I sleep as much as I need in order to not feel exhausted.


Second, I don't eat meals, so much as I graze on light, lowfat foods all day long. For a long time, I've noticed that heavy, fatty meals seem to make my flares worse. Recently, a study came out suggesting that fatty foods decrease the body's response to bronchodialators, which suggests to me that the fatty foods weren't making my flares worse, they were making my flares less responsive to my rescue medication. Big meals also make ongoing flares worse for me, hence the small snacks all day long.


Third, I stay a little active, if possible. Depending on the severity of my flare, this may be as simple as walking around the house for twenty minutes, or as challenging as attending my martial arts class but taking it easy in the warmup. Stopping all activity worsens an ongoing flare for me, I find. That said, if I do need to stop activity, I stop it (and around then is when I'd be going to urgent care, since I can walk despite being quite short of breath, so if I'm at the point where I can't walk much, if at all, I'm at the point where I need to be getting some help). How active I stay is a judgement call, and one I can't make for you... You have to know your body and what it can do. I'm young, and in pretty good physical shape to begin with, so my body can take a lot more stress than most people's can. The rule of thumb I've found for activity while flaring is if I'm not sure I can handle it, I can't. Every time I've gone into an activity I was unsure of, I've regretted it.


Fourth, I talk with people as much as I'm able. This is for two reasons: First, it distracts me from how crappy I'm feeling. Second, it helps me see how short-of-breath I am. If I'm having to interrupt my sentences, I need my rescue inhaler. If I've taken the rescue inhaler already and I still interrupt my sentences, I need to go to urgent care or to the ER.


Fifth, and this is something I do normally anyway, I take and record my peak flow and the number of times I've used my inhaler. In prolonged flares, I lose the ability to objectively measure how badly I'm breathing. I get the Denial Record going off in my head, "I'm able to get my peak flow to go up! I'm fiiiine! I only need my inhaler every two to three hours. I'm fiiiiine!" Etc. I'm sure you know what I'm talking about, as I have yet to meet a persistent asthmatic who doesn't have their own version of the Denial Record. Stuff like the walking, talking, and taking my peak flows help me figure out if I need to go to the ER or if I can hold off until I can go to the walk-in clinic later on in the week.


Finally, if someone who knows me well says, "Do you think you need to go to the ER? You look really bad." I try to take their advice and go. I know myself well enough to know that these people who know me well are better at judging when I need the ER than I am when I'm flaring. Every time I've pooh-poohed the idea while in the middle of a flare, I've looked back on it and thought, "What was I thinking?"


Good luck, and get well soon!

nscangal, Community Member
6/17/10 8:41am

Also, I must point out that I've gotten the OK from my doctor and respiratory therapist to take my inhaler up to every 2-3 hours when flaring without going to the ER. I have difficult allergic asthma complicated by multiple environmental allergies and bronchopulmonary dysplasia, and needing it that often doesn't necessarily mean I need to go to the ER. However, I'm under strict orders that if I need to dip below every 4 hours, I'm to call my doctor for an appointment within the next 24 hours, and if I dip to or below every 2 hours, it's "go straight to an urgent care center (if available) or the ER. Period." Furthermore, I'm working with my doctor, allergist, respiratory therapist and soon, I'll add a respirologist to the list of professionals I work with, in order to try to get my asthma under better control and get myself back up to the standard guidelines for asthma control. Most people should go to urgent care at the very least if they need their inhaler more than every 4 hours, so please, if you haven't gotten the OK from your doctor to not go to the ER when you're that bad, don't follow my example. Go to the ER or urgent care instead. 

Dr Yahya, Community Member
6/25/10 2:37am

Asthma attacks occure mostly always after a trigger, either indoor out outdoor. I advise you to be sure you do not have a cormobidity such as sinusitis or GERD.

best wishes

Dr Yahya Shihadeh

mom with asthma, Community Member
6/25/10 8:40am

I can really relate to your questions.  In April I had an exacerbation of asthma that landed me in the ER twice and the hospital twice.  The last time was pretty bad.  My doctor had them admit me after the ER talked to him.  I have not been prepared for the long term affects.  I also have had questions about pushing myself being a home school mom.  Before this, I was going to the gym every morning, I haven't been since March.  I am still busy around the house, but I can't do anything outside.  I usually have a garden.  My asthma is allergy induced, so we are working on allergy control.  The doctor started me on Xolair in May hoping that would help.  We are doing some remodeling right now, so that isn't helping with people constantly going in and out and leaving the doors open.  Here in the South it has also been really hot and humid, which also doesn't help.  I felt like through the exacerbation in April, I was learning through trial and error, mostly error on my part, because my asthma had never been that bad before.  I was behind and didn't know how to get in front.  I looked all over the internet trying to find symptoms and information about asthma so I would know ahead of time What was happening with my asthma, what to expect when I got to the doctor or hospital, and how to make the right decisions about medical care.  When it got really bad, I realized it was also important for my husband to know all the warning and danger signs.  I finally started finding some of the information I was looking for by browsing the Asthma Action Plans on the internet.  The most helpful information about level of severity of symptoms was on the AeroNeb Go website under education, I believe.  I think it came from Wikipedia.  My asthma doesn't follow "normal" guidelines.  I was looking for "concrete" evidence before acting.  I have learned, with my doctor's input, that I have to go on how I feel.  Now, I am where you are, I am trying to recover.  I hadn't thought before about having to "recover" from an asthma attack.  It seems to be for me, a few steps forward a few backward.  Watching out for triggers.  I must admit, I am probably being a little of a goofous asthmatic right now because I am getting tired of the time consuming breathing treatments, doctor visits, medicine, attacks anyway, and not being able to do some of the stuff outside my kids want to do.  Because of the nature of my asthma, and the fact that I am not responding in the usual way to some meds, I think it is slowing the recovery process too.  I thought Rick Frea's response was helpful too.

Jayne Bettles, Community Member
4/24/12 9:35am

I am a Mom also with Asthma and I am at home recovering as we speak.  I have not been into hospital but my asthma was triggered off by a virus.   I have been put on a week of steriods but they didn't do the trick, so another week of steriods and I have been signed off work for over a week now. 


I believe that every asthma sufferer is different.  You have to have lots and lots of rest and I must admit being a mother of two, it is very difficult to relax but you have to go with your symptoms....  It can drain you for weeks after an attack but you have to go with the flow, don't push it as it will take longer to recover.


I have also had pains down my arms and back.  It feels like I have been punched in the arm, but again, I think that can be down to the steriods that you are taking.  Steriods have so many side affects which can make you feel very low, tired and depressed amd many more.


I hope you feel tons better real soon, but don't rush it.


Kind Regards


Jayne Bettles

Mother of 2


asaye001, Community Member
7/ 3/14 10:42am
I am a mom of 5, exercise enthusiast, teacher (high school), wife, and chauffeur (kids all swim, run track/cross-country, play in musicLs, etc). So I hear what you're saying about not being anle to afford down-time. My asthma developed 1 1/2 years ago out of the blue after an serious allergic reaction to a cleanser they switched to at school. I coach Track, and we were running in the halls, breathing it in rapidly and deeply. BAM!!! A non-stop cough and wheezing. My son has an inhaler, so, recognizing the symptoms, I used it. Due to ghe daily exposure, i had repeated attacks, and eventually Had to see a doctor. Since then, I have developed a sensitivity to everything in the air except possibly the oxygen. Pretty tough when one teaches in a high school--constant ebb and flow of hairsprays, perfumes, and other delightful products. I use an air purifier in my room, but sometimes you HAVE to go out in the hall! Anyways, lately everything sets off my asthma, including exercise. Even when I want to just work out at home--purifiers running--I get about 10 minutes in (if I'm lucky), and have to stop and nebulize. Today I felt great, humidity was down, so I tried to ease back into running with Couch to 5K week ONE, and at the second run phase (run 60 sec, walk 90, etc), I blew a bad one--rescue inhaler did NOTHING! I was hit by such a wave of depression I had to fight not to cry. Made it back to the car, and sat doing breathing exercises and coughing up stuff. 1 hour later and it's better, but not gone. Anyone else struggle with SEVERE depression after an attack? I'm normally fine mentally, but right after attacks like these I just want to lay down and give up. (of course I won't, since I know logically that I'll feel better later, but physically and mentLly at the mmoment--it's just so d#+*^ed hard to deal. pS I didnt go to ER because my daughter would be out of class in 1 1/2 hours, and I'm both her ride and provider of lunch, so she would have been scared and hungry. Reply
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By Hazel, Community Member— Last Modified: 07/03/14, First Published: 06/16/10