One of the most difficult decisions to make as an asthmatic is: "When should I call my doctor?" Or, "At what point in the progression of asthma symptoms do I decide to go to the ER?"
Obviously if asthma hits hard and fast the answer is easy: "You GO RIGHT TO THE ER NOW" In fact, you may even be justified calling an ambulance.
However, asthma attacks can also progress over a period of time. And many times you experience symptoms but you can still function. You may not be comfortable, but you are not yet compromised.
Then, over time, you become a little more winded. Now you think you're worse than you've been in a long time. Now you're coughing. Now your chest feels tight. Now you think your respiratory rate has increased. Yet, you still don't really WANT to go to the ER. Right? No one does.
I'll tell you from personal experience that deciding what to do when your asthma is acting up is never easy. In fact, just the other day I was working and there was a microwave fire in the critical care unit. The unit filled with smoke.
The nurse working there had an asthma attack. She came to me hoping I would give her a breathing treatment. I said, "You need more than a breathing treatment. You need to go to the ER."
"But," she said, "I don't think I'm that bad."
"Trust me," I said, "You need to go to the ER."
Ironically, I repeated this same scenario with the other CCU nurse later in the night. While they both knew they had asthma, and were both gallant asthmatics, they still needed assistance deciding what to do.
No asthmatic is an exception to this rule, including myself. Even while I'm a lifelong asthmatic, there have been many times I've had trouble making the decision of what to do for my asthma.
Yes, it sounds like this would be an easy decision. But, trust me, it is not.
So, that in mind, I would like to provide you with five tips that should help you assess symptoms and decide when you need to call your doctor or go to the ER:
Ask a friend or family member
I don't care how much of an asthma expert you are, it is never easy to make such a decision on your own. It is far easier to tell someone else what to do than to make the same decision for yourself. I have done this many times, and so have many of my asthmatic RT and RN co-workers. They can usually tell if you are suffering and help you to make the decision.
Use your peak flow meter
Of course you were a gallant asthmatic and determined your personal best, "or highest number you regularly blow," when you were feeling good. Right?
Every asthmatic should blow into a peak flow meter twice a day: once in the morning before you take any meds and once before bed. After two weeks, you take the highest number that you blew and this is your personal best.
Now, when you blow 80 to 100 percent of your personal best, you are good to go. When you blow 80 to 100 percent of your personal best, you should use your rescue inhaler, wait 20 to 30 minutes, and blow into your peak flow meter again. If your peak flow rate is now above 80 percent, you are okay for now, but you should use your peak flow meter every four hours after to make sure you are stable.
However, if your peak flow rate is still below 80 percent, you should call your doctor.
When you blow in your meter and your peak flow rate is less than 60 percent, you should use your rescue inhaler and then have someone take you to the ER. Or, if you are bad enough, 9-1-1 and inform the operator that you are experiencing an asthma attack. Driving yourself to the ER should be a last resort.
Beware of inhaler overuse
If your asthma is so bad that you have to use your rescue inhaler more than recommended , it's time to at the very least give your doctor a call or have someone drive you to an urgent care center or the ER.
Avoid second guessing
When you start to second guess what you should do, it's time to go to the ER. Likewise, if you are thinking things like the following, go to the ER: "One more puff of my inhaler and I'll be fine." Or, "If I just wait another hour I will turn the corner."
Or, perhaps you have caught yourself saying this a time or two: "If I go to the ER they'll just make me feel stupid. I'm not sick enough to go to the ER."
Look, if you follow your asthma management plan, and it is not working, then you should come in to see us in the ER. At the very least we will quickly evaluate your symptoms, likely use a rescue medication and allow you to go home as soon as symptoms are resolved. The sooner intervention occurs, the sooner you will be stable to leave the ER.
Avoid downplaying your asthma
"Oh, my asthma is not bad enough to go to the ER." If you find yourself saying things like that, then chances are you are downplaying the severity of your asthma and it's time to go call your doctor or go to the ER. An asthma attack can worsen quickly and the mantra you should follow is – early intervention means earlier resolution of symptoms.
I think downplaying and second guessing are the two most common reasons asthmatics don't come into the ER when they should. It is true your asthma might get better, but it is also true that your asthma might get worse. It's a dangerous gamble. So err always on the side of caution and the payoff will be intercepting symptoms before they become severe and life-threatening.
You should never be afraid to call your doctor and ask for his advice. Likewise, you should never be afraid to come to the ER and seek out our services. We will never make you feel unwelcome no matter how "mild" your asthma attack is.