Use of EpiPen in brittle asthma

I have had brittle asthma for many years. It has recently changed so that I am much less wheezy between attacks. However, when I do have an attack it comes on within 5 minutes or so and deteriorates very fast. I used to get much more warning than this and it is becoming quite scary. I have now been told to use an EpiPen whilt waiting for ambulance and having a neb. I have an EpiPen for anaphylaxis but have not needed to use it for a long time. I didnt realize they were used for asthma so am suprised by this. Are there any side effects after you have injected it. I am a bit worried as not used one before and dont know what to expect. Any advice would be great.

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Heya Karly

i have type two brittle asthma and am the same as you, go from being well 1 min and then 10 mintues later i have sats of 65 - 70% and no air, i use nebs, oxygen and epipens for my attacks becuase of their life threatening nature. the pens are dead simple to use and in my case do open up my airways to an extent that i can get some air in! as for side effects it increases your heart rate but then again actue attacks combided with nebs put it up anyway, it increases your BP and your resp rate. they are the only side effects that i have but then again i would have them anyway without the adreniline so nothing new! and yeh save my life so cant really complain!

mail me if you have any other questions there are couple of othe peeps here that use eipens for their attacks, there is a post tread somewhere about eipens and brittle asthma so have a look!!

best wishes

rob x x x

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Hi Karly,

Sorry to hear about these scary attacks that you have been having - I can sympathise, I get very sudden onset crashes with my brittle asthma too and I don't think I will ever really get used to them. I think it can be particularly difficult when a condition that you have had for years, and think that you are in some way used to, changes it's behaviour.

I have Epipens for the sudden onset attacks, initially suggested by Prof Ayres (when I used to go to Heartlands) after a couple of close calls when sats were very low or I was not breathing by the time the ambulance arrived. They are only rarely used for asthma, and you will find that some GPs and A&E docs will express surprise that you can use them for non-anaphylactic events - for this reason and others, I find it very useful to carry a letter clearly documenting my medication and other points of note.

I have to say I do not often use my Epipens these days, as I don't find that they make any disernable difference to my breathing (although of course it is impossible, once you have used it, to know whether you would have deteriorated faster without it). The major side effect I do find is that the Epipen tends to push my heart rate even higher than it already is from the nebs, the hypoxia, etc. If I don't use the Epipen, I typically find that I reach A&E with a heart rate of approx 180 - if I use it, it is more likely to be nearer 220. This then means that A&E staff are more hesitant to give things like back-to-back nebs, IV amino and IV salbutamol, which do help me. I have very seldom actually been refused these things on the basis of my heart rate, but giving adrenaline as well obviously makes these treatments a little more dangerous in terms of causing nasty heart arrythmias.

I'm not trying to frighten you or to put you off using them - if your consultant says that you need them then I am sure that is correct. It is worth making sure, though, that you (and your friends/family) have a clear idea of when it is appropriate to use it. These days, now that I am well known to the paramedics and Ambulance Control and we live so close to the hospital, it rarely takes more than 10 or 15 minutes in between calling an ambulance and arriving in Resus; I have nebs and O2 to use while I am waiting. For this reason I usually don't use the Epipen, and don't accept adrenaline from the paramedics. My husband and family are instructed to use it if I am unconscious or not breathing, but not otherwise. It is very individual, though, as to when you should use it and how much relief you will get with it, which is why prior discussion is so vital.

I suppose in summary - like any powerful medication, these things are a double-edged sword, but used appropriately, they can be life-saving.

Two more points occur:

- you mention that you have Epipens for anaphylaxis but that you haven't had to use them for a long time - if you have some stashed away please do make sure they are in date and have been stored appropriately, as the adrenaline can deteriorate and become useless quite quickly - discard it (return to your pharmacist) if it is out of date or discoloured

- occasionally some people with brittle asthma will find that a single use of an Epipen will cause a really dramatic improvement in symptoms - if this happens to you, congratulations - but YOU STILL HAVE TO GO TO HOSPITAL! Both because the asthma attack may recur, and to be monitored for the effects of the adrenaline (in hospital adrenaline is never given to someone who is not on a heart monitor). Please don't think that things are all better and you can get away with not going in - I have seen that assumption go badly wrong in the past (with someone else - not with me).

Hope this helps - please do PM me if you have other questions or want to chat!

Em H

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PS - there are several other threads on Epipens both in 'Medical' and in 'Parents and carers' if you do a search for them - I have not bumped them to the top as there are several, but there is some useful information there.

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Thanks for the replies. From what the consultant was saying it seems I am the have back to back nebs and use the epipen if there is a delay and I am deteriorating fast. The last admission went wrong because I was at the GP and they called and ambulance which took 40 minutes by which time I was very unwell. If this kind of situation happens again I am to use the Epipen but otherwise I am to wait till I get to hospital if possible. Good to know about the heart rate issue. Aminophylline seems to be the one thing that really works for me so would be quite bad if they couldnt give me it because I had already used adrenaline, especially as I dont know whether the Epipen will make much difference to me anyway. Its always so confusing knowing what to do for the best and even more confusing when you are ill and trying to make these decisions!

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I know exactly what you mean, Karly - it is so difficult to make these decisions, especially when your judgement is clouded by being unwell.

I am in the same situation - iv aminophylline is (or was - not so much any more) the one thing that really helps me, so I am very reluctant to do anything to compromise its use. Just to try to reassure you a little - I have very rarely actually been refused aminophylline because of my heart rate (and even on the couple of occasions when I was, I believe it was over-ruled by more senior doctors once they had my notes - I don't know, it's difficult to remember all the details). I am very much aware of the fact that using adrenaline then makes iv aminophylline more risky, in terms of causing heart arrhythmias, but - if you are cardiac monitored, which you always would be in that situation, heart arrythmias would be detected and treated very rapidly. The consequences of not using your Epipen and being seriously starved of oxygen before reaching hospital would be a lot more difficult to deal with.

It seems like you've discussed it thoroughly with your consultant and have a pretty good idea of when to use it, which is great. It's worth making sure family / partner / friends are also aware of the rules and of the importance of insisting on the treatment that you know works for you. My husband has become very good at telling A&E docs exactly what to do and they pretty much always listen to him - of course, it helps that he is now a doctor too, but even before he did medicine he was still pretty good at giving them the right information - I do think it makes so much difference, both in terms of getting the right treatment and in terms of having a bit of confidence that you are safe. If there is no one friend or family member who always tends to accompany you to hospital, the good old protocol letter (complete with impressive consultant signature if possible) is an excellent substitute.

Hope this helps, take care

Em x

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Thanks for your help and advice. Hopefully wont need to use the EpiPen too soon!

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I hope so too!