I am in the middle of a chest infection which has, of course, exacerbated my asthma. I keep preds and clarithromycin at home, and started them last Friday at the usual dose. I neb with salbutomol and atrovent when I get an exacerbation. By early Saturday morning, I was fairly convinced that I was going to have to go to hospital (it has been a bit of a miracle staying out since January.....). However, I decided that I was panicking a wee bit, and should persevere on my meds a few days longer. (My PF was a respectable 240/250 out of a best 350/360, so I wasn't hugely worried about that. My temp was 38, but came down to 36.6 in the course of the day). I suppose what I am saying is that I invariably KNOW when things have got so bad that I need to go in, and I trust my own judgement (together with that of my partner).
I am so glad that I didn't arange an ambulance, because I know that they would have admitted me when I went in through A&E . I got my GP out on a house-call yesterday, more because I needed another script for clarithromycin than anything else, and the receptionists would have caused a kerfuffle about me asking for it on the phone. One of the GP's is a very, very cautious doctor who checks prescriptions 3 times before she hands them over, writes down every word you say verbatim, can't process more than two pieces of information at any one time, won't make ANY decisions about ANYTHING without asking you to check it with the consultant, and generally appears very nervous all the time. (That apart, she's nice!!!).
So, I had hoped against hope it wouldn't be her who was sent out, but of course it was. And of course, she wanted to send me to hospital. I assured her that I did not feel sick enough to go. (It would have been a waste of NHS resources for me to go). She accepted this OK, with the caveat that I phone 999 if things got worse, which I assured her I would.
ANYWAY, and this is me FINALLY getting to the point, she did not have a portable sats monitor in her bag, which I don't think is right (surely all GP's doing house calls should carry one in their bag?). She agreed with me, and also said she thought that ""responsible"" asthma patients should have a sats machine at home. I have long thought this - knowing what your oxygen saturation is, is surely a key indicator of whether you need hospital or not? (Perhaps not a one off reading, but a number of readings over the space of 6 or 12 hours). I have looked at the cost of them online, but they are too expensive for me to purchase. I have noticed that some people on here have them at home. Did you get them ""prescribed"" for you, or on loan, or did you have to purchase them yourselves? Plus, do you think that being able to know what your sats are gives you a good indication of whether or not you have to go into hospital (or not, as the case may be?
Whew, I am sorry that was a long road for a short-cut.........If you have managed to read up to this point without your ears bleeding, I would be very grateful for your response.
Love,
Maz
xx
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hiya, i have a finger sats moniter which i bought about 18 months ago on Ebay.
They have quite a few on there at the moment starting about £56 for buy right now - or u can bid for some.
A SATS monitor isn't part of standard GP kit. Cathbear only carries one because she bought her own; the surgeries don't supply them in the doctor's kit bags.
My (admittedly fairly limited) knowledge - now confirmed by my GP wife! - would have to disagree with the Dr who said that ""responsible"" asthma sufferers should have their own SATS monitors. I believe that they may show good SATS at a point at which other symptoms would suggest seeking medical advice would be a good plan.
I would imagine most GP's and most cons would not want a person having sats monitors at home they are rarely used in a home setting. One of the newsest lines of thinking with SAts is we can all live on much lower sats than previously thought. In that we our bodies will readjust to less oxygen. My cons says a sats of 80-85 can be exercised on gradually and the body will tolerate. They use this especially in COPD. The danger as with nebs etc is if the patient isnt given a strict protocol they will rely on the monitors, nebs etc rather tan seeing their Dr or going to A&E. They will worry people will use these as a guide and not how you rae feeling and leave things too late. The people i know with SAts monitors at home either have a strict protocol from a specialist centre or have purchased them without medical advice. As far as i know unless your cons funds them they are not avaiable thru NHS.
I don't have a Sats machine at home because I can be deteriorating, on my own O2 but not show a marked deterioration in O2 levels until it is too late. I have sudden drops, which cause Resp. arrest occasionally, so I go on symptoms and know in myself when to get help.
Sats machines only show O2 levels and not CO2 build up which can be serious, especially if like me you have home O2 to keep going! ( does that make sence??)
I don't think it is a good idea either to have one at home unless strongly advised by a Cons.
It is better to get a feel of your symptoms, can take time but I now don't do regular peak flows (on recomendation by my cons) as I have learnt to listen to my body - takes years of experience! LOL! I do PFs when going down to have some sort of base line etc.
Kate
Hey,
I have home sats monitors. They are for me a good guide as to whats going on and the figures usually fit with the way I'm feeling. I have to play around with my oxygen quite alot I can be on anything from 4-8L during the day, 4-6L on exercise and 2-4L at night through Bipap. Just lately though I have been adjusting my o2 according to how I'm feeling and just checking my sats to see if I'm getting enough but I usually know whether I am or not now. When I first went on o2 at home and didn't know what signs to look for that my sats were dropping and didn't really know how much I needed in the day the paediatric home care team funded a sats monitor for me (a very rare event apparently!) and it was a god send. I was given strict instructions on what I was to keep my sats at (no lower than 94% at the time, I don't see that figure now :-P) and what to adjust my o2 to if they dropped, at the time the instructions were very strict any lower than 94% for more than 5 minutes I was to go to the ward. I later bought a finger tip one that I used for exercise. Home pulse oximeters need servicing and collaborating like any other piece of medical equipment, false readings at home could be dangerous and in my opinion you should at least tell your doctor your thinking of buying one so he can tell you whats safe and what isn't for you. You will probably have to pay for it to be serviced every 12mths, I get away with it as the hospital funded it. Having said that I have one for sale on ebay at the moment, PM me if your interested.
Tks xxx
In short answer to the original question - no, sats aren't a good indicator of whether you need hospital or not.
I've said it before and I'll say it again - low oxygen saturations are a *very* late sign of a severe asthma attack, as is cyanosis. I won't bore you too much with physiology, but once sats start to drop it's like a slippery slope down. For most asthmatics, once your sats start dropping then you needed to be hospital, like, yesterday.
As per usual, this rule won't hold true for a number of folks on here who, as Bowmei says, may run at low sats and tolerate them as ""normal"". Tks is a noteable exception as well - home O2 therapy does need careful guidance and a sats monitor can be a useful tool in helping this.
As Kate says, sats monitors give no indication of CO2 levels which can be a more useful measure of severity of an attack before sats start dropping. The only current way we have of measuring CO2 is via the much-loved (ha!) blood gases done in hospital.
As for GPs carrying sats monitors - no, it's not at all standard. For almost all adults, a sats reading is not going to make a blindest bit of difference whether I send the patient to hospital or not. Clinical impression and examination (pulse rate, resp rate, chest signs etc etc) are going to make that decision for me. I have a sats monitor for use in making decisions in kiddies, where often the clinical impression and signs can be minimised compared to the actual ongoing pathology - put another way, kids compensate very well for illness and have a huge reserve, so may be running at low sats with a rip-roaring pneumonia without outwardly showing much sign of it.
I know personally I wouldnt want a sats monitor at home!
If I waited to get help till when my sats dropped I'd be in big
trouble! I am similar to Kate I dont drop my oxygen levels till
far to late but yet get high CO2 retention and end up in
serious trouble and end up arresting!
I need to get to A+E well before my sats drop so I am already
there when I go off big style!
On the gp carrying them - they are not standard kit - most surgeries and gps will not need one or carry one!
Our surgery funded one themselves to be kept in the surgery for emergencies but one of our nurses carries her own too as she is also a trained first responder for the local volunteer service (used when the ambulance service first responder for this town is busy)!
I have to say unless a consultant specifically tells you u need a home monitor I would run out and buy one yet!
sats monitor
Hi my daughters hospital funded a sats monitor at home for us to use as she is on c-pap at night her sats drop quickly at night and we adjust the o2 accordingly, with a lot of support from community nurses. It is not always an indication of how bad she is as she was admitted a few weeks ago before she started sub-cut and her sats were running at 93/94 but she still ended up in ITU . Its entirley your consultants decision and yes they are really expensive to by.. Take Care Nikki
Thanks for the information everyone. I feel much, much clearer in my mind now about the usefulness of sats machines, and won't be buying one. This kind of thing shows the huge benefits of forums such as this, where people are so experienced, and so well informed.
A few people have made this point already, but I think your own assessment of how you feel is the best indicator of when hospital is needed
I have been challenged a couple of times by ambulance crew, and once by an admitting A&E doctor and told that I wasn't that ill, only for my judgement to be borne out by blood glasses, x-rays, white blood cell count, spikes in temperature etc. I think this is because when I am ill, I do not wheeze loudly, I can usually speak in full sentences, and I do not noticeably ""gasp"" for breath. Also, because I am used to admissions, I am generally quite calm.
Training for ambulance crew and new doctors should include information about how some people do NOT show what is traditionally understood as the hallmark signs of exacerbated asthma. There is nothing worse than going to hossers in an ambulance, feeling very ill, and being told (as I once was) that I maybe had an allergy to my dog, or to my pillows. Or being asked ""So, what was it that made you think you needed an ambulance?"". Grrrrrrrrrrrr................
Anyway, I digress......thanks for the info about the sats meters.
Love,
Maz
xxx
Maz what u say about ambulances and admitting drs rings very close to home for me !!
Part of the reason I dont go in until I am desperate (do not follow my example - it works for me) is because countless times when I allowed myself to be sent to A+E or MAU earlier than I would normally go in - I was made to feel a fraud shuffed in a corner and forgotten about !!
Only to be found to be in respiratory distress and even arresting when the registrars review me !!
It mainly happens to me in MAU now so much so that unless I am desperate and go via the green men to A+E first I will not goto MAU !!
A+E found out quite quickly that when I go in my sats may be ok till just before I arrest and that just cause I very often dont wheeze (I cough to get air in) that it doesnt mean I aint in need of help !!
Yes it took a few admissions to the medical bay - being left alone and going into serious issues quickly that now if/when I go in I go straight to a resus bed (the green men always call me in now) !!
Now paramedics are a different story -Staffordshire ambulance service are excellent !!
I've only ever had one incident and that was when the first responder was busy they sent a technician who was one those ""I know best"" type of people and he just didnt do anything but when the 2 man crew arrived one of the men is the husband of a very old friend of mine and the technician got a very big dressing down after my mates husband had done the checks he should of done - I was blue lighted in as my sats were 60% and I was fitting !!
I have to say the paramedics have me on file now so they know what issues there are and what may or may not happen !!
Plus I now have a medic alert necklace that I tend to stick under someonew nose if they give me the ""U aint that bad speal"" !!
U can still get the odd idiot when admitted to a ward and u deteriate to quick to be believed but its always going to be like that I think !!
I think alot of us have had experience of being made to feel like frauds - its all to common when people dont understand how brittle asthma can be !!
Maz - in all that I just wanted to say u aint alone - I and many others here know how u feel hun !!
That's bad wheezer - the kind of attitude that has been shown towards you could have been fatal for God's sake! I can go down quite quicky as well, but not as badly as you.
I don't know what the answer is - I suspect many more could pitch in with their tales of woe with ambulance people and medical staff. (Although, of course, it has to be said - many are fabulous). One of my bugbears is that the ambulance people invariably think I should just walk out to the ambulance, and I have to ask to be strapped in a chair. (To be honest, I think they get pished off because I am, how shall I put it, not exactly in competition with Victoria Beckham in the size zero stakes, and they just don't want to lift and carry me).
I'll tell you another of my bugbears. Spirometry, and how it can be ""normal"" when your asthma isn't exacerbated. I see an endocrinologist about another health problem I have, and had told him several times about my frequent admissions for pneumonia, and had asked how / if this could be related to my endocrine disease. He didn't have my full notes for ages, but then he got them, looked at spriometry tests I had done YEARS ago, and said (his exact words): ""Your asthma isn't even that bad"". That would be right - a disease that could potentially kill you on a regular basis unless you get hospital treatment, sometimes in ITU, ""isn't that bad""?????? (He's one of those doctors whose sole mission is to be contrary and to dispute everything you say...........).
Oh well, another day, another rant.........It's good to get stuff off your chest.......
Maz
xxxxx
I see an endo too - for my diabetes and insulin stuff.....
Must admit he is more helpful from my ex-asthma dr (who signed me off as I wouldnt take areosol inhalers - I react to the propellant) but the endo is getting me sorted to go onto steroid sparing agents to try and reduce the betamethasone tablets - he knows I cant come off them totally due to tests but he goes far beyond his job so just shows there are good ones out there....
I am lucky in the fact I live in the county with the best ambulance service in the UK - wish they didnt know me so well but hey makes it easier to treat us lol.....
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