Hello, I’m 17 years old and recently I’ve been struggling with my asthma. Within the space of 3 weeks I have had 2 asthma attacks, one resulting in a ambulance and the other a trip to a&e. The first asthma attack developed throughout the day, I had been taking my blue inhaler however it didn’t relive any of my symptoms, eventually Imy friend edged me to go to the hospital as my lips started to turn a bluish colour. I had both steroids and a nebuliser before returning home a few hours later eventhough my peak flow was still very low. Only 2 weeks later I was walking to school when I felt my chest to tighten, again I took my inhaler to no relief. I went to the school nurse who immediately called for an ambulance. Once the ambulance came my heart rate what tachicardic at 157 bpm however my oxygen levels were 100%?! They then attempted to calm my breathing to a natural rythm. They said I was hyperventilating due to the stress and worry of my asthma. My question is, does this mean my asthma is getting worse or is it a symptom of a panic attack?
-lots of love, Chloe.
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Lushie17
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Hi Chloe, are you taking any preventer inhalers? And have you been to see your GP or asthma nurse since this happened? You really need to see someone after this - especially since it sounds a bit like the first one didn't resolve properly if your peak flow was still very low. That may have been why you then had another attack a couple of weeks later - how were you in between?
For the second one, were they trying to tell you in the ambulance that it wasn't an asthma attack because your oxygen was normal? Although it is natural to be scared if you have breathing problems, hyperventilating and a high heart rate are also normal physiological responses to asthma, not just panic. Asthma doesn't have to have low oxygen sats but a lot of paramedics and doctors don't always seem to understand that, or realise that your heart rate and respiratory rate can be compensating for the asthma and keeping your oxygen saturations high, and they will sometimes blame it all.on panic or the Ventolin. I am very laid back and not worried in asthma attacks and I usually get a high heart rate and good oxygen saturations, which often makes them think oh not asthma and try to say I shouldn't have a nebuliser, when in fact if I get treated for asthma the heart rate will go down. This is all in asthma guidelines including the raised heart rate and respiratory rate/hyperventilation.
Did they give you any asthma treatment at all the second time? And how are you now - how are your peak flow and symptoms?
I think you need to try to get an appointment as soon as possible with your GP. I'm not a doctor so can't say if it is your asthma but these do sound like they could well have been attacks and you need to discuss why this is happening. Your GP may want to change your preventer medication, or start some if you don't have any, and keep an eye on things. The good news is that it is usually possible to get things under control once you have the right medication, though it can take a bit of time trying to find that sometimes.
You might also want to call the Asthma UK nurses as they are very helpful ans friendly, and can advise on what you need to ask your GP.
Maybe keep an eye on your peak flow too if you find that's helpful, and if you start finding your inhaler isn't working again like before don't hesitate to call an ambulance or get help right away even if they were saying it was a panic attack last time. It seems like you know whe to get help anyway, but it can be offputting to be told that you're just panicking when you felt it was actually asthma, and I know it makes me doubt myself and whether I should be doing something! So just throwing that in there and saying don't let it delay you getting help if you need it.
Hello! First of all thank you so much for your reaponce, I have been taking my daily preventative inhaler and I tried to make an immediate appointment however the closest one was 2 weeks away. In day to day life, I struggle quite a lot with getting out of breathe to the point where I’m taking my inhaler atleast 5 times a day. For the second event, they rushed in and as soon as they saw my oxygen reading and listened to my chest they put down their bags and instead wanted to control my breathing with techniques. They didn’t seem at all phased eventhough I was barely conscious and hands had frozen due to excess amounts of carbon dioxide in my body. My heart rate was still 110 by the time they left (they left as they told me I shouldn’t waste my time in A&E and should call back if it happens again, whilst telling me about 111) the second Time the ambulance staff never even checked my peak flow reading! I’ve researched quite a lot and hyperventilating is serious so especially when linked to asthma, I just don’t understand why they failed to take it seriously and maybe I’m just over exaggerating?
I don't think you are exaggerating at all! You probably had too little rather than too much carbon dioxide if you were hyperventilating, but this is actually normal for asthma. It *can* help to try and control your breathing a little if you can but since as I.mentioned the hyperventilating is often a natural response to asthma, it doesn't mean you can ignore the asthma just for that and you.will probably still be doing it to.some extent as long as the asthma flare is going on. 157 is a pretty high HR and even 110 in the context of asthma is high and should normally be taken seriously.
I suspect you are someone who doesn't wheeze with asthma if that was their response after listening to your chest. I am a non wheezer and get this ALL the time - there are still way too many medical people who think you have to have a wheeze to have asthma and it's just not true, but it does make it harder. Oh and 111 usually calls an ambulance anyway in my experience especially for breathing things ...plus your school nurse clearly thought it was best to call the ambulance direct!
If you're taking your inhaler that much it sounds like your preventers really aren't working that much and something is going on. I would ask for an urgent appointment with your GP - and if they quibble yes asthma can qualify as urgent and you definitely shouldn't be waiting 2 weeks! Perhaps point out the recent A and E and ambulance in a short space of time if they seem doubtful? If you are unassertive like me when it comes to things like this, do you have a family member who could be insistent for you?
At the beginning of the attack my school nurse told the paramedics she heard me wheeze however the paramedics denied being one. It’s so frustrating, with asthma it seems that people don’t care until it’s unbareable! I’m not too close with my family, I’ll call my GP again and urge them to get me an appointment. I’ll upload the notes which the paramedics gave me. X
Hmm so this attack may have settled down by the time they arrived - could have been that the inhaler you took earlier had started to kick in. Doesn't mean there was no asthma there however or it was just hyperventilation alone - given the background of needing inhaler more I think you definitely need to pursue this, but sounds like you plan to anyway.
Re the wheeze etc - sometimes you can also have good air entry but less good air exit - I have been told by a helpful medical student on here (thanks Js706!) that often they don't listen to expiration much and this is a problem earlier than.air entry. I have been told at times by people who were listening for both that the air entry was fine and the exit not during attacks, but a lot is dependent on their skills and knowledge of asthma.
It is frustrating being in that kind of limbo where you need to do.something but it's not *too* bad, or they see you when things are better and forget that asthma is variable- definitely emphasise the history and inhaler use over the last couple of weeks to your GP when you see them.
Lysistrata has given some excellent advice. The only thing I can emphasize is call an ambulance. I don't believe it is a panic attack particularly with your recent struggle with asthma and the symptoms you have described. Don't be afraid to call the ambulance. Often, as Lysistrata has said, the ventolin (and your body) kicks in by the time they arrive. The ambulance people listening to your breathing and looking at your oxygen stats is not a diagnosis and not really pertinent to how you were when you went to the nurse.
It is important to see an asthma specialist. Too many medics don't realize that some asthma doesn't have a wheeze. I used to wheeze but now I often don't. Personally I consider it a slight deterioration. I can't seem to cough up the phlegm as much.
There would be a reason for your deterioration recently and you need to look at what might have changed. (eg a new pet in the house/new perfume/ beginning of a chest infection/ cold air?) There are many things which could cause a flare up. I often start to get a tight chest when I'm developing a chest infection. Before any other symptoms my tight chest warns me that I am coming down with something. This is good because I then usually take preventative measures to try to head it off. I've given up telling new doctors that I'm coming down with something as they usually look at me as if I'm a nut! However I have some great doctors, who have seen me deteriorate, and I now have Tamiflu in the house to take if I come down with the flu. (Tamiflu works for me but not everyone.) What I am saying is - "Trust your own judgement".
When was the last time you saw an asthma consultant? Sounds like it is time to see one again if you haven't seen one recently. Some GPs don't like to refer too easily but if you haven't seen one in the last two years, then it is time to see one again.
I think you need to separate the two. Find out all you can about asthma, preferably from the asthmauk website and remember that the vast majority of deaths from asthma are preventable. Talk to the nurse at asthmauk if you can, especially about coping when the asthma is bad. Then think about why you might be having a panic attack - is it based on not knowing what is happening? You did recover, and you'll recover again. Understanding what happened is key.
Its more just based on my experience and trying to "logic" out solutions to things. I've noticed people seem to mainly be concerned with 1. Can they hear any air exiting? and 2. Is there an obvious wheeze? when first listening to expiration. And then move on to focusing on inspiration to rule out chest infections etc. Also, sometimes wheezes/quiet patches can be in quite small areas and there's a chance that they do get missed (obviously they try to avoid this by listening to lots of areas but it can still happen).
I'm not 100% certain on the reduced air exit occurring before reduced entry but it has happened in that order a few times for me and also makes sense. Given that asthma can cause air trapping, it makes sense that air would struggle to get out first, and then later on would struggle to get in as your lungs would be over-inflated.
I agree with what others have said about getting in to see your GP soon - its important to emphasise that its for a deterioration of your asthma and that you've already had to seek emergency help for it. Regular appointments may not be available for a couple of weeks, but they should have emergency appointments to book on the day (and in GP land, deteriorating asthma control definitely fits the criteria for an emergency appointment!).
Regardless of how much of the ambulance incident was pure asthma or not, your control has clearly been getting worse over the last few weeks from what you've put here. What preventer inhaler are you on? It sounds like you might need a higher dose or a different preventer to try (even if its only temporary to get over this).
Also re the breathing techniques, I know its really annoying when you're struggling and staff don't seem to take it seriously and just try to get you to do them, but they can be really helpful. If you can remember them (or if not its worth looking up some diaphragmatic breathing exercises) its worth trying them for a couple of minutes, a couple of times a day - it doesn't seem like much but can actually make a surprising amount of difference in daily symptoms. As Lysistrata has said, a normal response to asthma attacks is to increase your breathing rate etc to try and cope, but a lot of the time in asthma this can start to creep into how you breathe every day (even when the asthma isn't causing a problem). The issue with this is that either it can trick your brain into thinking the asthma is flaring, OR it actually makes your airways more twitchy over time - meaning your asthma is more likely to flare. The breathing exercises can help fix this. Also it then means if you have to call an ambulance you can tell them you've already been doing breathing techniques - so if they're not helping you're probably more likely to get a neb quickly!
The main types of breathing exercises they teach asthmatics are based around diaphragmatic breathing.
Diaphragmatic breathing is generally the maintenance exercises that are taught (Papworth method on the website below). To start put one hand on your chest and the other on your stomach and just breathe normally to see which is moving when you breathe. The aim is to have the hand on your stomach be the one that is moving.
Its also really important to make sure you breathe in through your nose rather than your mouth wherever possible, as the nose helps warm up the air and filter allergens etc out before the air hits your lungs.
Physios also sometimes get asthmatics to do "controlled breath holds", normally after you have finished breathing out. So breathe in and out normally and then hold your breath for a few seconds before breathing in again - although advice on this one varies a bit so is normally best done with a physio.
If you want to go through them in more detail you could always ask for a referral to respiratory physio, as I've just listed what they taught me in my sessions above. And they were really helpful
Thank you - that's really helpful! My consultant said he's considering sending me to a physio so I'll see about pursuing that and try these techniques in the meantime.
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