May I ask if anyone takes measurements of O2 saturation during asthma attacks? Do you see numbers drop significantly during attacks? I know my asthma is bad when I cannot talk in sentences and must lie down to let it pass. While lying down, the heart rate is at 130 and stays until rescue inhaler kicks in (takes 30 min, wears off in 3-4 hrs). Yet, no matter how miserable I feel I rarely see O2 saturation drop. As a result, AE hesitates to provide nebs and O2, blaming "anxiety". High IgE, high Eos, prior diagnosis of asthma, attending a severe asthma clinic and prior Xolair treatments are hard to explain while having an asthma attack, and they do not check records. I understand that they have to make judgement calls, and when I collapse they finally give me O2 and nebs. As a result, I have mostly given up going to hospitals altogether, b.c. these visits and the stress only make my asthma worse, it's uncomfortable to drive while having an asthma attack, and I may also get Covid as a bonus. Instead I just take ~20 puffs of the rescue inhaler to make it through the day.
My theory is that the heart can compensate the lung function by pumping more blood, thus keeping O2 normal, but I am not a physiologist, so I may be wrong.
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As asthmatics we compensate well. This is why we rarely desat unless I’m at life-threatening/near fatal levels of asthma. Children don’t compensate so well so they can desat at an earlier level.
When I’m at a hospital level I take my hospital form with me, which contains how I present and my ‘usual’ treatment plan (as well as all my other things like drug list etc). You can also print of the BTS guidelines so they can see it’s ONE of xyz
If you’re having an asthma attack you shouldn’t be driving as it’s dangerous. The correct thing to do is to call an ambo who can start treatment immediately. And worse you should get a lift from someone else. Driving in attacks is both dangerous for yourself but other drivers and pedestrians too, so please (anyone who is reading this) DO NOT DRIVE if you thing you need hospital.
If 10 puffs of vent doesn’t work then you need hospital. Taking paperwork can help if you present ‘weirdly’ (ie without wheeze), and if you really won’t go to hospital you need to call your GP for them to start a rescue pred pack and to check that you are safe to be home. The more you alert people to the fact you’re having issues (by contacting medics) the more they’ll realise the issue. Under treating by not seeking help can really worsen asthma control and increase the risk to your life.
In general if you’re needing hosp then the risk of asthma issues is higher than the chance of catching COVID. I and many people I know had multiple admissions in the peak of covid and we have managed to avoid catching it (so far!). The ones I know did get it usually don’t think they caught it from hospital but actually from other family members.
But yes that is how it works. HR increase compensated and maintains Sats well in most asthmatics. I’ve found that the slower my Hr is in an attack the lower my Sats tend to be. It’s once the compensation mechanism starts to ‘wear out’ that co2 retention happens and that’s a much bigger problem.
What Emma said! I was replying but she's covered it. I created a summary for them to read, like the one Emma mentions, for these reasons. It often does help, I've heard them say it's helpful, and it can stop them being so sceptical that the issue is asthma. Not perfect but anecdotally, I feel I get better results with the summary than without it. I've seen them read it and pass on information to other staff which has then been taken into account, though sadly this doesn't happen as much as it should.
For pretty much the reasons you and Emma mention, Asthma UK doesn't recommend routine measurement of O2 sats at home: healthunlocked.com/asthmauk...
However, as you've found, this message hasn't always got through to medical staff, nor has the fact that asthma can increase heart rate. I find they often blame it on salbutamol use, so my summary addresses this point explicitly. I haven't mentioned guidelines because I can't work out how to do it without getting their backs up, but it could definitely be an option if they won't believe you.
Also backing up everything Emma has said about safety and going to hospital when you need it. I present atypically (normal sats, no wheeze) and I still go - had some bad experiences but also been treated and admitted plenty of times. I also went several times during the worst of COVID and did not catch it; I was concerned the first time, but staying home would have been the more dangerous option and they reinforced that I had done the right thing.
Others may be able to answer this better than me. I don't measure O2 Sat's as they don't tend to drop with me unless I'm really in trouble. I think this is pretty much true for asthma in general.
However carbon dioxide levels can increase which has led me to going into respiratory arrest several times in the past. I have severe asthma (diagnosed by a tertiary asthma clinic). This isn't always understood by nurses in A&E which is very frustrating.
Please seek medical help if you are having an asthma attack, I have all my details including medication, treatment which has helped in the past and the fact that I can deteriorate very quickly. I have the information on small cards which are in a card wallet. I hand this to the paramedics and they have said that it's really helpful. They pass the information on to the medical team. So far (fingers crossed) I haven't lost it.
I also wouldn't advise driving to a&e during an asthma attack, if necessary call an ambulance. They will treat and assess you, if you need to go in they will take you as I'm sure you know.
As for lying down whilst having breathing difficulties that generally makes it harder to breathe. I lean forward and concentrate on breathing out, leaning forward helps the muscles associated with breathing to work more efficiently. This in turn helps during the attack. I was taught this by a respiratory physio years ago.
Some breathing problems are caused by dysfunctional breathing. Lots of helpful posts have been written about that. I also have bpd which is common in asthma.
Lysistrata and Emma -- how detailed is your list? Do you bring multiple copies? How "official" does the list have to look? Are there any online samples people use that I could look at?
" I present atypically (normal sats, no wheeze)" -- this is exactly my situation, too. In addition, my baseline peakflow (one steroids and xolair) is 900.
I was told by my MD that I can get admitted to a respiratory hospital directly (mine is Glenfield, LE), and bypass AE. There must be some other phone number (not 111), but he was talking very rapidly, and I forgot to take notes.
It sounds like AE has no clue, sadly, and have to be told what to do. One would think that with the prevalence of asthma it would not be the case. Do not want to make comparisons again... but in the USA (San Fran) I would just show up, say I am having a bad asthma attack, and they would give me nebs and O2, no questions asked.
I have had 3 ambulance calls for asthma attacks in 6 months. They come, measure O2, say my lung function is normal, that I should "take it easy", and consider mission accomplished. My wife does tell them each time on the phone that I am having an asthma attack and cannot speak.They never bring a nebulizer or O2 with them, and never offered them as an option. Last time I had to wait for 2 hrs. This is why my wide brings me to AE in these days (faster)
Mine is pretty similar to Emma's, so would advise to start with her template and adapt. I based the format on my CV because that gets positive feedback and communicates what I need it to there! I have had people think mine is official because of the layout. I based it on a) what they ask me and b) what I want them to know
I give it to them as early as possible, and take an extra copy in case one goes awol and the doctor hasn't seen it - though now they often add to my notes. I often adjust it after an admission if something hasn't seemed to get across or it came up as a thing and I realised it wasn't on the summary.
It includes, fitted on two A4 pages:
- the fact I go to a severe asthma clinic and have a confirmed diagnosis
- how I present in an attack and my best peak flow, which is much higher than predicted and higher than most women's
- what has worked for me before in attacks
- medications - deliberately not at the top to make it harder for them to read that and ignore the rest
- triggers
- how to know I'm doing better
- a blank space for me to fill in what led up to this attack and what I've done at home before going - they always ask
I’m in Leicester too and my local specialist hospital is also the Glenfield (I’m under the severe asthma service there).
Feel free to message me if you have any questions about the service around here etc.
You can get admitted directly to CDU and avoid a&e but it can mean a longer wait to be seen if they’re busy and they won’t accept you if you’re too unstable/unwell. It normally needs to be organised by your GP or the asthma nurses calling the bed managers, or sometimes paramedics can take you straight there if you’re not too unwell
honestly, I am terrified of glenfield. When the ambulance brought me there from AE, the ward had no air ventilation, so they cracked a window to provide "fresh" air, and there were two diesel ambulances idling right next to the window >>> asthma even worse. 5 different people asked me the same 10 questions, without taking notes themselves, with me barely being able to speak. A consultant asked to "check my lungs", even though I told them I present with no wheeze, and ignored my comment that my PF is 900 at baseline. So they just left me where I was, and later asked me to vacate my trolly, b.c. they needed it. I called my wife, walked outside, laid on the ground (could not stand up), and waited for her to pick me up. Been at home for 2 weeks since. AE was more helpful (O2, neb, and prednisolone pills at least). I am not sure what else to do at this point, except stay in my DIY HEPA-isolation tent, and wait for xolair.
Unfortunately a lot of nhs wards will be like that with ventilation as they’re limited by when they were built.
And again unfortunately cdu is extremely busy, and always has been (even pre covid). It doesn’t have anywhere near enough beds or assessment spaces for the demand so they often have to shuffle people round and move more stable patients to chairs so they can assess new ones or treat unstable people. It doesn’t make it ok or less stressful as a patient but the staff are often a bit stuck when it’s busy!
Sorry that you ended up running into one of them who is fixated on wheeze - having seen pretty much all of the respiratory team quite a bit I can say that the majority are actually really good and can definitely appreciate atypical presentations so try not to let one bad experience put you off seeking help if you genuinely need it.
Have you been seen at the difficult asthma clinic there yet?
Thank you, Js706. My appointment is on the 16th of Aug. In the mean time, I take the rescue inhaler every 4 hrs to make it through the day, Seretide 500, and 10 mg prednisone. I just found a pack of qvar from a year ago, I may just throw this is.
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And just from my own personal experience, my sats never drop even in really bad attacks.
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