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Asthma Exacerbation Protocol or treatment chart

I just wanted to get this definition clear in my mind. When I was in A &E on Saturday the doctor who saw me had a flow sheet/protocol of what they do when they treated me. The title of this document was Asthma Exacerbation which I now know means asthma attack. I been in A &E twice in three days last November but that was after I manage to resolve my asthma attack with Ventolin. I had blood taken then and an ECQ. I was on prednisolone already at the time day 11/13.

Has anyone seen this protocol when being in A & E being treated for asthma. I was deem to be in the middle section as my peak flow was 60% of my best. So I was treated with steroid tablets and 3 lots of 10 puffs of Ventolin. Each one 30 mins apart then doing my peak flow after 5 mins of 10 puffs. Then when the doctor was happy with me he discharge me. Lastly end of the chart said I would be referred to respiratory (code on it was ICE) but I am ready under a consultant. (due to having two more before this one)

The reason that took me to A&E was my peak flow not going up even though I had had 3 (8-10 puffs) lots of Ventolin 1 hr and 2 hrs later and 1 hour later that morning. My peak flow had been this low for 2 days before this (I been treating it with Ventolin 4 hourly with just being very tired) but I think that's when I got to crisis point on Sunday morning. (I felt like I couldn't get enough oxygen to my brain) No breathless or coughing only the cough from my cold.

So what I trying to ask is has anyone had this experience like the one I had on Sunday?

2 Replies

I know protocols for management of acute asthma exist and have heard them referred to plus read about them. I often confuse drs massively as I tend to be all over them with factors in every step from very severe to.mild! In that case they are meant to use judgement and lean towards treating based on the most severe end. I certainly would be extremely unimpressed if they insisted on only using my peak flow.to decide how bad the attack was and how to.treat, given I can have severe attacks with peak flow (and oxygen sats) that aren't too bad.

I think the protocols used are based on the BTS guidelines and they are not always the easiest to.interpret eg it is not always made obvious that you should escalate treatment if nothing is helping the attack, even if other conditions for a severe attack are not all met.

Generally A and E drs especially more senior ones take a sensible approach (I have heard them clearly saying they are not happy I am.not better with treatment even though I haven't got dramatically worse) but I have seen juniors use the protocol, not always get it right then not be confident enough to use clinical judgment to say yes this person has a severe attack even if their oxygen sats and peak flow seem.reasonable. On the other hand, if used properly those guides for management can be helpful I think where drs are not familiar with asthma.

Hope this is vaguely useful? Also hope you are doing better now.


Thanks Lysistrata your explain was helpful. To give credit where credit is due. The doctor who treated me has asthma and has worked in asthma ward with children. So he was definitely knew where I was coming from. It turn out that my inhaler technique I usually use was not going to work for how I was being able to breathe. I was trying to take in Ventolin when I couldn't hardly suck it up. As he explain I needed to do tidal breathing. So I take responsibility for my part of my treatment for getting it wrong.

He seemed a very clued in doctor and I felt once I got my head around what he was saying. He had to say it three times for me to take it in. I suppose it was the shock of the whole thing. My brain was definitely working as well as normal.

Like you my asthma can be not typical. I can be having an asthma attack and have perfect peak flow. I don't wheeze but this time did have a small wheeze. I can like on Sunday just have peak flow that drops like a stone but this has only happen this once.

I was very bless and I thank God to have this doctor who was through and didn't let me go until he absolutely sure that I was getting better.

I am much better thank you as you can see I still process the situation. You so busy concentrating on getting help for your breathing that you forget what it can do for your mental health.

Knowing as much information as I can is my way of coping with it. So thank you for taking time to answer me.


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