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What do people class as an asthma attack?

madonbrew
madonbrew

I’m just wondering what people here class as an asthma attack? It’s just that I regularly see people writing that they’ve had an asthma attack. I’ve got Brittle asthma and generally class an attack as when I need my ventilin inhaler enough that I need steroids or end up on nebs or in hospital.

I was just wondering , that’s all!

30 Replies
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An asthma attack for me is needing my symbicort prn as well as 10 puffs salbutamol - typically followed by a trip to hospital or at home neb

Hi Madonbrew. I go off the British Thoracic Society guidance. I was actually really surprised about what is considered to be an attack. It shows the characteristics of a moderate, severe and life threatening attacks. I’ve had several severe which I didn’t think were that bad as I controlled them at home with salbutamol. Turns out they were more serious than I thought. Hope that helps a little.

Hi Junglechicken, I did a search on the BTS website but it came up with an error. I’m not sure if I got the right site. Have you got a link? Thank you! X

EmmaF91
EmmaF91Community Ambassador in reply to AirIsUnderrated

brit-thoracic.org.uk/docume...

Page 15 (or 17 of 28)

Thank you! X

Yes it’s interesting! I would agree. It’s appears some people call an asthma attack when they just need an extra puff of ventilin. I was just thinking to myself that I would constantly be having an ‘asthma attack’ if that were the case.

Actually saying that...my asthma had been amazing recently! I ended up on a course of steroids and antibiotics about 6/8weeks ago and since then it’s been so much better. Funnily enough I find my asthma is generally better when I’m abroad so maybe this hot weather suits me!

By the way....I seriously haven’t asked this as a judgment...literally just to figure out how people class an asthma attack. I just realised my response might have seemed a bit judgemental... but I also know I’m prone to leaving things too long before seeking help..

Thank you for the info! It’s useful! Lol..I’m probably a bit like you junglechicken !

It's an interesting question - there's probably a different answer for everyone lol! I guess a big factor will be people's experiences of having asthma (how long, how mild it is, etc) - and then there will be an element of how dramatic some people are - not a criticism at all, just some people's nature is more like that.

So to me, needing one's blue inhaler even a few times would be something triggering their asthma. But if it helped and sorted the issue, I wouldn't class it as an attack. But someone who did refer to it as that might then think something more than that was a severe attack, all things being relative. Likewise, someone who day-to-day isn't that bothered by their asthma but then goes have something, either where it's triggered it more than a niggle or even an attack that needs looking at, might refer to that as a severe attack - whereas to others it's not. That's not to say people are wrong though as we can only gauge things relative to our own experiences.

I think my perception of my own asthma is probably quite skewed....it's difficult to control and is basically annoying all the time - so your comment about "constantly having an attack" made me smile! Therefore I would see an "attack" as something that (for me) is massively worse than normal and probably quite sudden rather than slower deterioration. I always find it hard when paramedics or doctors ask when it started for example - about 10 years ago really 😅 Also I suppose because mine doesn't 'go away', having it described as 'an attack' (by medical people) grates slightly!

That all sounds a bit 'woe is me' - it's not meant to at all. Just rambling about the differences in perception which can only ever be personal. Before I had asthma I assumed that an attack was just that - ok most of the time and then the odd attack requiring lots of ventolin (as opposed to the odd puff for a trigger) - how wrong I was that it's all the same 😅

To me I was always told as I have had asthma since I was 2yrs old that an asthma attack is where you get the tight chest and can't breathe and in most cases the inhaler don't offer much help but the nebuliser is the only thing that will help. A flair up is when you sound wheezy or chesty so might need to double you daily amount eg if you take your inhaler twice a day up it to 3-4 times a day my inhaler is as needed up to 4 times a day but I find I normally only need it before bed or if I have done too much then I might need a daytime dose so I still have two other doses if I have a flair up but this is what I have been tought since I was a child and a few years ago I had to have a check done on my heart and the nurse said my heart was very strong equal to that of a marathon runner she couldn't believe it as I have lots of other problems and she said that even though I don't look like I'm well I really do look after myself on the inside I asked her if she was sure she had the right file lol

I think this is a great question, Madonbrew!

I often talk about 'feeling tight' rather than having an attack and tend to describe an attack as an acute event where I have had to visit A&E or been hospitalised.

I don't think I am using the term correctly, having read the guidance shared on this thread.

I've had asthma since early childhood and have been in and out of hospital with it throughout my life (I'm 58 now).

As a teenager, a GP scolded me when I repeatedly went to him with increased symptoms and that put me off asking for help. That particular event led to an ICU admission and ventilation. These days, GPs are much more switched on, my current GP is great.

As someone who has been told countless times that I have waited too long to get help, I think it's important to be able to identify an attack and when to get help quickly. We can be too used to feeling tight and breathless, worried that we are being a nuisance, or scared to go into hospital. Too many people lose their lives to asthma.

twinkly29
twinkly29 in reply to actinglife

Omg to your previous GP!

I also have a great GP - glad you do too! It seems such a lottery with GPs/surgeries as a whole, some people are really lucky to have good knowledge and support - yet others seem to have clueless or almost arrogant GPs who are not supportive and asthma care is deficient to say the least. Not only is this dangerous but actually good primary care would help to prevent deeper issues for the NHS as well as the patients.

ninelives
ninelives in reply to twinkly29

Agree with your comment on GPs

My last GP was amazing ,he would either assess and deal with the problem himself or ring my respiratory consultant.

New GP if I go with asthma says'cant help you with that' end of conversation ,no examination no assessment no liasing. with hosp.Hopeless .

actinglife
actinglife in reply to ninelives

Hi Ninelives,

Is it possible to change your GP? Without being dramatic, your current doctor is risking your health/life x

ninelives
ninelives in reply to actinglife

Bless you.A lot of our GPs who have been at the practise for many years have retired ,the new ones have the potential to develop into outstanding GPs given time.

I won't touch the GP am registered with ,am fortunate one of the others who is experienced is still there,failing that I ring the hospital respiratory team.

Thank you for your concern.

Wrabness
Wrabness in reply to ninelives

Mine to wouldn’t change medication said they are all the same had to twist his arm to get me a consultant app. New medication and at the moment I’m well.

ninelives
ninelives in reply to actinglife

Great post.

Have been in your position!

One thing I would say having been scolded by medical staff for leaving it too long is that when your sats start dropping I think it does affect your ability to think clearly,and you can get into difficulties very fast.

So the only thing I would add is seek advice /help sooner rather than later if you think you are having an attack that is not helped by resue inhalers

twinkly29
twinkly29 in reply to ninelives

Spot on - and even if sats don't drop at all, something not helped by rescue meds needs seeing to in case it drops quickly or differently to normal (as you said). It might not and all may be ok, in which case great. But better to be safe.

This is a very interesting question and at times I’ve wondered the same, do people feel what I feel etc? I’ve had asthma all my life, which has been worsening ever since my teens (28 now) and is now quite severe and still not under control unfortunately. I find so many things trigger my chest in a way that forces me to use more ventolin.. just a general build up of tightness/wheeziness and that feeling of an infection (a lot of the time there won’t actually be one but with eosinophilic asthma my exasperation rate is high), allergies, mild exercise that leaves me sort of breath and wheezing some more.. all these things make me take my ventolin more often than I’d like. I never class these moments as “attacks” only because they happen so often and are just so normal to me.

For me personally, an attack will scare me. It will be very sudden and I can only describe it as being a ‘choking sensation’. I’ve never discovered the triggers behind these but I’ve noticed I’m more likely to get one in the morning within the first few hours of being awake, although I’ve had them during the nights and also at random times throughout the day too. It’s the worst feeling in the world, it’s like a sudden attack of coughing that my body can not control and it certainly makes me panic when it happens.

I live quite far from a local hospital and have 2 young children at home whenever I’m home (my hubby works 7 nights a week) so hospital admission isn’t something I’ve ever wanted since I was a lot younger. And I’ve thankfully managed to avoid.

I’ve learned to always keep the ventolin to hand and to go through things in my head that will calm the moment enough that the ventolin works, steady breaths etc.. this isn’t always easy and I can understand why people would need extra help at this point, I’m just stubborn and I’ve managed so far.

To me I class them as something that isn’t my normal daily struggles but different and brings with it great fear.

If my asthma is well-controled, I consider an attack to be whenever I flare up so much that I need to use my ventolin more than once a day. My attacks are always followed by days weeks or months of exacerbation which I'd describe as a lingering attack.

you are having an asthma attack if...

Your reliever inhaler isn’t

helping or isn’t lasting over

four hours

You’re breathless or finding it

hard to speak, eat or sleep

Your symptoms are

getting worse

Your breathing is getting

faster and you can’t get

your breath properly.

just taken this of an asthma action plan

Thanks to everyone this has been really helpful to me. I was diagnosed with bronchiectasis last summer and then a few months later asthma. So these are both new conditions for me. In May my breathing became very difficult, chest tight the reliever inhaler did nothing to help and it was several days before breathing was normal. My GP asked me to start on a course of prednisone. I assume this was some form of asthma attack. My consultant has prescribed me back onto high dose Relvar, the RESPS team had prescribed Fostair. So see how this goes. Thanks again everyone it is so reassuring to have this support.

What an interesting question. I've had asthma my whole life. I assumed an asthma attack meant the situation that require doctor or hospital treatment, or when I pass out from not breathing, but maybe it doesn't have to be that extreme.

This is a very interesting topic... I hadn't even thought about that until I read this post, I was diagnosed 2 years ago and on seeing this, I realised that no one has ever told me what actually is an asthma attack... I have my asthma plan, which is useful as an overview, but I guess it's one of those things very much open to interpretation, and as everyone's asthma is different! I think that is definitely a question to ask at my next asthma review!

Lysistrata
LysistrataCommunity Ambassador

Interesting question - I often wondered too. A consultant I once saw years ago said 'it's only if you need hospital' which isn't the correct definition, and also I don't think is something drs should be saying, as it's likely to minimise someone who is poorly controlled and needing more treatment as 'well they don't have attacks as they haven't needed hospital (yet) so they're doing ok'.

Before I started having hospital admissions doctors seemed to assume that I never would have them because I hadn't yet...not quite sure of the logic there, but I definitely felt like what I experienced day to day was minimised because it wasn't acute hospital level. I still sometimes feel that even though I do have admissions now ie it doesn't 'count' if it's ongoing and annoying rather than acute.

I know that for research purposes an 'exacerbation' (they tend not to use the word attack in academic circles, but I think it is similar) is usually considered to be either needing oral steroids, increasing oral steroids if you're on them long-term or needing A&E treatment/admission. This is how they will define it if you're being considered for biologic treatments (ie they look at how many times in the last year you had an exacerbation/attack that meets those criteria.)

The BTS criteria above support that (basically anyone with a moderate acute attack or above ie increasing symptoms, PEF >50–75% best or predicted should have oral steroids). (NB I have severe attacks in that peak flow range, it's not all about peak flow: please see healthunlocked.com/asthmauk... for more on this).

I now wouldn't meet those exacerbation criteria unless I land in hospital, as I am resistant to oral steroids and don't get them when I get worse. I'm personally a little annoyed at how much is steroid-based as I feel it can minimise severity when actually it's just about the type of asthma I have, and I suspect there are probably more people like me who shouldn't be getting pred so much because it's not actually helping them. One asthma registrar I saw was very much aware of the problem of how to define an exacerbation for me because of this, and wondered if, because I have to increase my hydrocortisone for adrenal insufficiency when my asthma gets bad, I could count this as increasing steroids? I can see the logic there but not sure if others would.

tbh I now have a really skewed idea of what an attack is and for myself I use 'getting admitted' - not even just going to A&E, unless it's like a couple of times last year where I went to the closest hospital and they loaded me up with all the drugs and sent me home at 1am. I suspect other hospitals wouldn't have done that, so I would probably count it as an attack because they really didn't have much clue - but I got mag and nebs at least. However, they weren't among my worse attacks as I was actually capable of walking out after the treatment.

Just needing my neb at home a few times (not a one off for a trigger) doesn't count for my personal definition, even though it probably would fit the definition, especially when a normal asthmatic would start/increase steroids. If I have a sudden trigger like scent and need nebs I might call that a 'mini-attack' because it was sudden and needed intensive treatment but not hospital.

HOWEVER this is not how I would define it for others and I know it's not the correct definition! So please don't go by this! I also think I'm skewed because I had years of doctors downplaying things and saying it wasn't real, so I now feel like I have to go to hospital and have it confirmed - again this is just in my head.

Hi All

Yes would agree with others on here that after many years of dealing with over worked/disinterested GPS and medics I only really view an attack as hospitalisation.

I manage at home with nebs and self medicate until I know that it is no longer sustainable. I even have pred on repeat script - no questions asked!

Not advocating this at all - as it’s not the right thing to do but I think you just get worn down by the system and end up having to manage your own symptoms as best you can.

If I sought help every time I needed to use extra blue I would not be popular with my surgery!!😂

Sorry that’s all a bit negative - but it’s the way it is for me...

All take care 😊👍

I'm so interested in this question too. I confess, until recently I always saw asthma attacks as when someone needs hospitalisation/medical attention beyond their usual inhalers. I didn't even realise the complexity of treatment plans so many asthmatics are on. So, perhaps embarrassingly now, I've always told the Asthma nurse I've never had an actual attack. However, I see Asthma UK classify an attack exactly as per Kerry72's post above. You can find it here (right under the 'What to do in an asthma attack' graphic): asthma.org.uk/advice/asthma...

Wow,I’m sorry some of you have such bad GP experiences! My GP has needed to call an ambulance on a number of occasions for me or have me on nebs at the surgery for a while so maybe that’s why she’s a bit more on it! Saying that,she generally would have consulted the asthma nurse too to figure out the best plan before I was referred to hospital doctors.

It’s amazing how differently we all interpret an asthma attack. I’m glad it’s helped us to discuss it. It’s made me think I possibly should act a bit sooner sometimes!

I tend not to use the word 'asthma attack,' and use flare-up. Reason for not using 'asthma attack,' is not to be pc. From my perspecitve attack references, well controlled asthma and because you are exposed to a trigger, your symptoms become worse. Since my asthma is not well controlled and my asthma tends to correspond with the seasons, I use 'flare up.'

For me, a "flare-up" is when I become dependent on my ventolin and I carry my spacer around with me. If the ventolin does not stop the coughing, I will, at some point, begin coughing up phlegm. It is at that point I will call my gp.

The problem, for me, I tend not to wheeze and experience a tight chest. So, instead of wheezing I get more short of breath and struggle to take a deep breath. Up until this year, I have not had problems getting weak from coughing where it is hard to breathe but this year, I did.

For me, a flare-up or an attack is when ventolin will not provide me relief and my symptoms worsen.

This is a great question, my doctor says an attack is when your air ways start the process of being restricted. This i think is a good way of saying what it is, it also helps to explain the broad scope of symptoms and also the different levels of severity. I personally don’t like the word attack as it suggests something that happens quickly. I prefer episode, as it covers both those incidents that come on quickly and longer ones. My worst episodes seem to last for weeks, and occur when my normal medication can’t get on top of the episode. If you are reaching for your reliever you are probably going into an episode. It is important to recognise your symptoms for the start of an attack to avoid the episode becoming more severe.

Because of the connotations that the word attack suggests in my teens, twenties and early thirties I wasn’t as clued up and didn’t take action when required. I also think non asthmatics struggle as well. I remember one woman saying to me once, after being off work with an episode, that I just needed to take my inhaler. She was then shocked when I told her how often I was taking reliever and preventer, which didn’t work.

EmmaF91
EmmaF91Community Ambassador

I try to stick to the official classifications and not my brains 😅. To my brain (as a severe asthmatic) my brain won’t call it an attack unless I’ve ended up in resus or admitted to hospital which I know is silly and incorrect but heyho 😅 (case in point last week I got taken to a&e, given hydrocortisone and magnesium and sent home with sandoK 🤢 but still struggle to say that’s an attack cause I wasn’t admitted 😅) so I try to reinforce with the official descriptions (so above attack was severe bordering very close to life threatening).

I tend to use the word flare/spiral to describe when I’m not controlled but not at hospital level and desperately hoping a pred increase will be enough to keep me out of hospital 😅

But I agree it’s very subjective on here as to what people describe/interpret as bad asthma and asthma attacks 😅

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