Yo, fellow asthma sufferers! Tell me what your acute attacks are like (please)

In My Humble Opinion
1

Okay, so this whole acute asthma attack thing is new to me. I had exercise-induced for years, but when aggravated, it just made feel like I couldn’t get a satisfying breath–a heaviness, pressure, not the wheezing and such. I needed my inhaler maybe three-four times a year. Then I got the flu while pregnant, and all hell broke loose. A year+ later, I’m still dealing. Two weeks ago, a bronchitis knocked me flat on my ass–I was no good for a week. I felt better for two days, then felt AWFUL (in a different way) and found myself in the ER.

I wanted to check in with you experts (har, har) and find out what is normal in the recovery from one of these more acute, ugly-sounding things. What put me in ER 5 days ago was significant chest pain (ER doc said it was probably from the excessive wheezing I was having), extreme fatigue/weakness/lethargy, and a still-productive cough. They showed me how to use a peak flow meter, and I was initially blowing about 30% below normal–after three breathing treatments, it rose up another 120 or so.

Anyway, I’m on a Medrol dose pack, using ProAir every 3-4 hours, and Advair 2x/day. I still have an icky, rattling cough that’s occasionally productive, still have some chest pain (muchimproved, though), still wheezing, still weak, and still get very tired very easily. I don’t want to be calling or visiting my doc if this is a fairly normal progression of things as I heal, so I thought I’d check with the Dopers to find out if this is how things usually go after a more significant attack. What may be distressing to me may be par for the course and totally unremarkable to my docs.

Just like to say, this is NOT fun. Ick. Have you guys every had to go to ER? What sent you there?

2

I’ve never been hospitalized, but I am on Advair. When I was only using Primatene, I had a couple of times, most notably while moving furniture, when I had to run to the drug store to buy an inhaler because I didn’t have one on me. During one occasion, my breathing was becoming so labored that I was starting to become dizzy with blurring vision. I bought the inhaler, tore the packaging open right at the counter and sucked it down. The store folks let me sit down until I felt better.

What does seem sometimes to help me is to lie down on my front with my head lower than my feet at a sharp angle. I think this is what used to be done before inhalers were in use.
It does seem to send the mucus upwards where you might be able to cough it out.

3

I’ve never gone to the ER yet. But I do find that the throes of an especially bad attack can make me, well, STOOPID. Case in point: about 3 years ago, I had a cold that, not surprisingly, morphed into a flareup. I called the doc in the morning, and they couldn’t fit me in until the next day.

By afternoon, I was getting worse. I called again to see if someone could phone in a scrip for some Xopenex (for the nebulizer) and prednisone, to keep me going that night. The receptionist called back and said “Dr F is swamped and says to just keep your appointment tomorrow”. Instead of saying “Look, I’m really getting sick. If someone can take 2 minutes to phone in a scrip, I can avoid the ER tonight”… I said “:::wheeze::: OK”.

Wound up sitting up all night as I literally could NOT lie down to sleep. This sucked.

Anyway: My normal course of events is for a cold to morph into coughing and wheezing over 24+ hours. Usually I phone for an appointment as soon as this happens. I see the doc, wind up with a chest X-ray (not always, depends on how the chest sounds) in case it’s turned into pneumonia, then a 10ish day prednisone taper plus, often, an antibiotic to knock out any secondary infection. Possibly the doc is too liberal with those. And I usually get a scrip for Xopenex then too because at that point, the albuterol inhalers really are having zero effect.

Within about 12 hours, I’m feeling MUCH better. The lung passages start to open up, and if anything I sound worse: I’m coughing more because a) I can, and b) it’s helping. And I’m bring up more gunk.

Over the next couple of days, I’m improving. I can sleep at night because I can breathe. This is battled of course by the fact that as I taper off the prednisone, the lungs get tighter again. Hopefully not as tight as they were initially; if that happens, I’ll need to bump the pred back up (like I did this last time).

Are you improving at this point or just staying the same? It’s possible you need a longer steroid taper, and/or a different form of bronchodilator. I trot out the nebulizer as soon as possible… foul as the side-effects are (shakiness, heart racing), it really does a MUCH better job of opening up the passages. I don’t personally like the Medrol dosepaks because a) they have you taking the stuff multiple times a day (and who can remember that), and it’s a very fixed and short course. I need a longer taper than the Medrol packs provide. OTOH, they are very clearly labelled; a prednisone taper requires pretty specific instructions for how many to take on what day.

4

I’ve only had two really bad attacks in my life, both of which landed me in the ER but for which I was not admitted, just treated in the ER and released.

In both cases I had a prednisone taper after all the hoopla in the ER (where I found out I happen to be VERY prone to the mental side effects of the steroid) and in one of those two cases a cough suppressant. That’s because I was coughing so hard and forcefully I was starting to spit up a little blood (small broken blood vessels). That’s the thing with me - I almost never, ever wheeze but I sure cough like mf, to the point it really starts to hurt me and cause damage. (At the time I was playing bagpipes several hours a day - my breathing muscles were fantastically strong, which might have had an effect on all that, but my asthma always has and still does manifest as coughing, not wheezing)

Usually, I start feeling better in 24-48 hours, and by the time I taper off the steroids it’s back to normal for me, I don’t have lungs that get “tighter” as the previous poster said. Which gets back to everyone being different.

With steroids you should get relief of some sort pretty quickly. If you’re not, talk to your doctor. That said, it may take you longer to get better than someone else.

5

Commenting on why Broomstick emphasised this: The reason this is noteworthy is that when you’ve got respiratory stuff going on, there’s often gunk you need to bring up. Usually they don’t like to suppress coughing because you want that crud out of there, or else it a) aggravates the breathing issues, and b) can form a lovely breeding ground for a secondary infection.

But when coughing becomes too violent, it’s counterproductive as well. Not just the broken blood vessels as Broomstick mentioned, but it is exhausting, and it disrupts your ability to rest and recuperate. Plus it aggravates the breathing passages.

Docs won’t be eager to prescribe a suppressant, but I’ve found I can make a good case for the prescription stuff because of the exhaustion. I’m always cautioned to only use it for a day or two, at bedtime. The OTC stuff won’t touch that kind of coughing - I’ve needed to use codeine cough syrup for that.

The flareup I mentioned from 3 years ago was one time when I too needed a cough suppressant - the night I began the prednisone / nebulizer, I could breathe… then the uncontrollable coughing started. Unfortunately, OTC stuff didn’t help at all and I didn’t have a stash of the good stuff. That kinda sucked.

For what it’s worth, most of my flareups don’t require going there, like my latest one. The coughing was never into the uncontrollable realm.

6

It’s like breathing through a pillow. You can do it, but it’s slow, exhausting, and you can’t really do anything else.

Once I got sick when I was little and my normal inhalers and nebulizer weren’t doing the job. My mom had to carry me into the ER because I couldn’t walk there from the car.

7

Oh man, I remember those. I’m so much better medicated now I sorta forget how things used to be.

–Cliffy

8

I went through a period years ago of going to the ER or the doc in the box every other week. Once they finally gave me a home nebulizer, I was able to cut that to once a year. I also had an attack that put me in the hospital for a week, although I was able to avoid intubation.

I discovered it was my allergy to guinea pigs (!!!) that did it - we had some, I had no idea I was allergic to them, so they were in the bedroom and yeah…ugh.

For me, it feels like I can’t breathe out. I can breathe in, wheezy, but ok, but not out. I also am tired and feel like I can’t think properly. I tend to get a tune on playback loop in my head, too.

9

Oh, yes, the exhaustion is terrible. You’re utterly wiped out, and when you try to sleep the coughing wakes you up, it hurts, it hurts just to breathe and then you cough… it’s terrible.

Yes, codeine cough syrup. When you get to that point it’s a godsend. It didn’t entirely suppress the coughing, just took enough of an edge off so I could get some sleep. Between that and the prednisone I started recovering in a matter of days.

Of course, they don’t give you much coedine, but I usually find I don’t need even as much as they give me. At first I don’t mind the soft fuzzy feeling because it helps me rest but after 3-4 days I just hate the way it makes my brain feel like it’s wrapped in cotton balls and lint.

Thank goodness I don’t go through that sort of thing very often.

10

I’m pressed for time right now, so I can’t respond to each of you the way I would prefer–but, in short, thank you for sharing your experiences and history. One thing I learned from you is that asthma can have many variations of symtoms in an attack.

Right now, I’m dealing with edema. My hands are swollen up to my elbows, though not excessively. I can still wear my rings, and if I wriggle them, I can take them off. I think (hope?) this is from the Medrol dose pack (although I finished it yesterday). It reminds me of when I was pregnant…ugh. Hubby has been “de-squishing” my hands for me at night as the edema just feels icky. My feet are swollen, too, but I don’t notice it as much since I’m walking around. They don’t feel near as “squishy” as my hands do.

I still have tightness in my chest and an occasional ugly, deep cough, though not as often. The fatigue is insane. My whole body just aches, and all I want is sleep. I lie down, and BAM!–I’m out for anywhere from 5-90min. Good times, good times.

I see the pulmonologist Friday. Whee!

11

You’re probably right about the swollen hands being linked to the medrol. Now that you’re off it that should go down in a few days.

What non-asthmatics don’t always understand is that even when the acute symptoms have subsided you still feel like you’ve been slapped around and pummeled for awhile afterward.

12

I think you mis-spelled “wheeze” :).

Sorry about the edema. I’ve never had that particular problem because of steroids (though I did when I was pregnant, and it was pretty uncomfy!). Drink lots of fluids, that’ll help your body pee it off.

Between the Medrol and the flareup itself, it’s no wonder you’re trashed. If nothing else, I suspect it’s all really disrupted your sleep. I’m 3 weeks out from the start of this and am still feeling more wiped than usual.

13

Oh yeah: I thought I’d mention one counterintuitive thing (for me, anyway). When I’ve got crud to bring up, just coughing doesn’t do the job for some reason. I have learned to exhale as rapidly and completely as possible without allowing myself to cough. Do that 3-4 times… then I can cough and expel the crud.

Sounds truly awful for anyone in the same room as me (as I’m generally producing some awful wheezing / rattling sounds as I’m doing so)… but it works better, and is less painful, than trying to cough up the crud.

14

You know, I never really understood just how annoying some of my allergic/asthmatic breathing/coughing/rattling crud sounds were until one of my parrots started doing perfect imitations of them. For an hour at a time.

I hereby offer belated apologies to anyone who has ever been in ear shot of that.