When Asthma Attacks
What I learned as a physician having an asthma flare
Since he started daycare, my son has been sick. Every single week.
Which means I’ve been sick.
Every.
Single.
Week.
Usually, the illnesses are pretty mild. Just a little cold. But ten days ago, my son had a fever and was coughing up yellow phlegm. I knew it was going to be a more severe illness, and I braced myself for getting it.
And get it I did. I somehow still can’t keep my toddler from coughing directly and unexpectedly into my face.
As a family physician, I’m used to treating people who are unwell with colds, flus, stomach bugs, etc. Especially in call clinic in the winter months. I usually give the spiel that colds hit their peak between 5 and 7 days, and then they start to get better. I always say that if it’s not getting better after that timeframe, or certainly if it’s getting worse, then they need to see a doctor again.
Well, my cold wasn’t getting better. Even after ten days.
For some background, I was diagnosed with asthma as a child. I’m a very typical case of someone with asthma and allergies, which often go hand-in-hand. I’ve had to take puffers all my life, and my asthma is usually well-controlled. In fact, a few weeks ago, I saw my Allergist. He said my asthma was great, and that my lung function tests were pristine. Woohoo!
But something was different with this latest illness. Like I said, I just wasn’t getting better.
I also started needing my puffer all day, every day. Including in the middle of the night. I woke up from sleep with unstoppable coughing fits. I couldn’t do my workouts, even at home. (I didn’t go to the gym for 10 days because I avoid it when I’m sick. Right after writing a post about being proud of sticking with my New Year’s resolution to go to the gym!)
Plus, I was having a hard time breathing, even when I was sitting still.
Typing this, my medical training is screaming out, “this sounds exactly like an asthma attack!” Textbook, in fact.
And yet, it took my husband telling me that I needed to see my own family doctor because I was having an asthma flare. And that if I couldn’t get in that day, I needed to go to the Emergency Department.
Uh oh.
I went to my doctor that day, and she said that indeed, I was having an asthma attack. She prescribed me prednisone pills, medication reserved for moderate to severe attacks in order to keep people out of the hospital.
I have to point out that I’m very privileged. My medical training has impressed upon me the importance of good asthma control at baseline, I was able to access my own family doctor that same day, and my husband is also a physician who could point out what I had clearly missed. I avoided the worst consequences of an asthma attack.
In the rest of this post, I’m going to share what I learned (and re-learned) about asthma after my personal experience with a flare.
1. Good asthma control saves lives
My recent experience underscored the importance of having good control over your asthma at baseline.
Asthma is a chronic disease, not a symptom. People with asthma have inflammation and tightening of the airways in the lungs. The WHO has a succinct summary about asthma if you want to learn more. When not well-controlled, this inflammation and airway narrowing can lead to problems.
Asthma can cause trouble breathing, sleep issues, tiredness during the day, and poor concentration. It can lead to absences from school and work, and missing out on physical activity. If severe, asthma can lead to emergency care, hospital admission, and death.
So, what does good control look like?
Asthma Canada has a chart I’ve added below that outlines signs of good control. Essentially, for asthma to be considered well-controlled, you should be functioning normally at work/home/school, breathing well, sleeping through the night, and not needing a reliever puffer more than twice a week.
Your healthcare provider may send you to get a lung function test if you need this checked as part of your asthma management.
2. Asthma attacks can be insidious
A decade ago, I had an asthma flare that was sudden and obvious. I had trouble breathing when resting, and my reliever puffer wasn’t helping. I went to the Emergency Department and had to get prednisone to mitigate the flare.
I made a mistake this time: I didn’t recognize I was having an asthma flare because it was insidious.
Over the ten days I was sick, I gradually started waking up more at night coughing. I gradually had to take more and more of my puffer. I convinced myself I just had a cold and that tomorrow it would get better.
That’s why the next lesson I (re)learned is so important.
3. Have a plan in place before you have a flare
Remember all those school talks about fire safety? They always highlighted the importance of having an escape route and a plan for your family in case of fire.
You’ll note that they didn’t say, “just wing it when you hear the fire alarm.”
As with my own case, it’s hard to make decisions about your health when you don’t feel well. Even if you’re a trained medical professional. (Maybe especially if you’re a trained medical professional.)
Have a plan before you have a flare. In an ideal world, your asthma is so well-controlled that you don’t ever need it. But keep it in your phone in case of emergencies.
Here’s a picture of the asthma action plan I made after having this flare:
And here’s a link to a template where you can make your own plan with the help of your asthma care provider, like your family doctor, nurse practitioner, or lung specialist.
4. Don’t delay getting help if you’re worried
It took me three days to make an appointment with my family doctor at the insistence of my husband. That’s three days of horrible sleep, missing work and workouts, and not being able to play as much with my son. Three days where things could have gone from bad to worse. Maybe if I hadn’t appropriately taken more of my puffer, they would have.
As a resident family doctor, I tell patients that I’m all about prevention and nipping problems in the bud. I want my patients with asthma to come see me before things get bad. You’re not bothering your healthcare provider by seeing them if you’re concerned.
I really hope this helps even one person to check in with their asthma. You can take control of your health, reduce your risk of flares, and overall feel better.
Stay well friends,
Dr. Kuhnow
Dr. Kuhnow is a family medicine resident physician and former physiotherapist in Ontario, Canada. She writes about healthy habits for healthcare providers on her blog no trophies for perfect. To get healthy habits and practical tips directly to your inbox, sign up for her weekly newsletter.
This post is meant for educational purposes only, and doesn’t replace advice from your qualified healthcare professional.
