I am not your stereotypical asthmatic, I suffer from what my consultant calls complicated, severe asthma. What I am going to try and do in this piece is describe how I feel when I am having an asthma attack. Asthma and asthma attacks can vary dramatically from person to person but this is what happens to me, how I feel and what action I take.
My asthma comes at me in 2 different ways, there is the flare up which does not always result in an asthma attack of sorts but it leaves me feeling unwell and tired. From the outside it may not be that obvious that I am struggling, I do not usually wheeze, I usually develop a cough, I will suffer from shortness of breath (especially on exertion) and I get a very tight chest. The chest is what usually causes me the biggest problem, the tightness and pain becomes almost unbearable, it is hard wok doing anything, it is impossible to sleep and will usually lead to a full blown asthma attack.
These flare ups are often the result of a cold bug, chest infection or develop from one of my usual triggers such as sudden changes in or extremes of weather. My peakflows usually become very erratic but in general are a lot lower than usual, my oxygen levels also tend to be all over the place. I know that how I deal with these flare ups will often determine whether I end up having a fully blown attack and / or end up with a hospital admission. I have an asthma action plan which is a viral tool for all asthmatics, I know mine off of the top of my head but regardless of what my sats or action plan say I think that I know my condition better than anybody else. I always have an emergency course of antibiotics at home in case of infections, I do my breathing exercises, I use my flutter device, I know that one of my problems is that I struggle to cough up mucus and that is why I get so many problems. I usually increase my prednisolone and I will increase my nebs, if I continue to struggle I will speak to my respiratory nurse or go see my GP but ultimately there is only so much that they can do. I will try to stay out of the cold (even miss football matches) and if I have to go out I get wrapped up, in the winter I always wear a snood or scarf. I keep my fluids up and I hope things improve, sometimes they do, sometimes they don’t.
Sometimes you know that you are fighting a losing battle, you know that the attack is coming, it’s just a matter of when. The difficulties in this period are what do you do, I can’t just keep ringing work up and telling them that I aren’t going into work because I might have an asthma attack! Life becomes a balancing act of resting and protecting yourself and still trying to get on with your life. I don’t think that I do a bad job of managing it but I don’t always get it right.
It is very strange when you go to bed on a night, knowing that you wont sleep and there is a possibility that you could have an asthma attack. When I am like this I always keep a hospital grab bag ready with the vital stuff that I would need to take with me if I ended having an attack and going to hospital.
When these flare ups occur I start to prepare for an attack, if it doesn’t come it’s a bonus. However it often does come and then the hope is that it isn’t a bad one and you can manage it yourself with the nebs. When an attack actaully kicks in, my already tight chest becomes much tighter, a crushing feeling. You know that there is very little air movement and everything becomes difficult, you try to control your breathing, you try slow deep breaths, you try to stay calm, you try to sit upright even though you want to lay down or bend over double because of the brain. I understand that I go a funny colour, usually bright red in the face but my lips often go pale. I must look wonderful!
I will fire up the nebuliser (during an attack I always prefer to use a mask rather than a mouth piece) and hope that they help ease things. The coughing usually then kicks in, this obviously doesn’t help with the breathing. I will usually attempt a few back to back nebs but eventually the salbutamol starts giving you the shakes, your heart races, your head spins, you become dehydrated and you get to the stage where you aren’t sure whether it is the asthma or the nebs causing the problems. I’m often asked whether I prefer to be by myself or have somebody with me during an asthma attack. I usually prefer somebody to be available and be nearby but not necessarily sat looking over my shoulder. I prefer it if it isn’t a loved one such as my wife or parents as seeing them worrying about you getting upset because they know that you are struggling, it just makes me feel worse. On the other hand I don’t want somebody who doesn’t have a clue about my condition and keeping asking questions or telling me to breathe or stay calm. Saying that though it is not nice if you are completely alone while you are having an attack. My wife through experience is pretty good now, she will give me space but keeps checking on me. I also have a couple of workmates who are very good when I have attacks at work. Usually if the nebs aren’t helping, the decision will be made to ring for an ambulance. If the nebs aren’t helping I become drowsy and I struggle to speak properly, again this signals that it is time to make the call. It is quite interesting though that sometimes that attack may feel worse for me and look worse to my wife yet the sats aren’t always that bad, yet in other occasions I haven’t felt as bad yet my sats be horrendous. This combined with a quiet / silent chest with no wheeze often confuses paramedics, doctors and nurses, this is one of the problems with severe asthma, it isn’t easy to diagnose and can easily be missed or not treated properly during an attack. Many times I am told not to worry and my condition is made worse by panic or stress, this really annoys me because usually when I am having an attack I am the calmest person in the room, I usually feel in control (even though you can’t say that you are fully in control if you can’t breathe).
The other attacks that I suffer are those that come on without warning. These are the ones that I live in fear of. Within minutes of feeling fine I can suddenly start suffering the same problems as described above, the tight chest, the works. I have had these attacks in various different places, at home, at work, on holiday etc but the worst time and place is when you are driving on a motorway (with no passengers). You know that you need to find somewhere safe to stop the car. I always have to portable nebuliser with me and it sets up in seconds. I also try to ring somebody to let them know where I am and what is happening, not with the intention of worrying us just in case the nebs don’t help and you may need assistance, it is better to tell them that while you still can talk.
It really is strange to describe my exact feelings during a bad attack. I would say that it is like been in the eye of a tornado, I can hear everything what is going on around me, the voices of family, workmates, nurses, I can hear the nebuliser powering away but I aren’t really taking it in, I usually recall things the later on and piece things together, I suppose in some respects it is like remembering what happened the previous night if you had gone out and got drunk. So I can hear things, I will try to respond to any questions but ultimately I am in my own world, in my zone just concentrating on breathing. In some respects it all feels like an out of body experience, as though I am on the outside looking in!
I have a song on my iPhone which is an acoustic cover by the Manic Street Preachers of the Rihanna song “Umbrella’ for some reason if I listen to the song in my head or actaully listen to it I find that I breathe in time to the tune. Strange really but it does seem to help, you should also see the look on the nurses face when I am having an attack in hospital and I ask for iphone and headphones before my nebuliser!
Listen to Umbrella by Manic Street Preachers by the link below
Obviously by the fact that I am writing this tells you that I am lucky enough to have recovered from every attack, sometimes due to home nebs, sometimes due A&E / Resus, sometimes via intensive care, high dependency or acute medical unit but always the help of my fantastic respiratory team. Following an attack though I am always prone to further attacks, a big like aftershocks following an earthquake. Virtually every bad asthma attack that I have suffered as resulted in a few weeks hospital admission which usually includes numerous other asthma attacks before discharge. This is then usually followed by a few weeks rest and recovery at home before starting to get things back to normal such as returning to work. It’s during this period of recovery when I start to suffer from feeling down, worrying about missing time off work, reflecting on what has happened, trying to do too much too soon and at times even feeling sorry for myself!