Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
If you are in the emergency room, treatment will be started while the evaluation is still going on.
You may be given oxygen through a face mask or a tube that goes in your nose.
You may be given aerosolized beta-agonist medications through a face mask or a nebulizer, with or without an anticholinergic agent.
Another method of providing inhaled beta-agonists is by using a metered dose inhaler or MDI. An MDI delivers a standard dose of medication per puff. MDIs
are often used along with a "spacer" or holding chamber. A dose of six to eight puffs is sprayed into the spacer, which is then inhaled. The advantage of an MDI with a spacer is that it requires little or no assistance from the respiratory therapist.
If you are already on steroid medications, or have recently stopped taking steroid medications, or if this appears to be a very severe attack, you may be given a dose of IV steroids.
If you are taking a methylxanthine, such as theophylline or aminophylline, the blood level of this drug will be checked, and you may be given this medication through an IV.
People who respond poorly to inhaled beta-agonists may be given an injection or IV dose of a beta-agonist such as terbutaline or epinephrine.
You will be observed for at least several hours while your test results are obtained and evaluated. You will be monitored for signs of improvement or worsening.
If you respond well to treatment, you will probably be released from the hospital. Be on the lookout over the next several hours for a return of symptoms. If symptoms should return or worsen, return to the emergency department right away.
Your response will likely be monitored by a peak flow meter.
In certain circumstances, you may need to be admitted to the hospital. There you can be watched carefully and treated should your condition worsen. Conditions for hospitalization include the following:
an attack that is very severe or does not respond well to treatment;
poor lung function observed on spirometry;
elevated carbon dioxide or low oxygen levels in your blood;
a history of being admitted to the hospital or placed on a ventilator for your asthma attacks;
other serious disease that may jeopardize your recovery; and
other serious lung illnesses or injuries, such as pneumonia or pneumothorax (a "collapsed" lung).