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Asthma (cont.)

Medical Treatment

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).

If your asthma has just been diagnosed, you may be started on a regimen of medications and monitoring. You will be given two types of medications:

Controller medications: These are for long-term control of persistent asthma. They help to reduce the inflammation in the lungs that underlies asthma attacks. You take these every day regardless of whether you are having symptoms or not.

Rescue medications: These are for short-term control of asthma attacks. You take these only when you are having symptoms or are more likely to have an attack -- for example, when you have an infection in your respiratory tract.

Your treatment plan will also include other parts:

awareness of your triggers and avoiding the triggers as much as possible;

recommendations for coping with asthma in your daily life;

regular follow-up visits to your health care provider; and

use of a peak flow meter.

At your follow-up visits, your health-care provider will review how you have been doing.

He or she will ask you about frequency and severity of attacks, use of rescue medications, and peak flow measurements.

Lung function tests may be done to see how your lungs are responding to your treatment.

This is a good time to discuss medication side effects or any problems you are having with your treatment.

The peak flow meter is a simple, inexpensive device that measures how forcefully you are able to exhale.

Ask your health-care provider or an assistant to show you how to use the peak flow meter. He or she should watch you use it until you can do it correctly.

Keep one in your home and use it regularly. Your health-care provider will make suggestions as to when you should measure your peak flow.

Checking your peak flow is a good way to help you and your health-care provider assess what triggers your asthma and its severity.

Check your peak flow regularly and keep a record of the results. Over time, your health-care provider may be able to use this record to determine appropriate medications, reducing dose or side effects.

Peak flow measures fall just before an asthma attack. If you use your peak flow meter regularly, you may be able to predict when you are going to have an attack.