Because asthma makes breathing difficult, the muscles for breathing may tire and the volume of air exchanged by the lungs will decrease. As a result, a person's oxygen level drops while blood levels of carbon dioxide rise. As Birge and Shulman explain in their book, "A carbon dioxide buildup in the blood has a sedating effect on the brain, which may cause you to feel even drowsier. You may lose the motivation or energy to breathe."
"A person with asthma who seems to be relaxing more, who seems to not be struggling for breath anymore -- even though they've been at it for 6 or 8 hours -- may actually be worse. It could be a sign of respiratory fatigue," Birge says. Eventually, the person could stop breathing.
"They're really in a big danger zone," Shulman adds. Patients believe they're getting better when they're actually getting worse, he says. "They become sedated and seem to be peaceful when actually, they're dying."
One of the most important considerations is how long an attack lasts, according to both doctors. "If you've been having labored respirations with the asthma not relenting after a period of several hours, even though you may be apparently doing OK, don't let it go any longer," Birge says. "Get on to the emergency room."
6. Depression and suicidal thoughts.
Few people would put up with crushing chest pain or extreme shortness of breath, but many endure depression, even though, at its extreme, it can be life-threatening.
"Depression can be a very, very serious problem because people can commit suicide," Shulman says. "Some people will not seek care when they are depressed because they think that they'll be perceived as being crazy or not strong or not manly, and they have to understand that there is a chemical imbalance going on in their brain. It is a disease just like any other disease."
Symptoms of depression include sadness, fatigue, apathy, anxiety, changes in sleep habits, and loss of appetite. Depression can be treated with medications and psychotherapy.
If you have suicidal thoughts, you can speak to someone right away by calling national phone numbers such as 800-273-TALK or 800-SUICIDE.
Speak Up When You Think Something Is Wrong
Doctors are human: They can miss important diagnoses, including heart attacks. A patient's awareness and vigilance can make a difference, Shulman says.
"My feeling is, as a doctor, I want a patient who's informed. I'd rather have a patient who's informed who's helping me so I won't make a mistake," Shulman says. "And I can be honest and say, 'I'm human. Don't be intimidated by me because I have a white coat on. Don't be intimidated by me because I'm using big words.'"
If patients can recognize potentially serious symptoms, they'll have more power when they go to the doctor or the emergency room, he adds. "You have enough to say, 'Well, have you ruled out this problem?'"