Hospitalization for Severe Asthma

Whether your asthma is severe or usually well under control, you sometimes may find it very hard to breathe. An asthma attack that doesn’t get better even with a rescue inhaler can turn into a life-threatening emergency. But how can you tell if an asthma attack is bad enough to go to the hospital, and what can you expect once you get there?

Check Your Asthma Action Plan

The plan you wrote with your doctor to help control your asthma does more than tell you what medications to take. It also lists the symptoms to watch for and when to call your doctor or go to the ER if they get worse.

You should call 911 or get to a hospital right away if you:

  • Have wheezing or shortness of breath that doesn’t get better when you use your rescue inhaler
  • Are so short of breath you can’t talk or walk normally
  • Have blue lips or fingernails
  • Take more than 25-30 breaths a minute
  • Need to strain your chest muscles to breathe
  • Have a heartbeat higher than 120 beats per minute

Very few people need a hospital stay for asthma treatment. It’s more likely to be necessary if you:

  • Have had a bad asthma attack before
  • Went to the ER or stayed in the hospital because of your asthma within the last 10 days
  • Got diagnosed with asthma after age 40
  • Take steroid medications regularly to control your asthma
  • Use your rescue inhaler more than twice a month
  • Have other long-term health problems, such as heart or lung disease

What to Expect at the Hospital

Emergency room doctors will decide whether you can be treated and released or whether to admit to you the hospital. They’ll examine you, note your symptoms, and test your lungs.

Treatments

Depending on your symptoms, different medications and treatments may be given in the ER to get your asthma attack under control. These include:

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Tests

While they treat your asthma attack, your doctors will probably run tests to see how well they’re helping. These tests may include:

  • Peak flow reading, which measures how quickly you breathe out
  • Spirometry, which measures how much air you breathe out in 1 second
  • Blood oxygen levels, as measured through a device on your finger

Hospital Stay

Even if your symptoms get better quickly, your doctor may want to keep you in the ER for a few hours to make sure symptoms stay under control.

If you still have signs of severe asthma after several hours of treatment, doctors may have you stay in the hospital. You also may be admitted if you have asthma complications, such as air in your chest.

Another reason for a hospital stay is if you have so much trouble breathing that it exhausts you. Sometimes oxygen levels go down so much during an attack that doctors worry you could go into lung failure without quick treatment.

A hospital stay for an asthma attack usually lasts 3-5 days. Rarely, an asthma attack is so severe you may need a breathing tube to pump oxygen into your lungs.

Going Home

Not all your asthma symptoms need to go away for your doctor to let you leave the hospital. But they have to be much better. You’ll need a follow-up visit soon after being released. Your doctor will give you directions on what to do if you have another attack.

Usually you’ll be prescribed corticosteroid drugs to take at home to lower the chances of another severe attack. If your lung test results are still a little low, your doctor will also be more likely to release you if they think you’ll take your medications correctly.

Prevent Future Emergencies

The best way to prevent another severe attack is to treat an asthma flare early with a nebulizer and possibly corticosteroid pills. Take all your regular medications as outlined in your asthma action plan.

Another key step is to avoid your specific asthma triggers. Talk to your doctor to determine what triggers your asthma (such as dust, smoke, cold weather, exercise, or viruses). Washing your hands often can help lower chances of catching a cold or other virus.

If your asthma isn’t well-controlled, chances are higher that you’ll have another severe asthma attack. Be sure to go to all scheduled doctor’s appointments. If you have regular flares or other signs your asthma isn’t well-controlled, see your doctor.

WebMD Medical Reference Reviewed by Jennifer Robinson, MD on November 01, 2018

Sources

SOURCES:

Mayo Clinic: “Asthma Attack.”

CDC: “Asthma Action Plan.”

National Jewish Health: “Asthma Action Plan.”

Canadian Medical Association Journal: “Management of Acute Asthma in Adults in the Emergency Department.”

Annals of Emergency Medicine: “Assessing Severity of Adult Asthma and Need for Hospitalization.”

The Asthma Center: “How is Asthma Treated in the Emergency Room?”

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