Asthma – When to Go Emergency Room

Thursday, September 3, 2009, 12:20
Asthma
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Andrew:

Dr. Gower, one of the things that any parent would wonder about, and I think we heard from John earlier about their child being at the emergency room, is when is it an emergency? Maybe not certainly the first initial diagnosis, but now they’ve been to the emergency room one time or they’ve been to someone like you, found out that their child has asthma. How do they move forward then and know when to call the doctor, when to rush to the emergency room or when simply to step up the medication that’s been provided to them?

Dr. Gower:

That’s always a real concern. I think that with respect to one of the previous questions, a management plan should be engaged between the patient or mother or father and the physician or provider, and that should be a written plan that you, in an emergency, can look at and measure and know what to do step by step. That should be written down by the provider who’s taking care of the asthma. I think from a parental standpoint, you look at a behavior change. Obviously, if the person is turning blue, it’s an emergency. But if there’s a change in behavior, he’s been very active, or she, and then they slow down or they’re coughing after exercise, or there’s a respiratory infection and all of a sudden they become listless – they can’t lie down without coughing, they can’t breathe, they can’t sleep, their sleep pattern’s changing and so on – that’s a bad sign.

If they have a peak-flow meter, which most patients with chronic asthma should have, they should have a written parameter guide of a red zone, which is a danger zone, and that’s less than 50 percent of their usual peak flow reading. The peak-flow reading is from a peak-flow meter, which is a little instrument that they blow into when they’re doing well and also during crises, and it gives, other than behavior changes or symptom changes, it gives them a number that somebody can hang their hat on.

And if they blow, let’s say, 300 liters and all of a sudden they’re blowing only 100 liters, with the same machine, same technique, that’s less than 50 percent of what they should be. That’s a problem. You yell for help immediately. When in doubt, after you’ve taken the emergency steps to take the albuterol or other rescue medicine or nebulized albuterol, then one should take prednisone if you have that, and then if you’re still not doing well, get to the doctor’s office or to an emergency room.

Andrew:

That’s helpful. And of course, you’re talking giving a general plan, but the idea of having a plan specifically worked out in advance with your doctor is what’s critical, I’m sure.

Dr. Gower:

It’s very important, and I find that in the past I’d been deficient in doing that. I’m doing it more and more, especially for parents, for the reasons that we’re talking about. If one gives a lot of discussion and advice, then at the last, if you tell the patient or the parent, one expects it to be understood. But it always helps to have it in writing so that when something happens, they or their spouse can take a look at that because we all forget the instructions when we go to a physician. So, I think the written guideline is very helpful, on an 8″ by 11″, not a little piece of paper, and it says what to do, how to recognize it, what the peak flow guidelines are, what medicines one should take, how much prednisone to take, and what the phone number of the physician is or the allergist or pulmonologist would be, and also if they’re not on call, what the numbers of their partners would be. It takes a lot of worry away from the parent that way.

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