I find that the fatigue hits almost immediately after the attack, while the depression and despair hit during the attack.
In the ER today, I could feel the despair/ helplessness/hopelessness hit like a wave, and had to fight mentally to overcome it and stay calm. My attack took place out of town, and I had to walk 15 minutes to the ER, as I couldn’t talk on the phone (in my hand!!) nor would anyone respond to my attempts to flag down help. I truly didn’t think I would make it–inhaler didn’t even make a dent.
More recently, the study by Lindenauer et al examined outcomes between patients treated with high-dose IV steroids (equivalent of 120 mg-800 mg of prednisone on the first or second day of treatment) compared to low-dose oral steroids (prednisone equivalents of 20 mg-80 mg per day). 12 The authors found no differences between the two groups regarding the rate of treatment failure, defined by initiation of mechanical ventilation after the second hospital day, in-hospital mortality, or readmission for COPD within 30 days of discharge. After multivariate adjustment, including the propensity for oral treatment, the low-dose oral therapy group was found to have lower risk of treatment failure, shorter LOS, and lower total hospital cost.
Perioperatively drugs used to treat asthma should be continued, sometimes in a different format (see table). Patients taking more than 10mg of prednisolone daily will require steroid supplementation perioperatively, and may require IV maintenance doses until absorbing drugs.
Perioperative recommendations for asthma medications
Class of drug Examples Perioperative recommendation Notes ß2 agonists Salbutamol, terbutaline, salmeterol Convert to nebulised form High doses may lower K + . Causes tachycardia and tremor Anticholinergic drugs
Convert to nebulised form Inhaled steroids
Beclomethasone, budesonide, fluticasone Continue inhaled formulation
If patient on >1500 mcg/day of beclomethasone, adrenal suppression may be present
Prednisolone Continue as IV hydrocortisone until taking orally (1 mg prednisolone equivalent to 5 mg hydrocortisone)
If >10 mg/day, adrenal suppression likely Leukotriene inhibitor (anti-inflammatory effect)
Restart when taking oral medications Mast cell stabilizer
Continue by inhaler Phosphodiesterase inhibitor
Continue where possible Effectiveness in asthma debated. In severe asthma consider converting to an infusion perioperatively (checking levels 12-hrly)