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When does asthma require hospitalization?


Asthma is a chronic condition that affects the lungs and airways, causing wheezing, chest tightness, coughing, and shortness of breath. For most people with asthma, symptoms can be managed with medications and lifestyle changes. However, severe asthma attacks may require emergency care or hospitalization. In this article, we will discuss the signs and symptoms that indicate a need for hospital treatment for asthma exacerbations.

Difficulty breathing

One of the most apparent signs that asthma has progressed to a serious stage is labored or difficult breathing. Symptoms may include:

  • Chest tightness that won’t go away
  • Feeling like you can’t get enough air
  • Hunched posture while breathing
  • Gasping for air
  • Flared nostrils while breathing
  • Inability to complete full sentences due to shortness of breath

If breathing becomes so difficult that you are unable to speak more than short phrases or are struggling for air, this indicates a medical emergency requiring prompt treatment. Get help right away by calling emergency services or going to the nearest emergency room. Severe shortness of breath means insufficient oxygen is reaching your vital organs.

Rapid worsening of symptoms

For people managing their asthma with medications, a rapid worsening of symptoms is cause for concern. You should seek medical attention if:

  • Your rescue inhaler is not providing relief
  • Symptoms are getting significantly worse over a period of a few hours or days
  • Physical activity is triggering wheezing or coughing
  • Nighttime symptoms are waking you up

A quick decline in your condition or lack of response to medications indicates your asthma is destabilizing. This warrants evaluation and treatment to get it back under control before it becomes critical.

Peak flow values below 50% of normal

Using a peak flow meter at home can provide objective data about your current asthma control and lung function. Peak flow numbers measure how strongly you can exhale air from your lungs. If your peak flow values drop below 50% of your personal best, this indicates asthma that is not well-controlled and requires adjustment of medications.

Consistently low peak flow values below 50% despite taking asthma medication as prescribed also indicate the need for medical intervention to stabilize your asthma. Seek care promptly before your condition deteriorates further.

Fever

Fever often accompanies severe asthma attacks requiring hospitalization. Fever likely indicates the presence of underlying infection that is exacerbating asthma inflammation in the airways. Associated symptoms may include:

  • Fever over 100.4 degrees Fahrenheit
  • Chills or sweating
  • Body aches
  • Cough with yellow/green mucus

The combination of worsening asthma symptoms plus fever is a red flag for needing emergency asthma treatment and evaluation for infection, such as pneumonia or bronchitis. Prompt medical care provides important treatments such as oxygen, intravenous steroids, antibiotics, and inhaled bronchodilators.

No symptom relief from quick-relief medication

Most people with asthma use an albuterol inhaler as needed for quick relief of acute symptoms. Typically, using your rescue inhaler should ease asthma flare up symptoms within 5 to 15 minutes. If you are not experiencing improvement in your breathing after taking quick-relief medication, this is a key indicator to seek urgent medical care.

Lack of response to albuterol may occur with:

  • Severe asthma attacks
  • Undertreated or undermanaged asthma
  • Worsening asthma triggering hospitalization

Do not simply increase your use of albuterol beyond your prescribed instructions if symptoms are not improving. Quickly worsening symptoms require prompt medical assessment and treatment with stronger medicines like systemic steroids to stabilize your breathing. Call your doctor right away or go to the emergency room if albuterol does not provide relief.

Decreasing mental alertness

Worsening asthma can lead to oxygen deprivation, increased carbon dioxide levels, and lack of air reaching the brain. This may result in deterioration of your mental status including:

  • Feeling drowsy, confused, or barely conscious
  • Combativeness or agitation
  • Slurred speech
  • Glassy eyes
  • Irritability or change in behavior such as hallucinations

Altered mental alertness alongside asthma symptoms indicates a need for emergency care to prevent respiratory failure. Call 911 or go to the nearest emergency room right away.

Bluish lips or fingers

During severe asthma attacks, oxygen levels in the blood may drop significantly. This can lead to a bluish discoloration of the lips and fingernails called cyanosis.

Cyanosis occurs when:

  • Blood oxygen saturation drops below 85%
  • The skin, lips, and nail beds have a grayish-blue color
  • The tongue and mouth may turn blue as well

Cyanosis indicates your body is not getting enough oxygen and immediate treatment is needed. Go directly to the emergency room and notify your doctor if you notice these blueish signs during an asthma flare-up.

Relying on rescue medications daily

Needing albuterol or other rescue inhalers every day is a sign your asthma is poorly controlled. Having to use quick relief medication several times per week or more indicates worsening asthma that requires medical attention.

If you find yourself increasingly dependent on bronchodilators just to get through your days, your asthma management plan needs adjustment by your doctor to reduce exacerbations. Relying too heavily on rescue inhalers means your lungs need stronger controller medications to manage inflammation and prevent complications.

Hospitalization criteria for children

Parents of children with asthma should watch closely for any of the above signs requiring prompt medical care. Additional reasons to take your child to the emergency room or hospital include:

  • Chest retractions – skin sucking in around neck and ribs with breathing
  • Shoulders rising and neck extending with inhalation
  • Wheezing or whistle sounds with breathing out
  • Hunched body posture
  • Inability to drink or eat due to shortness of breath

Young children are at higher risk for dehydration and exhaustion from labored breathing, so inpatient treatment may be warranted sooner. Monitor your child’s effort with breathing, chest wall movement, and fatigue level. Seek emergency care if symptoms do not improve or worsen despite treatment at home with rescue medications.

Summary table

Signs of asthma emergency When to seek emergency care
Difficulty breathing/shortness of breath Unable to speak full sentences between breaths, gasping for air
Rapid worsening of symptoms Within hours or days despite medications
Peak flow less than 50% personal best Consistently low numbers below 50%
Fever over 100.4 F Along with worsening asthma symptoms
No relief from quick-relief medication After standard dose of bronchodilator medication
Decreasing mental alertness Drowsiness, confusion, agitation
Bluish lips or fingers (cyanosis) Grayish-blue skin, nails, mouth
Daily use of rescue inhaler Medication no longer controlling symptoms

Conclusion

Asthma attacks can escalate quickly from mild to life-threatening. Close monitoring of your symptoms and response to treatment is key. Prompt medical care for exacerbations helps prevent a severe asthma flare-up from becoming a respiratory emergency.

Know your personal signs of worsening asthma. Be ready to seek emergency treatment if you experience difficulty breathing, declining peak flow readings, or lack of symptom relief from bronchodilators.

Do not ignore symptoms assuming they will get better on their own. Stay in touch with your doctor and follow your written asthma action plan when symptoms flare up. With proper care and management, most asthma can be controlled, avoiding hospitalization and threats to your health. Work closely with your doctor to adjust your treatment plan if your asthma seems to be spiraling out of control.