Asthma in intensive care

Find out how intensive care gives life-saving treatment in an asthma emergency

If you have a life-threatening asthma attack that’s not responding well to treatment you’ll be cared for in the intensive care unit (ICU).

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What is intensive care?

The intensive care unit (ICU) is a separate area of the hospital for treating people who need the most urgent help. It is sometimes called the ‘critical care unit’. 

The staff who work in ICU are specially trained to deal with critical care patients. There'll be a lead consultant and a team of doctors and nurses, all looking after you very closely. In ICU there is usually one nurse to one or two patients – so they’ll be able to monitor you properly. The nurses play a key role in making sure you’re kept stable and in keeping a close eye on how your body’s functioning.

Why does someone with asthma go to intensive care?

If you arrive at the hospital needing urgent care to get your symptoms under control you may be treated first in the resuscitation area of A&E. This is an area of A&E with specialist staff and equipment needed to deal quickly with life-threatening situations like not being able to breathe.

Once your condition is stable, you may be moved into a high dependency unit (HDU), where you get more focused care than you would on a general ward. But if you need more intensive treatment, you’ll go into the intensive care unit.

You’re most likely to go into the intensive care unit if:

  • you’re having an asthma attack that has left you unable to breathe on your own
  • you’re not responding to treatments, for example your peak flow score is getting lower despite treatment
  • your body isn’t getting enough oxygen –  a drop in oxygen levels is known as ‘hypoxemia’ - and this isn’t improving
  • there’s too much carbon dioxide in your body – a rise in carbon dioxide levels is known as hypercapnia
  • there’s a risk of respiratory failure because your body is unable to keep either oxygen or carbon dioxide levels steady
  • you’re showing signs of being exhausted, drowsy or confused, which indicates a lack of oxygen or an increase of carbon dioxide in the blood.

How will I be treated in intensive care?

ICU can look a bit daunting with lots of machines and wires. Some of these monitor levels of oxygen, or carbon dioxide, in your blood, or measure your heart rate or blood pressure. In intensive care you might be sedated to help you cope with the intensive treatments and monitoring. The ICU team will focus on giving you lifesaving medicines and helping you breathe.

  • You may be put on a nebuliser, which is the best way to get high doses of reliever medicine to you in an emergency when you’re really struggling to breathe.
  • You might also be given intravenous medicines to help you get on top of asthma symptoms. This is where a line is inserted into a vein so the medicines can go straight into your bloodstream, so it works faster. The ICU nurses will make sure you’re getting the medicines prescribed to you and monitor how they’re working.
  • If you’re struggling to breathe on your own you may need a little bit of support. You’ll be given air and oxygen through a facial mask – known as ‘non-invasive’ ventilation.
  • If you have a lot of mucus and fluid on your chest you may be given physiotherapy to clear this so you can breathe better. Sometimes more help is needed to clear the mucus, using a tube inserted into your lungs through your mouth or nose. This might be a bit uncomfortable but it is quick and effective and the nurses in ICU will talk through any concerns with you beforehand.
  • Sometimes doctors need to put a special tube through your nose or mouth into your airways and you’ll be attached to a ventilator to help you breathe – this is known as ‘intubation’ or ‘mechanical’ ventilation. If you’re given mechanical ventilation you’ll be given medicines to sedate you and help you relax so that you feel more comfortable. Intubation needs to be done by a doctor or anaesthetist and recovery time is longer, the doctors will only use this type of ventilation if absolutely necessary.

Are visitors allowed?

Visitors are allowed, and in fact visiting hours are often more flexible on ICU than on general wards, but it’s still important for your friends and family to check with staff on the unit first. 

How long do you need to stay in intensive care?

Some people are in intensive care for a few days, others for longer. Once you’re starting to improve the consultants will gradually reduce the amount of help you’re getting from the machines supporting you, so you can start to manage independently again. If you’ve been on sedatives, these will gradually be reduced. This is known as ‘weaning’ and it can take between hours and days.

Weaning is an important part of your recovery process, helping you to be well enough to move out of ICU, either into the High Dependency Unit or straight to a general ward.

If you’ve been moved into the High Dependency Unit, your consultants think you no longer need the intensive care of ICU, but you’ll still benefit from more focused care than you’d get on a general ward. If you go onto a general ward the staff there will be given a plan from the ICU department so you continue to get the level of care you need. Sometimes you might be visited by an ICU nurse.

While you are in the HDU or on the general ward you’ll continue receiving the asthma treatment you need. This may be in the form of nebulisers, inhalers, tablets or infusions/injections to help ensure that your condition stabilises and then improves. The ward staff will continue to monitor your progress by taking peak flow readings and measuring your blood pressure, heart rate and oxygen levels. Sometimes you’ll need to have blood tests too.

You may get support from a physiotherapist who will use massage to help keep your lungs clear and give you exercises to help strengthen all your breathing muscles so you can breathe well on your own again, and avoid the risk of lung infections

Being discharged

Once the hospital consultants think you’re well enough, you’ll be discharged. You may be referred to a specialist consultant in your local hospital for a follow-up appointment, or to a specialist asthma care centre to help you continue to manage your asthma .

Before you leave hospital, make sure:

  • you have a written asthma action plan to take away with you
  • you get to see someone in the specialist respiratory team to review your treatment plan before you’re sent home
  • you understand any medicines you need to take and how to use them, and have collected them from the hospital pharmacy
  • the hospital has told your GP about your asthma attack and you have a follow-up appointment booked as soon as possible and certainly within two days of leaving hospital. Check with your GP practice too to make sure you don’t miss out on this important follow-up appointment
  • you know when you need to be seen for any follow-ups – you should have appointments with a respiratory specialist for at least a year after the attack that led to your hospital stay.

Coming to terms with what’s happened

Being unwell enough to need treatment in intensive care can be a traumatic experience. You’re likely to feel tired, weak and lacking in energy, particularly if you’re recovering from being supported by a mechanical ventilator. On top of this people who’ve been in ICU can’t always remember clearly what happened and a sense of confusion can be distressing.

You might find you need some time to recover, and to come to terms with what’s happened. Be realistic about your recovery time – it can be a slow process – and set some small, achievable goals to help you keep positive and show you you’re moving in the right direction. For example, aim to contact friends on the phone or by email; do small bits of housework; cook a meal; or walk to the local shops, or the park.

Remember that this was a scary experience for close friends and family too and they might be dealing with the trauma in their own way. Talking about what happened might help them as well as you. Make sure you have the emotional support you need.

How likely is it to happen again?

You may be at higher risk of another asthma attack if you’ve recently been admitted to hospital for your asthma. But it doesn’t have to be this way – there’s a lot you can do to reduce the chances that you’ll have another asthma attack.

There’s good evidence to show that you can lower your risk if:

  1. you have a review with a hospital consultant before you leave hospital
  2. you’re given a written asthma action plan
  3. you go to all your follow-up appointments
  4. you continue to take your medicines as prescribed.

How can I avoid going to intensive care?

Most asthma attacks that are bad enough to need hospitalisation and intensive care develop quite slowly, over six or more hours, sometimes much longer than that. This gives you a ‘window of opportunity’ to get on top of symptoms before they get much worse.

This will be a lot easier to do if you’re already in the habit of keeping an eye on your asthma symptoms. People who have an asthma action plan are better equipped to manage their symptoms and so less likely to be admitted to hospital for their asthma.

If you’re monitoring your symptoms, with a symptom diary or a peak flow diary, you can feel more confident that you’ll notice when symptoms get worse before they develop into an asthma attack.

It might also help you start to feel more positive about your asthma again, helping you notice when your peak flow starts to improve and your symptoms are more manageable.

Last updated December 2016

Next review due December 2019