What Actually Happens in the Emergency Room During an Asthma Attack

Before you read — 10 seconds: Why might the emergency room give you steroid pills instead of putting them in an IV?

a) Pills are cheaper b) When you can swallow, the pills work just as well c) IV steroids are not used in asthma

If you have never been to the emergency room for asthma, the not-knowing is its own kind of stress. Here is what the team is actually doing, and why.

They start treating before they finish checking

This surprises people. The team will start your rescue medicine and oxygen while they are still measuring how severe things are. That is deliberate. Waiting for a complete picture before starting treatment would cost time that matters.

Oxygen, but not as much as you would think

The goal is to bring your oxygen level into a target range — not as high as possible. More oxygen is not automatically better in asthma, so the team aims for a specific range rather than turning it up as far as it will go.

One thing worth knowing: the finger clip that measures oxygen can read falsely high in people with darker skin. It is a known limitation of the device. It is one reason your team also measures how well you are moving air, rather than relying on that number alone.

The rescue medicine, often more than one kind

You will get your usual type of rescue medicine, repeated as needed. In a severe attack the team often adds a second kind that works differently. Used together, the two lower the chance of needing to be admitted compared with the first one alone.

They may give it through an inhaler with a spacer rather than a nebulizer. That is not a shortcut. For most people the two work equally well.

Quick check: Is a nebulizer always better than an inhaler with a spacer?

a) Yes, always b) No — for most people they work equally well

Answer: No. For most people an inhaler with a spacer works just as well as a nebulizer.

Steroids, early — and usually as pills

Steroids bring down the swelling inside the airways, and they work best when given early — inside the first hour.

Most people are surprised they come as tablets. When you can swallow, pills work just as well as an IV. A typical course runs five to seven days, and usually there is no need to taper the dose down at the end.

For a severe attack that is not responding, there is an additional medicine given through an IV over about 15 to 30 minutes. It is well studied and it reduces the chance of being admitted.

What they will probably not do

People often expect a chest X-ray, a blood test, or antibiotics. For a straightforward asthma attack, guidelines advise against all three as routine. Asthma attacks are usually not infections, so antibiotics usually do not help. Not ordering them is the team following the evidence, not cutting corners.

Before you are discharged, the team rechecks your breathing — usually about an hour in. They are looking for two things together: that you feel better, and that your breathing test has come back up toward your normal range. Both, not one.

Talk to us about an asthma review

If you have been to the emergency room for asthma in the last year, that is exactly the conversation worth having with the team.

Call (847) 860-7250.

Never change or stop a medication on your own. Talk to your care team first.

The answer

When you can swallow, the pills work just as well. The IV is reserved for people who cannot take anything by mouth.

This article is for education only and isn't a substitute for medical care. Questions about your situation? Call the office — we're happy to help.