And she also did an asthma plan for me to make sure that I understood what my peak flow was. What a peak flow is to actually breathe, you take a, you breathe out and how well you breathe out is your maximum, and my maximum is 550. If I go down to 330 it’s serious, call an ambulance, don’t hesitate, hospital straight away.

So that’s helped me to understand. So if ever I start to get a bit chesty cold, and it starts to get really chesty and not to go straight, then I take my peak flow and if it’s very low, then I have no hesitation, I know exactly what to do, and I can deal with it.

And it’s through that I’ve been able to manage it. You get the odd occasion, like even when you’re taking all your medication properly, unfortunately you still get ill. And my worst case scenario was five days in hospital and I, because I had a really bad asthma attack and that was hard, because I was obviously married with my husband and it was five days away from him which was, I hated, but it was necessary.

Not everybody has what you might term an asthma crisis’ but what happens when you do have one? What does it involve? How would you know you were having one?

With a crisis with asthma the airways become much more inflamed, often very rapidly. So somebody may have a response, a reaction to something that they are allergic to that they have a very severe response to. It could be that they’ve had a lot of things irritating the airways at one time so lots and lots of irritants in the air or it could be that theres lots of, maybe they have had a cold or a viral infection that can suddenly trigger off the asthma. And what happens in those circumstances is that the person will start to feel much more breathless than normal.

Very often their blue inhaler won’t work so they try their reliever inhaler or their blue inhaler and they don’t get good response to that and they feel progressively more breathless. These attacks can come on sometimes over a day or two but sometimes can come on very, very rapidly and the person will feel very wheezy, breathless and struggle. And we often tell people to watch out for whether they are able to move around or talk and if somebody is not able to talk properly so they are talking in broken sentences and only can say a few words at a time then that would indicate a very severe attack. And in those circumstances the most important thing is to seek an increase in treatment. So with the slowly progressing attack then increasing their preventative treatment, increasing their reliever treatment and often starting a course of steroids will get the attack under control if they’ve got so severe that they can’t talk properly they should seek medical advice very quickly.

And in terms of seeking medical attention do you mean actually going to A&E in some circumstances or what would that involve, just going to the doctor?

Yes again it very much depends on how severe the attack is and how well the attack is coming under control. So somebody who is perhaps feeling more breathless, blue inhaler is not working so much but is able to walk and talk we would suggest that they go down to their GP and seek advice from the GP or practice nurse. But if somebody’s attack was so severe that they were too breathless to walk and talk properly then we would advise that they call for help immediately so going to A&E and preferably not driving themselves in a car in case the attack gets worse on the way, so usually calling an ambulance so that they can get there with some medical advice.

I feel that if I want to say anything at all, is that you can survive it, it’s not the end of the world, you think it is when it’s happening, it’s one of the most terrifying things to have an asthma attack, it’s terrifying to have it and it’s terrifying to watch it, but it passes. You know, the doctors are brilliant nowadays. The medication is superb. People understand a lot more about why you are having this attack and how you can prevent another attack. And you can still grow up, have a career, fall in love, fall out of love, get a job, have children, do all the normal things that people do, travel the world, I wouldn’t recommend the Arctic.

[laughs]

Because it’s too cold. But you can do, you know, practically everything that everybody else does, you don’t have to be imprisoned by it.

It’s like as if, the sensation is of constriction in your windpipe and in your lungs. It’s like you’ve got a balloon that is, you know, won’t blow up, which I guess is your lungs. The hardest thing to control, when you have an asthma attack, that you feel is getting out of your control because I suppose the thing to remember is that you might have an asthma attack, which just means you’re feeling a little bit wheezy, where I don’t know, you’ve, you know, a bit of exertion or bit of tiredness or whatever, and you know that if you then go and get the reliever you’ll be fine. But you can also get to a point where you maybe ignore that for a while and then you start to panic, so the physical feeling of being short of breath then becomes a psychological feeling of fear and panic because your body becomes really aware very quickly that you’re in danger and your, just your normal fright flight responses kick in and you you’re looking for action. You want something to happen. But your ability to take that action is diminishing by the moment because, of course, you’re not actually processing any oxygen and you need people around you to know what this looks and feels like so that people around you, family, friends, work colleagues, would be able to work out that they need to go and run and get your inhaler or they need to phone for help for you. So I suppose first it’s a physical feeling and then next it’s a psychological panic.

And of course, the whole aim of the medication is to ensure that you never get to that point.

When I was I think was ten, maybe eleven, I can’t remember quite right, I probably had the one and only serious asthma attack I ever had. I had it in school and I had it at lunchtime and it’s, if you have an asthma attack you remember it, that’s the best way to describe it because you can’t, it’s just, I don’t think it’s the scariest moment in my life. But the scariest moment in my childhood because you just can’t breathe and you don’t know what’s going on. So I remember being like that in school and my dad was a teacher in the school and I would have been for lunch and then I would have went and played football after lunch and my dad would have gone home for lunch. And him coming in and me, and I remember leaning up, leaning up against something and not realising what it was, obviously, but then him having to take me to the, I don’t remember him taking, I can remember him taking me to the, it wasn’t the ER, it was the clinic in [Place] and being on a nebuliser. That was when I really thought it was a serious thing, I suppose.

It was my only serious proper asthma attack but it’s a very strong memory, put it that way. The fear, just utter fear of not being able to breathe, theres just nothing like it.

Okay and can you tell me, describe how you were feeling at that time.

At the… having an asthma attack?

Yeah.

I had, I remember, I just, it’s just fear. It’s just utter fear of breathing in and nothing happening. It’s just like you keep breathing in. If sometimes, having a panic attack or hyperventilating it’s the it’s, I’ve done that, but it’s not the same thing. It’s just breathing in and just, just not getting any air and you start slowing down and you start, you can’t move, you don’t want to move although you need to move somewhere where somebody can help you, but I didn’t want to move. I just, I just thought I’d stay there and hope that somebody would notice that I was having an asthma attack. It was yeah, it was kind of scary and thank God my dad came along at the time, I suppose. But it was just frightening, that’s for sure and when, nine or ten, it’s even scarier.

I think I would recognise when I’m starting to have problems and try to take action earlier but it’s just I had that experience where I woke in the night and very often an asthma attack is something that happens in the night and wakes you from your sleep, the shortness of breath and it’s the fact that if it’s the night and if it’s dark and if you’re feeling bleary eyed and if you’re already not functioning at a hundred per cent, you don’t really know anymore how near or how far you are from a dangerous threshold. So you need an objective measure. And I learnt that when I let my reading drop below two hundred and then had the hospitalisation and I now know that the worst time for you to be objective about how well you are is when you are unwell. So you need something that you can see in black and white.

You know, and so that’s, for me that’s what the peak flow meter is about because there is a kind of a need to decide when you’re in so much danger you really need to seek help and you need to be moving towards a car or a train or a bus and towards a hospital or a clinic, as opposed to going on taking more reliever.

Because one of the dangers is that you think, Oh, I’ll take more of my Ventolin and then I’ll be fine. And in actual fact, you’re not going to be fine and you need to use that time to go and seek you know, another intervention.

I’ve had a few occasions usually in the evening, that just seems to be at the end of the day – that seems to be when I have more problems. When I’ve had a very sudden onset of chest pain. That’s quite unusual for me, usually I do have a little bit of a warning, I feel a little bit uncomfortable and I know, normally I know that I need to take some extra medication and I actually don’t get to a state where I’ve got severe pain. But occasionally that happens and it is, I do find it very scary. I do spend quite a bit of time on my own because although I live with my husband, hes away so much and that’s just a fact of life. But it’s never, I’ve never got to the point where I thought I don’t know what to do next.

So far I’ve been lucky that I’ve not been so unwell that I couldn’t get to my medication and I’ve always had it around me, my Ventolin, I always have it around me in the same room.

An asthma attack is where the airways narrow rather quickly and so they have a relatively rapid onset of breathlessness and wheeze. Under those circumstances, they’ll know, the individual will know what to do themselves. But if that fails then they need to seek medical advice. Either go to their GP or if necessary go to the accident and emergency department at the nearest hospital. Treatment then is usually with what’s called a nebuliser, which is a, a mask whereby a solution of bronchodilator, which is the same stuff as we give in the blue relief inhaler as a mist and its basically given in, in large dose, so that you get a larger dose of drug, getting into the airways. And that’s very effective.

But if an individual needs nebulised therapy, then, very strong and careful consideration needs to be given to whether they need a course of oral steroids to try and cut down the inflammation, which was, which flared up, and therefore gave rise to the attack.

Now some people may be admitted to hospital. Some people may be discharged after a period of observation in, in the A & E department. It really depends upon how quickly an individual responds and so on. If they’re admitted to hospital, then in general terms they’ll be admitted for two or three days, sometimes longer. For children it’s usually 24, 48 hours tops.

And other than nebulised treatment and possibly some oral steroids, what other treatments?

Well sometimes we will give intravenous dosing of the bronchdilator drug again. Solely because if the airways are very, very narrow, trying to get air, the stuff into the lungs by inhalation is, the problem is that the airways are narrowed. And therefore you can’t get the drugs out to the very smallest airways. That’s sometimes then you have to give the drugs intravenously, so that they just get to the lungs by another route. And of course, if you need intravenous drugs like that, then usually people are kept in hospital for longer.

And so they would stay in hospital until their condition?

Until their condition is stabilised, peak flows have started to settle down and so on.

And is it helpful there having these people who are able to guide you through and help you manage your asthma?

Yes. It is and I am happy enough with all of that. The only thing that does bother me is living where I live, because I have no support. I have I don’t feel I have an externally anyone I can run to.

Yes.

Say for instance if, in the middle of the night, I needed to do that, thank God for phones and mobile phones but getting to the doctor is a stumbling block. In my head I’d be thinking, I’m living here on my own off the beaten track. What am I going to do if it got this bad in the middle of the night? Because, about five years ago [son] was at home. He was the only one of my children living at home, and I woke in the middle of the night really, really bad, and I had to phone from my bedroom to his bedroom to get him to come up to me. I couldn’t shout. I hadn’t the puff to shout, [Son] will you get up. And I rang down to the bedroom next door, to get him to come up. He come up and got me into the car and got me to the hospital, and then, I went to sleep okay that night. This, whatever.

This wakened me and I could not breathe, and that worries me. It’s getting to the doctors from where I live and, particularly, if I’m living on my own.

I try to avoid it, but there are times when it is inevitable. I mean, I think the thing I don’t like about hospitals is the, is the regime, you know, which has to be because it’s a hospital. Whereas I tend, at night times which I find the worst because you’re by yourself and you can’t really feel like phoning anybody or anything like this when you’re sitting wheezy so you have may be a cup of tea and you watch the television. You can do all that when you’re at home, but in hospital you’ve got other people to think about. So you’re just alone with your thoughts at night.

And in terms of that bit, do you live alone? I’m not quite sure do you live on your own?

Yes. I do, yes.

And is that a worry for you. Or a concern at all that you’re here by yourself?

It was very much when I was having, when I went through that really bad spell. It’s not so much now because I’m able to get out and about. I’ve got a car I can drive so I get out and about for that.

And so do you have something, I kind of a plan for you know, if things went downhill or you were taken ill or something?

Well my GP is fantastic, as is my consultant. So I just need, I mean I get told off by the GP for not calling him out, you know, not at all for not calling him out unnecessarily. So he would, they’d come out. They’ve got a really good network, they got a GP Cooperative in [place] so you can see a GP any 24 hours, you know, any time, any period of 24 hours. And if it’s the middle of the night they’ll send a taxi for you to take you to [Hospital] to see the Cooperative GP.

So is it a case of being able to recognize when you actually, at the point at which you would perhaps need some help?

Yes. Yes. And I’ve got an emergency admission card as well so And I know I can phone an ambulance as well. I’ve only ever done that once.

Can you describe when you had catastrophic attack how that, actually what you were feeling. Did it come on quite suddenly?

It did. I, we went to the doctor very early on, I said, you know, I woke up and I could tell the night before I wasn’t feeling too good. And I said to my husband, I just need to go. You know, and we, it was at the time when it was walk in appointments. So we walked in and we, we were given the standard prescription for oral steroids and we then went, we went to Sainsbury’s shopping and I can remember just sort of, I don’t know how I got round, but there was a pharmacy there and that’s why wed been there. And we got back and I said to my husband, I’ve just got to sit in the car. Because we live up 25 steps so [laughs] it wasn’t a case of just walking into our house. And he just took me back down to the doctor, who then, you know, rang forward to the hospital. And when I got in there, I wasn’t actually frightened, I can actually remember actually kneeling by the bed, because that was the most comfortable way. You kneel and you lean forward. And I actually can remember thinking if I die. I die.

Did you think it could happen?

It could happen, but there was no sort of panic about it because you get to a point where you think

You go with it?

Let’s just go with it. You can’t, you can’t really fight. You know, you can only just do whatever you know, sort of, sort of try and relax yourself. And it was just, there was a 20 minute period where it was really bad. And I was being monitored every ten minutes. You know, blood pressure and I couldn’t when you’re in that state you can’t do a peak flow you know, [laughs]. You know, you’ve got to use your breath for other things, than to give measurements to, to medical staff.

Did you have a nebuliser at that time?

Yes, I’d had a nebuliser and there was only, I mean I was having a nebuliser every, I don’t know, twenty minutes, you know.

And how soon did it pass off?

It passed off to bearable within less than two to three hours, because I can remember saying to my husband, Have you fed the car park meter? Because it was the time when we were still paying for car park. Have you fed the car park meter? And in some ways it was a way of just giving him, you know, an excuse to go, because it’s very distressing to see somebody, you know, in that state. I mean in some ways I was just forced to think about me and not to worry about, about the distress that he was obviously feeling.

Can you describe the actual feeling that you had during that attack? Was it just gasping for breath?

It’s not gasping. It’s that you know, you imagination breathing through the thinnest tube possible, you know, less than a straw, you know, just trying to get every little bit of air down, you know, that terrible constriction.

How long did you have to stay in hospital for?

For that one I think because I was I think I was on probably on the point of being what they call intubated. Which is a tube put down to help me breathe and with the drugs and the nebulisers I was just at the point of you know, of doing that and then I, everything seemed to relax after then, so the, I didn’t have to go into intensive, intensive care. Oh I can’t remember how long. I was in, I always seemed to have these things near a weekend and like most hospitals it just becomes a crèche at the weekends and nothing happens. If it had happened on a Monday, I dare say I would have been out on the Thursday or the Friday, but because it happened you know, and I was finally admitted on Wednesday night. That was it. I was in there until the following Monday.

Going into hospital for the first time. We went to A&E because I’d been gradually getting worse I have to, I have to remember the, the, you know, the sequence of events, I think mum had rung the GP who had sort of questioned her and said, you know, Have you done this? Have you done that? And, yes, basically it’s a case of well, You’d better go to A&E. So they took me to A&E, as I say, and I managed to pass out at the reception desk because my oxygen levels were so low, and I was just so tired because I had been fighting this for, fighting it for days, not realising how bad I was getting.

And had you been on steroids, at that point, or were you just using your inhalers?

I think at that point, I was just using my inhalers because I hadn’t realised that I’d got an infection or anything because previously I’d had the infection in my foot, I’d had antibiotics for that.. and was just assumed that I was better and thought the cough was because it was the middle of summer, you know, was it hay fever or whatever I was having a bit of a cough and stuff. And then, when I say I got to A&E, they just thought that my temperature was very high and I had this infection and they did the x-ray and it was, it was pneumonia in the left lung, and I was in the hospital for ten days with that.

And what took place whilst you were admitted into hospital and what, what sort of things were they doing?

In A&E I had nebulisers, oxygen, fluids because I’d got de-hydrated because I was coughing so much.

What the, do you know what the nebulisers called?

Salbutamol and Atrovent nebulisers yeah.

So that’s to kind of stabilise you, and so when you were in hospital they were monitoring you and keeping, trying to get on to

Yeah. The idea is, before you go home from hospital, you have to be back on your normal medication, unless they happen to have increased it or whatever. I mean, it turned out I then went on to a drug called aminophylline which they put straight into your veins and that sort of increases the blood supply to your lungs and it relaxes things down.

Now I have, since being here, I’ve on my first admission it was all set up for me that now my home phone number and my mobile phone number are red flagged, what they call it with the ambulance service, so if I ring them up, it’s, they know who I am, they the chances are that it’s probably my asthma; if I can’t say much I don’t need to say much to them. They’ll sort of say, you know, they’ll ask you for your phone number, where you are or the location and then often they’ll say Is that Jenny? Yes. Is it your asthma? Yes. Someones on their way, and they sort of say, they give you the usual do this do that, whatever.

So it’s sort pre-set for a priority call?

Yeah.