Another asthma attack! Second wave?

it's been a long day.

my girlfriend had a few really bad asthma attacks this morning and just got back from the hospital a few hours ago. they gave her a lot of meds and said that she still needed a lot of time to recover, but she was stable enough to come home.

about an hour ago, i noticed that her breathing sounded tight and wheezy, but she said that its normal after a bad attack and that she's fine. then, she took a nebulizer treatment and her breathing seemed to get better and she fell asleep. about 5 minutes ago, she woke up with another asthma attack; she's wheezing and coughing and taking another nebulizer treatment, but her chest is still really tight. my gf doesn't want to go to the ER -- she says it is normal to have symptoms after a bad attack.

i called a nurse through our insurance who said that the symptoms are normal and an additional attack called a second wave a few hours after the initial attack does occur and to just help her use her meds if she's having another attack and she'll be fine.

after her last nebulizer treatment, her asthma seemed to ease up a little and i thought it was over, but i guess i spoke too soon. i returned from getting her some tea 5 mins later, and found her hunched over, her ribcage is sucked in and her breathing sounds SO tight. she's now on another nebulizer treatment, still insisting that she'll be fine and theres no need to go to the ER.

how much worse are these follow up "second wave" attacks supposed to be and how do we deal with them? what other asthma symptoms are normal to expect during recovery?  and how many nebulizer treatments does she take for an attack before we go to the ER?  is this a normal symptom after a severe asthma attack? i don't know if i should take her to the ER or trust that she can gauge her symptoms well.

[David Tinkelman, M.D.]

The sequence of events that you describe is very worrisome.  It is not “normal” to “sound tight and wheezy” after a bad attack.  Actually, it is a sign that the asthma attack is severe and has not optimally responded to the asthma therapy.  It is estimated that more than 5,000 persons die of a severe asthma attack in the U.S. every year.  Your girl friend is at very high risk at this moment including the risk of sudden death.  

I strongly encourage you to do everything you can to overcome her resistance to seeking further care, perhaps with the assistance of other friends or family members.

In her present state, she requires close observation in a hospital or large ER setting, staffed by doctors capable of taking immediate action to assist her breathing, if that is required.  You should consider this to be a true emergency situation, despite what she says about her past experience with asthma attacks, and it would not be unreasonable for you to call 911.

When this attack is resolved, I strongly recommend that your girlfriend seeks consultation at one of two medical centers that specialize in the treatment of severe asthma:  The University of Pittsburgh Medical Center in Pittsburgh, PA., under the direction of Dr. Sally Wenzel and, 2) National Jewish Health in Denver, Colorado under the direction of Dr. Richard Martin.

But, do not hesitate to take the necessary action right now, without delay.

Good