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Asthma Treatment In An Emergency Room/Is It Possible To Convincingly Fake An Asthma Attack?
Girl with Owl
speaky_bean wrote in little_details
I'm writing a story that takes place in New York City, in 2002. My character is a teenage boy who is asthmatic but is faking an asthma attack. I checked google, and the tags for this community, but I was unable to find anything particularly useful. I'm actually really confused as to why I can't find anything about the first part of my question, since it seems fairly basic, but I've been trying various keywords "asthma treatment" "asthma emergency room" "asthma hospital" and so on, and I haven't found anything. Also looked up 'asthma' on a couple of medical websites, but none of them really answered my question. (If I missed anything in the tags here, please forgive me.)

Anyway, my questions are as follows.

1) How are asthma attacks treated in an emergency room setting?

2) Is it possible for someone to fake an asthma attack and for emergency room workers not to pick up on this? Is the faking more likely to be overlooked if the person is actually asthmatic? How dangerous would it be to receive treatment when one is not actually having an attack? Also, what would one have to do in order to fake one?

Any help would be greatly appreciated. I've been stuck researching for ages now, and I really want to just get on with the story, but I can't until I figure this out. Thanks in advance!

Well they do tests - a peak flow metre. You can try not to blow out very hard, so it registers a low reading. They also listen to your lungs, to see how clear they are. You can't fake that.

It is possible to be struggling to breathe and for your lungs to sound okay though, and if the boy is known an as asmathic, I think they would be unlikely to accuse him of faking it.

Now this is a guess, but I think it wouldn't be dangerous. The treatment often makes me feel sick, and I felt shakey and a bit shit the next day, after a recent 2am attack where I needed treatment at the hospital.

In order to fake one - hm, catch your breath as you breathe in. Cough, perhaps. I often breathe quickly during at attack, as panic sets in a little, especially if I can't find my inhaler instantly. Try and sound as wheasy as possible, but again that's quite difficult to fake.

Sorry I don't think I'm being that careful, but feel free to ask any questions. :)

Edit: Forgot to answer question one! They would like do the two tests, checking the chest with a stethoscope to see how clear the lungs are, and do a peak flow test. If the attack was very bad, they would probably forgoe these. They would then put him on a nebuliser. This is something that looks like an oxygen mask, attached to a box.

Edited at 2009-05-23 06:21 pm (UTC)

Nope, they don't forgo those tests when it's really severe.

By that I meant if they can't talk, perhaps losing conciousness, and are unlikely to get them to stand up and do a peak flow test, you know?

It would depend on the doctor. My experience (in my comment to the OP below) where I wasn't able to talk, they still did the peak flow. So, it's definitely a big variable.

Ah, okay. Well it doesn't matter anyway, as he won't be classed as bad enough anyway. :)

Also they would probably give them steriods, or leave them with a course to take over the next week or so, if required.

This. Both inhaled and pill (prednisone usually).

(I ACTUALLY HAVE THE KNOWLEDGE FOR THIS LITTLE DETAILS POST omg)

heliology

2009-05-23 07:05 pm (UTC)

Yeah, prednisone, seconded.

Argh, by careful I meant helpful!

From my own personal experience, it would be hard.
When I had a serious asthma attack (severe enough to have my heart stop working intermittently), I was given a peak flow test immediately, unfortunately for me they were using averages - and my lung capacity is rather large (a normal peak flow for me is in the 700-800 range). I was lucky a doctor noticed that I was going cyanotic, and was brought into the treatment area (from triage) and given nebulised steroids.



Edited at 2009-05-23 06:22 pm (UTC)

Well, that would actually be fine. I should have added that his purpose is not of the Munchausen's variety where he's trying to make people think he's sick when he's not. He was trying to draw attention to himself in order to break up a fight. It would probably be better for him NOT to get treatment.

Sorry that happened though, that sounds sucky. D:

Wasn't the most fun moment of my life, but I lived - too danged stubborn to give up I guess. ;)

There, he could have any wounds tended from the fight, if nothing else. If he did have asthma (even mild) faking the attack could bring on minor symptoms.

(a normal peak flow for me is in the 700-800 range)

Holy crap, wow. XD <-- 450-500

Yeah, I'm not a small critter to start with (I'm 6'0"), and I've spent most of my life swimming, singing and playing wind instruments (flute, clarinet, sax), so my peak flow is never "normal". When I came in it was at 400ish, When I left it was 750ish if I remember right.

As one who frequently attempted to fake asthma in order to get out of sports in high school, I'm pretty sure it can't be done, at least not by someone who doesn't already have it. I tried everything, making wheezy noises and flipping out and all, and they were like, "You don't have asthma."

If you fake a low peak flow reading, they will more likely think that one of your lungs has deflated/collapsed rather than an asthma attack.

The only time I had any success at all in faking asthma, was when I had a severe allergy attack from camping in the woods. I am allergic to practically everything in nature: ragweed, flowers, certain kinds of trees, grass.. and I had forgotten my allergy medicine. I attempted to tough it out, and this gave me an attack very much like asthma, which was relieved by an inhaler. If there is something you can take a nice big inhale of that you're allergic to, that might do the trick.

Ahahaha, I was so tempted to try faking asthma back in middle school to get out of running the mile in PE, because I always felt so terrible afterwards, but I never could get up the courage.

Of course, the irony here is that, as I found out years later, the reason I felt so terrible was because I really did have asthma.*

*exercise-induced, which is why it never showed up otherwise.

Edited at 2009-05-23 07:42 pm (UTC)

Yes, this- I hated running and was horrible at it, turns out I had asthma the whole time- mild, cough variant. No one ever said anything or checked me out. I'm still pissed off about it. Similarly, no one ever checked my eyes out while I was in high school, so I didn't find out I needed glasses until I took my learner's permit exam. Stupid grownups.

Yep, that's exactly what I have. I'm not upset about not getting diagnosed except in a kind of vague way, mostly at myself-- I did kind of suspect it at the time, but was too embarrassed to say anything to anyone, in case I was wrong. (I'd always thought that asthma = wheezing, y'know? And I didn't really wheeze. And everyone kept telling me it was just because I was out of shape.) I know my mother would have had me at the doctor's in a heartbeat if I'd ever said anything, though.

And everyone kept telling me it was just because I was out of shape.)

This. I wasn't diagnosed until I was 20 - after high school gym classes adn even trying to do cross-country in college. No *wonder* I couldn't run a mile@!

To the OP: besides the peak flow meter (which I hate - I can't even do it well when I'm NOT having an attack), they will check the oxygenation of your blood by putting a painfree clip on your fingertip. Good oxygenation can't be faked.

For me, the inhale breath is fine. It's the exhale, as my lungs and bronchiods stuggle to expel the depleted air - I have hugely long exhales and you can hear the whistle or wheeze in my chest.

Both of these are hard to fake - but a boy known to have asthma is going to be checked out medically if he complains of breathing problems.

THIS IS TOTALLY ME TOO.

There's a whole party of us in the comments!

I don't know if this will help, but I'll mention it anyway. I have asthma set on by stress or exhaustion. I have never had to go to an emergency room, because even if I do get an asthma attack, a dose of emergency meds and some time to calm down usually settles it within half an hour. Point being, if I don't breathe properly - like if I laugh too hard, hyperventilate for some reason, breathe in smoke, or stress myself out I can get some mild attacks. Meaning I could probably give myself a mild attack by stressing myself out on purpose if I needed too. If you only need for your character to get the attention turned to him, he might be able to do that by hyperventilating or something, and then not actually need treatment in an emergency room after all.

My boyfriend has asthma--I asked him about it.

1. There's a device called a nebulizer which gives an albuterol and water mist that you breathe in.

2. Yes, it IS possible to fake it, all you have to do is make raspy breathing sounds and maybe say "asthma". The treatments are not dangerous. They're only dangerous if you do it A LOT. But there's no point, 'cause they're not fun, either.


When asked about his sources, he called on the fact that his sister's a nurse--a little light, he admits, but he's confident in it. His asthma isn't severe enough to have required a nebulizer at any point, and he never tried to fake it.


(PS - When I ask about the peak flow test, he says, "The priority at the emergency room is not to get an accurate diagnosis of asthma, 'cause it really doesn't matter that much because the medication is not dangerous. So if they think you've got it, they'll put you on a nebulizer. After that, they'll send you for a pulminary function test.")

From my experience, you go to the ER, you tell them you can't breathe and you're asthmatic, and they rush you to the front of the line.

Then, They give you a peak flow meter test and listen to your lungs.

Then, I got a nebulizer treatment of Albuterol. Ten minutes of breathing in by the mouth through a tube clamped between my teeth, and out the nose. And, trying not to drool.

Then, they listen to the lungs again. If it still is bad, they wait ten minutes for your heart to stop racing, then put you on for ten minutes.

Ten minutes on, ten minutes off.

I was in an Air Force hospital, and it was a few years ago. So, in a civilian setting, they may have the nebulizer with the face mask, and they may use drugs like Xopenex, Pulmicort, Duoneb, or others.

But, none of those have bad side effects from one use. They basically make your heart race, if that. And, the doctors wouldn't let you have another treatment until the heart rate went down.

As for faking it? If he's asthmatic, he'd know how to fake everything but the stethoscope, which can't be faked. But, if he's a chronic asthma sufferer, he'd probably not have the greatest of lungs anyway. That, and the stress of the scene with the fight would make his heart race, his breathing shallow, etc, and may start a slight asthma attack.

If you have fluid on your lungs, as I do, you they can't hear the wheeze anyway.

I already have asthma, and it's hard even for me to fake an attack. I tried once, just to see if I could - the wheezing is unmistakeable. It'd be far more likely for someone to seize on a trigger and get it to happen that way, like razzabeth said in her last sentence.

I have been treated in an ER for several asthma attacks without being tested with a peak flow meter first, so I think it depends on the hospital. For the record, I was never in bad enough shape to be losing consciousness, although one time the attack was bad enough that I was starting to get a little blue, and on another occasion it wasn't asthma at all, it was something much worse.

The first thing they will do for treatment is a nebulizer treatment (which they'll probably call just a "breathing treatment"), as described below. Depending on the hospital set up, it could be something like an oxygen mask connected to a box that they wheel up to the gurney, or it could have a hand-held mouthpiece something like this - http://www.allergyasthmatech.com/ProdImages/N1461.jpg. Also, some hospitals have a dedicated room in the ER for respiratory problems, which may or may not have the kind of set up where they just plug the mask or mouthpiece into the wall.

The actual medicine in the nebulizer will be albuterol, which is the same thing as the rescue inhalers most asthmatics carry, just in a different form. (A mist of liquid albuterol mixed with room air or oxygen. It doesn't really have a taste, but it feels a little different than plain air.) The hospital breathing treatment lasts about 10-15 minutes. I've never had any side-effects from it, personally. Afterwards they might send you home with a prescription for prednisone, which is a steroid, and WILL have all sorts of side effects, if your character actually takes them.

It would not be difficult at all for someone with asthma to convincingly fake an attack for bystanders. In the ER, generally speaking, they take your word for it that you have asthma and are having an attack, because the treatment isn't dangerous if you don't/aren't. To fake it, he'd want to try and make wheezing noises breathing in and out, cough, and try to breathe more shallowly than normal. And, like another poster said, doing this could very likely bring on a mild real attack.

Okay, there's a variable here. There is such a thing as non-wheezing asthma. I know because I have it. I don't wheeze when I'm having an asthma attack, I cough. So, if he has non-wheezing asthma then it would, I think, be possible to fake it if need be. For me, it feels like I'm breathing in (and out) through a straw and I start coughing. From there, it's a very short trip to big trouble. From my experience, which I admit is limited to my experience, my asthma attacks seem to come on slower than a "regular" asthmatic. Meaning, I can be slowing losing function over the course of an hour and simply not realize it until the coughing starts. I only know this is the case because my husband (and a couple of other people who tend to be attuned to breathing) sometimes notice that my breathing is getting shallower, and when I try to take a deeper breath, I can't.

Non-wheezing asthma is hard to diagnose, but responds to the same treatments as regular asthma, so he could be hooked up to a nebulizer and so on and so forth.

This. This is also my asthma.

Mee too! Cough variant w/post nasal drip! Took years to get it figured out.

Oh, and lots of pukeing. I used to lose my dinner on a weekly basis. To fake it, I would try to breath in really deeply and roughly and hyperventilate until I coughed, once that started it'd be pretty easy to go into a rather alarming coughing fit. Enough coughing and the gag reflex gets triggered and there's your lunch. Not fun, could be dramatic...

I do wheeze occasionally, but I'm more prone to coughing. As soon as I start coughing I know that I need to get my rescue inhaler.

I have cough variant asthma, I wheeze a little but what I mostly do is cough until I puke. You might give him that sort of attack, for one thing it's really dramatic and if he's trying to get a fight stopped, it's hard to overlook.

Yeah, and if you've had an attack where you reached the "puke" point recently, it's really easy to set it off again.

Uncomfortable, but easy.

Let me add that albuterol may not be "harmful" but it makes me feel jittery and paranoid after I have to take it. And the one time I had to do the nebulizer, the effect lasted for two days. I'll do just about anything (massive amounts of caffeine) to avoid doing that again.

It would be absolutely possible to fake it in terms of getting *non*-medical people to believe you, especially if one's asthma is severe or just poorly controlled - I can literally make myself start coughing/wheezing if I breathe just right... er, wrong, and can then (with some effort) make it stop before it becomes a true attack.

Once he's actually in the ER, though, there are peak flows, pulseoximeters (a little clip that goes on your finger and measures heartrate/oxygen saturation), and other stuff to actually measure what's going on, so they would know he wasn't in any *trouble*. (They wouldn't really be able to determine if he had had an attack on the way *to* the ER or not, because there are so many different kinds of asthma, which all present differently - so all they can say is "you're having an attack/not having an attack right *now*").

They'd most likely give him a nebulizer treatment just to be sure his airways were fully calmed down... some people can get "rebound attacks" where the second/third is worse than the first, so as long as he has a genuine asthma diagnosis, they'd go with "you're fine now, but better safe than sorry," and then send him on his way. Although if he's leaping around and being obnoxious/ *obviously* okay, they might just boot him out once the pulseox and peak flow are done... but he'd have to be being *very* obnoxious for them to skip the whole CYA thing of a "just in case" neb.

oh, and it'd be very unlikely for them to accuse him of faking, simply because, as I said, all they can tell is "you're not in trouble right now, at this particular moment," which doesn't mean you weren't in trouble five minutes ago or won't have another attack five minutes from now.

Basically he'd go in to the ER, wait an hour or two or three or six (and may simply walk out, which he'd be allowed to do at any time during the wait, since he hasn't been seen yet - no signing out required). If he does wait long enough to see a nurse/doc, they would hook him up to a pulseoximeter, which would display his heart rate and O2 sat, (and please, it's sat, as in short for "saturation" - not "stats," never "stats!") listen to his lungs, and have him do a peak flow, all of which would tell them he wasn't having an attack right *now*... but that he may well have been having an attack at some point during the wait, which had now resolved. Then they'd give him a neb (which he could refuse, but they'd encourage him not to) and send him on his way.

Albuterol (which is what's usually given in a neb) isn't at all dangerous at standard doses (.5 ccs albuterol, 2 ccs of saline, usually), even if you're not having an attack. In fact, for some asthmatics, it's used as a maintenance drug anyway (in combination with other meds). It will give him hand tremors and make his heart race, though. How much, or how bothered he is by it, depends on how often he uses albuterol. Also, the shakes are caused by the fact that albuterol tanks your blood sugar, so eating or drinking a glass of orange juice will make you feel much better. (A lot of asthmatics don't know that as such, but lots of people figure it out on their own and just don't really understand *why* eating/sugar helps.)

Even if you come in via ambulance, it's common to have at least an hour wait in the ER if you're not actively crashing. He'd just be waiting in a little holding room (looks like an exam room) instead of in the waiting room. If he does go in by ambulance though, the EMTs would know that he wasn't having an attack (by using the same methods the docs would) and would tell him so, and would urge him not to go... but they can't *refuse* transport.

It's possible to easily fake asthma attacks, and indeed, I've fooled an ER once as a kid. (I was more scared of my mother than of the doctors back then!) An important trick is to not breathe out fully. Always try and keep about half your lungs full. The asthma cough is air trying to escape, and the full on attack is the cough not helping. Once you've mastered forcing coughs without emptying your lungs, you're set. It makes the gasp easier and the coughs sound more characteristically asthmatic. It also gives a sort of posture that looks very asthma attackish.

Asthma attacks can clear up shockingly quick, especially if it's primarly coughing type. You might still feel like crap, but there can be little external evidence. "Man, I totally thought I was dying; I took my med, it wasn't that helpful, but I guess it just took way longer than usual to kick in and my trigger isn't here in the ER, so I guess I"m fine now!" Absolutely 100% believable, and the staff would have to be some seriously bad assholes on their worst day before they'd claim it was a lie.

Another trick might be having the stress of faking an attack bring on one. Coughing triggers my asthma. If I cough, even fake cough, I start having trouble with increased mucous and wheezing. The muscle tension from fake coughs seems to make me cough worse. Stress also is a common trigger, and the stress of being taken to the ER for a fake attack can certainly start a real one.

In my experience, it's really much harder to fool other asthmatics than it is medical staff.

I read over most of the comments first...

1) they do not usually give a Peak Flow test when you go to the ER. They check your Pulse/Ox (this is the "ET finger" test). You can not fake a low Pulse/Ox number. The test measures how much oxygen is getting into your cells.

2) unless you have a massive history of severe asthma, anything over a 96 is not considered an emergency (I have severe COPD, and have gone into respitory failure 2x. If I say I can't breathe and my P/ox is a 96 I will be listened to as my history says I have a lower tolerance for carbon dioxide).

3) Neubulizer is usually filled with a combo of Albuterol and Isabromide (tastes nasty as hell!). This makes your heart race, your lungs open up, and you shake.

4) They will also do chest xrays to verify there isn't anything else happening like pneumonia.

5) Patient will get at least 2 treatments, maybe more depending on how low P/ox is. And how much wheezing is happening (lungs will be checked by Dr & respitory person).


I had an asthma attack while in a PE class at my uni a few years ago and my professor called 911 and I was taken to the hospital in an ambulance. My memory is oddly spotty for part of it, so I'll tell you what I can remember.

Before the ambulance got there, my professor had me sit down and had another student stand behind me to hold me as upright as possible. She helped me use my inhaler as by that point I wasn't able to use it on my own. While we waited for the EMTs she talked to me to try and keep me calm--a lost cause and I added a lovely full blown panic attack to my asthma attack.

When the EMTs arrived they did a lot of random things, but this is about when my memory goes fuzzy. I know that they gave me both a nebulizer and oxygen and when they put my on the stretcher, it was slightly reclined which significantly hindered my breathing, so they set it back up again.

At the ER my stretch was met by a bevy of running doctors and nurses and I was taken into a private room in the ER. The nebulizer was taken away from me long enough for the nurses to get my shirt off. I was topless and in a hospital gown before I really knew what was happening. I was given the nebulizer again while the doctor listened to my lungs.

They put an oxygen monitor thing on my finger and gave me a new nebulizer. By this point I was trembling. Uncontrollable shaking. The nurses brought in (heavenly) warmed blankets.

Most of the nurses cleared out of the room, and the doctor had to duck out for a bit. I gave medical info and talked to both a doctor and a nurse. The doctor talked to me about preventing further attacks of that severity and prescribed me a new rescue inhaler and some steroids.

Meanwhile my uni was trying to get a hold of my parents and aunt (my emergency contacts) but none of them were answering their phones, so my professor came to the hospital. She sat with me while I finished up the second nebulizer and then took me back to my dorm.

Once I got back to my dorm I was exhausted and shakey and my mouth was dry and I felt miserable. I climbed into bed and slept for a few hours then got a friend to take me to get my prescription filled.

As for faking an asthma attack? I suppose to someone who wasn't very familiar with asthma, hyperventilating from a panic attack could be misconstrued as asthma--but anyone who knows anything about asthma would be able to tell the difference. Also, if this character actually does have asthma, trying to fake an attack might very well trigger a genuine attack. I know that whenever my breathing is changed from normal (for example, if I laugh, or blow up a balloon) I can trigger an asthma attack.

hey i hav had 1 and ya its possible 2 fake cuase he docs rnt assholes they wont acuse u of faking so ya