Which Asthmatic Are You? The 11 Types of Asthma Patients

Respiratory Therapist and asthmatic John Bottrell worked with some friends to compile this list of adult asthma personalities. Which one are you? Illustrations by Dash Shaw

Which asthma patient are you -- The Martyr who refuses treatment, the Actor who exaggerates her symptoms or the Poor Patient whose doctor is no help? Or are you another type? You may find that you are a combination of asthmatic types.

Click the links below to read about them and see which one sounds like you or someone you know.

The Gallant Asthmatic: The Perfect Asthma Patient

The Goofus Asthmatic: The Lazy Asthma Patient

The Phlegmatic Asthmatic: The Calm Asthma Patient

The Actor Asthmatic: Their Asthma Isn't That Bad

The Martyr Asthmatic: Too Tough For Asthma Treatment

The Recovered Asthmatic: Asthma Symptom-Free, For Now

The Doubting Thomas Asthmatic: Newly Diagnosed Adults

The Sometimer Asthmatic: Sometimes, They Don't Take Their Medicine

The Poor Patient Asthmatic: Need Better Doctors

The Hard-Luck Asthmatic: Their Asthma is Difficult to Control

The Bronchodilatoraholic: Overusing Their Quick-Relief Inhalers

Read the original blog post: 11 Types of Asthmatics

Bronchodilatoracholics: Frequently Using their Quick-Relief Asthma Inhalers

These are asthmatics who use their bronchodilators frequently, perhaps too frequently. It's usually an indication that their asthma is not controlled.

A bronchdodilator is a quick-relief asthma medicine that relaxes the airways in the lungs so it's easier to breathe. They are often prescribed in conjunction with anti-inflammatory asthma medicines.

Some bronchodilatoraholics are hard-luck asthmatics who just need help breathing very often. While others are regular asthmatics whose asthma is out of control.

But some bronchodilatoraholics are abusers, taking their asthma medicine more out of habit than necessity. They may also ignore the directions given to them by their doctor. Abusers don't work with their doctors on an asthma action plan and they may not bother withcontroller, anti-inflammatory medications. For them, puffing away is like a bad habit -- like biting your fingernails. In contrast, some hard-luck asthmatics may just need their bronchodilator frequently -- many times a day, every day.

Asthma Attitude: "Just one more puff, and I'll be fine."

Asthma Strengths: They know not to wait until they have severe breathing trouble to take their bronchodilator.

Asthma Weaknesses: A bronchodilator is not made to control asthma, but to relieve and prevent symptoms. Bronchodilatoraholics are not treating the underlying cause of their asthma symptoms -- inflammation in their lungs.

Lessons to Live By: The first step is to admit you have a problem. If you use your bronchodilator too frequently, then you need help controlling your asthma. The bronchodilator isn't going to solve the problem.

Originally published at healthcentral.com/asthma. 

The Hard-Luck Asthmatic: Their Asthma Is Difficult to Control

These asthmatics have asthma that is difficult to manage, no matter how compliant they are with their asthma medicine and how hard they try to control their asthma.

These are the asthmatics who, regardless of how compliant they are with their preventative medicines, still have bad asthma episodes. We don't know what bum luck would cause some asthmatics to get so bad, but some simply develop asthma that becomes difficult to control.

This can happen to any asthmatic from infant to adult. They see doctors on a regular basis. They are on all the state-of-the-art medicines (possibly even oral steroids), and yet still have asthma episodes regularly. They end up in hospitals more often than they'd like.

Asthma Attitude: "I'm really trying to manage my asthma, but it's tough."

Asthma Strengths:They are smart about asthma and work hard to control it.

Asthma Weaknesses: They must be careful not to abuse their quick-relief inhalers or just give up on managing their asthma.

Lessons to Live By: Stick with it. Follow your asthma management plan and change it if it's not working for you. Avoid your asthma triggers and always get help immediately when you need it.

Originally published at healthcentral.com/asthma

Poor Patient Asthmatics: Asthma Patients Who Need Better Doctors

These asthmatics would be okay if they had different doctors. We RTs hate to bad mouth doctors, but we know that since this patient has been in the ER 10 times in the last year, he should be on some type of preventative, anti-inflammatory medicine and not just a bronchodilator.

Poor Patient Asthmatics would take better care of their asthma if they knew how. They need help developing a good asthma action plan for themselves. They may even need to be prescribed different asthma medicine that works better for them. They know that something is wrong, but their doctor isn't helping.

Poor patients may also be children with asthma whose parents don't have a clue how to manage the asthma.

Asthma Attitude: "There must be a better way to manage this. But I need help!"

Asthma Strengths: They want to manage their asthma well and will do what it takes to feel better.

Asthma Weaknesses: They may not be pushing hard enough on their doctor and they may be afraid to simply find another physician who will help them. Children, unfortunately, can't choose their doctors (or their parents).Lessons to Live By: You know your asthma symptoms better than anyone. Get another doctor if you need to until you find one that is helpful. You may need a pulmonologist (a lung specialist). Ask questions about medications and work with your doctor to find an asthma medicine regiment that works for you. Get started with these 5 steps to controlling your asthma. If you're a parent, use ourChildhood Asthma Guide to get more information.

Originally published at healthcentral.com/asthma. 

The Martyr Asthmatic: Too Tough For Asthma Treatment duplicate

The opposite of Actor asthmatics, Martyr asthmatics could be dying and they still won't go to the ER. They are usually tough, macho adult men who only go to the ER at the insistence of their spouses.

Martyr asthmatics sometimes think their own toughness and sheer willpower will beat their asthma symptoms into submission. They don't seek breathing help when they need it and may forgo asthma medication. If they get help, it's because a spouse or a loved one forces them or pleads with them to do so.

Their biggest fear, although they won't admit it, is that they will be told their asthma is all in their head, and then they'll feel stupid. So, they think it's easier just to pretend they are fine.

Asthma Attitude: "Don't worry about my asthma, buddy. I got it under control."

Asthma Strengths: Martyrs are the opposite of Actor asthmatics and won't overplay their symptoms for sympathy.

Asthma Weaknesses: Breathing trouble is nothing to ignore. Their lungs are not protected by their toughness.

Lessons to Live By: Asthma is a difficult disease and it requires some toughness. But you should never ignore breathing trouble. Get help when you need it immediately and work with your doctor to develop an asthma action planthat will help you manage asthma symptoms on your own.

Originally published at healthcentral.com/asthma.

Sometimer Asthmatics: Adult Asthmatics Who Don't Take Their Asthma Medicine

They live normal lives, feel good 95% of the time, and so are in denial about their asthma and don't take their preventative, anti-inflammatory asthma medicine.

These are adult asthmatics who sometimes have mild asthma symptoms, and when they do they take a puff or two or three or four of their quick-relief asthma inhalers until they feel better. The trouble is, uncontrolled asthma can still lead to permanent lung damage.

Asthma Attitude: "If I feel fine, I don't need to take asthma medicine."

Asthma Strengths: Lucky for them, they are free of asthma symptoms most of the time. When they have breathing trouble, they know enough to use the asthma medicine they've been prescribed.

Asthma Weaknesses: Even though they have few symptoms, they still have asthma and still need to take their medicine as directed.

Lessons to Live By: Work with your doctor to create an asthma management plan that works best for you. The more controlled your asthma, the less quick-relief medication you'll need!

Originally published at healthcentral.com/asthma.

The Doubting Thomas Asthmatic: Adults Newly Diagnosed With Asthma

These are mostly adult-onset asthmatics who, all of a sudden, develop mild asthma symptoms, but don't want to admit they have asthma.

Asthma is often believed to be a children's disease that you either outgrow as an adult or never develop once you're an adult. But that is not the case.

People who develop adult asthma are often puzzled by their asthma symptoms. Once diagnosed with asthma, they have a hard time accepting it. They would rather suffer at home than seek asthma treatment. But when the respiratory therapist gives them a treatment they will say, "Wow, I didn't even realize I was short-of-breath." FamousOlympic swimmer Dara Torres may have been this kind of asthmatic. But now, I'm sure, she is a Gallant asthmatic.

Asthma Attitude: "I don't have asthma. I'm an adult!

Asthma Strengths: They may seek as much information about their symptoms as possible and ask their doctors a lot of questions to make sure they have the right diagnosis.

Asthma Weaknesses: Denial can stop these asthmatics from getting the asthma treatment they need to live their full, active lives.

Lessons to Live By: A diagnosis like this can be hard to accept, but the sooner you do, the sooner you can get to work feeling better. Here are 5 steps to controlling your asthma that can help the transition.

Originally published at healthcentral.com/asthma.

The "Recovered" Asthmatic: Asthma Symptom-Free And Reckless

These are often child asthmatics who grow up and no longer have asthma symptoms so they do some unwise things -- like smoke. When their asthma comes back, they are in a world of hurt.

People don't "outgrow" their asthma. Asthma is a chronic illness and there is no cure. If you had asthma, but you no longer have asthma symptoms, chances are that you still have asthma.

But Recovered asthmatics don't think so. They may throw caution and proper asthma management to the wind now that they no longer cough, wheeze and struggle to breathe the way they did as children. But smoking is one of the worst asthma triggers and can cause serious lung damage, especially for asthmatics.

Asthma Attitude: "I don't have asthma anymore so I can do what I want."

Asthma Strengths: None.

Asthma Weaknesses: They make poor decisions because they don't suffer daily with asthma symptoms.

Lessons to Live By: Remember that once you have asthma, you pretty much always have asthma. Once you are free of asthma symptoms, work with your doctor to tailor a plan that keeps you that way. And enjoy living with no symptoms!

The Martyr Asthmatic: Too Tough For Asthma Treatment

The opposite of Actor asthmatics, Martyr asthmatics could be dying and they still won't go to the ER. They are usually tough, macho adult men who only go to the ER at the insistence of their spouses.

Martyr asthmatics sometimes think their own toughness and sheer willpower will beat their asthma symptoms into submission. They don't seek breathing help when they need it and may forgo asthma medication. If they get help, it's because a spouse or a loved one forces them or pleads with them to do so.

Their biggest fear, although they won't admit it, is that they will be told their asthma is all in their head, and then they'll feel stupid. So, they think it's easier just to pretend they are fine.

Asthma Attitude: "Don't worry about my asthma, buddy. I got it under control."

Asthma Strengths: Martyrs are the opposite of Actor asthmatics and won't overplay their symptoms for sympathy.

Asthma Weaknesses: Breathing trouble is nothing to ignore. Their lungs are not protected by their toughness.

Lessons to Live By: Asthma is a difficult disease and it requires some toughness. But you should never ignore breathing trouble. Get help when you need it immediately and work with your doctor to develop an asthma action planthat will help you manage asthma symptoms on your own.

Originally published at healthcentral.com/asthma

The Actor Asthmatics: Asthma Isn't That Bad

They have legitimate asthma, but they take advantage of it to get out of doing things they don't want to do, like attending gym class, going to work, or going to their mother-in-law's 5th wedding.

Just when you need a household chore done, when you need volunteers for the church bake sale or just when the gym teacher asks for dodge ball players, they take out their asthma inhalers and puff loudly on them so everyone notices. Then a sickly pall suddenly descends on their normally happy faces.

It's not that Actors are faking it, but they are playing up their illness to avoid doing things they don't want to do, but that may be good for them -- like exercise.

Asthma Attitude: "Sorry, I can't do that. I have asthma you know."

Asthma Strengths: Actors may be wise to avoid activities and places that could trigger their asthma symptoms.

Asthma Weaknesses: Actors may miss out on healthy activities if they always use their asthma as an excuse to get out of things. And they can be plain annoying.

Lessons to Live By: Avoid activities, places and stresses that trigger your asthma. But don't exaggerate your condition.

Originally published at healthcentral.com/asthma.

The Phlegmatic Asthmatic: The Calm Asthma Patient

These folks are not easily excited into action. They are very composed and calm even under the worst situations. You may not even be able to tell they are having breathing trouble.

Phlegmatic. Definition:having or showing a stolid temperament. Unemotional.

How do you know you're dealing with a phlegmatic asthmatic? You won't unless they tell you they have asthma. These are the zen asthmatics who appear to be accepting of their condition, don't lose their cool and quietly deal with breathing trouble.

Asthma Attitude: "I am having trouble breathing, but panicking won't help me."

Asthma Strengths: They remain calm with breathing trouble. That's good, stress is an asthma trigger and can make an asthma attack worse.

Asthma Weaknesses: Sometimes breathing trouble is serious and requires immediate medical attention. It doesn't pay to ignore the severity of your asthma trouble.

Lessons to Live By: Get help as soon as you need it, but try to stay as calm as you can.

Originally published at healthcentral.com/asthma

The Goofus Asthmatic: The Lazy Asthma Patient

These asthmatics don't like anything to interfere with their fun. They half-listen to the nurses, doctors and respiratory therapists and don't take their asthma medicine as directed.

These asthmatics think they know how to take care of their asthma, but they don't and don't really try to learn how to manage their asthma properly. If they have an asthma attack (which is often), they go to the ER. When they leave, they only take their preventative medicine until they start to feel better. Then they go back to having fun, until the next asthma attack. But the longer they go without proper asthma management, the more they risk permanent damage to their lungs.

Asthma Attitude: "Asthma action plan? I don't need one of those. I got my asthma under control."

Asthma Strengths: None. But at least they will get help when they need it.

Asthma Weaknesses: Too lazy (or too uninterested) to learn more about asthma.

Lessons to Live By: Do the opposite of what a Goofus would do. Take your asthma medicine as described by your doctor, even when you feel fine. Measure your peak flow and follow a tailored asthma management plan.

Originally published at healthcentral.com

The Gallant Asthmatic: The Perfect Asthma Patient

These asthmatics do everything exactly as they are directed; they follow their asthma action plan and take their anti-inflammatory asthma medication even when they have no asthma symptoms.

These asthmatics are a doctor's best patients. They have their bronchodilator with them at all times, but only use it when necessary. They religiously take their controller, anti-inflammatory medicines.

These are the patients that may visit the ER rarely, for breathing emergencies, but they take the information and education they are given and follow it, so they don't have to return to the ER.

Asthma Attitude: "I have asthma. Asthma doesn't have me."

Asthma Strengths: They are aware of their asthma symptoms and do all they can to keep them under control.

Asthma Weaknesses: Maybe, just maybe, it's really really difficult to be as perfect as this type of asthmatic. But you can try!

Lessons to Live By: Be like the Gallant asthmatic. Work closely with your doctor to tailor an asthma management plan that's best for you and then stick to it!

Originally published at healthcentral.com/asthma

The best asthmatic you can be

After reviewing my past writings, I wrote a post a while back called, "Being the Best Asthmatic you can be." I've decided that this ought to be an asthma type.

Sure you have Gallant Asthmatics -- who are prefect. Sure you have Goofus Asthmatics who are flawed in every sense of the word. Yet what of the rest of us who are normal? We ought to have an asthma classification of our own. Hence, the Adept Asthmatic.

This is the more realistic asthma type. They strive to be the best they can be, although they are not perfect because, if you think about it, perfection is not achievable. Normal asthmatics will miss an occasional dose of medicine, and will take an occasional extra puff on their inhaler, and may even use their rescue inhaler without a spacer.

Yet they are also not completely imperfect like Joe Goofus either.

I've added this to my asthma lexicon. You can check it out by clicking here.

My Goofus Asthma Attack

The original plan today was for me to write about my experience at the asthma hospital when I was a kid, although I am going to defer those plans for the time being. First I have to tell you about my Goofus Asthmatic move of last night.

Obviously the goal of all asthmatics is to strive to be Jake Gallant. However, once reality sets in, we learn perfection is not achievable. As when I teach my patients to use an inhaler, I always teach them to use a spacer too. And then I give them a peak flow meter and teach them the importance of using it as part of an Asthma Action Plan.

Likewise, I teach that no matter how good your asthma is you should always take your preventative medicines, and you should always take your rescue inhaler with you wherever you go.

Well, even the best of us miss some of these steps. So, I suppose if an asthma expert as myself messes up on one of these steps you could call me a hypocrite. And, I suppose to be fair, I probably am a hypocrite. (or maybe it's just a little slippage).

I carry an inhaler around with me all day as I work, and I use it without a spacer. If you think about it, there's no way I can fit a spacer in my pocket anyway. That's my excuse. However, the truth is, carrying a spacer with me to work is an inconvenience.

So, anyway, for some reason last week when I picked up my new Albuterol inhaler from the pharmacy I only got one inhaler instead of two or three. I usually have my doctor write the script for three because we asthmatics are prone to lose inhalers. You know the routine, they get stuffed inside couch cushions, under the bed, in the freezer, under the front porch, under the car seat, etc.

So, for some reason when my doctor renewed my Ventolin prescription he wrote for only one inhaler. It was a little slippage on his paft. And, of course, two days after I picked it up I lost it.

Yesterday I went to my mothers. My asthma has been great for the past year or so, so I figured it would be no big deal if I went without my rescue inhaler. Well, guess what happened. Dad decided to make a campfire for the kids to make Smores. And, voila, the asthma struck.

It was totally unexpected. I was sitting on a bench near the fire and, the swirling wind wafted my way sending the smoke with it. It wasn't a mild attack. It was a full blown I-couldn't-even-take-half-a-breath asthma attack.

I was sitting their all frogged up on the bench thinking, "Well, maybe it will get better." It didn't. The agony continued. The kids were having fun, so I decided I wasn't going to be able to go home. My mom had an inhaler somewhere in her house, but I didn't want to bother her.

Then it struck me: I'm being a Goofus Asthmatic. I'm making excuses. I'm sitting here suffering and I didn't need to. I was acting like I acted when I was 10 years old. I was doing what I tell you guys never to do.

The ironic thing about this whole moment was that my mom was sitting next to me. Literally, there was no need for me to suffer -- well, assuming my mom still had a rescue inhaler somewhere in her house.

Finally I couldn't suffer anymore: "Mom," I whispered, "can I borrow your inhaler."

"Oh, yeah," she said, "no problem." What! Was I actually thinking she would tell me no? Perhaps an irrational part of me did. Perhaps that's the irrationality we asthmatics get sometimes when we can't breath. (Although I could have been downplaying my asthma as I describe in this post).

Perhaps this is a new type of asthma called Irrational Asthma. It's called doubt. It's called stupidity. It's called normal. And this is the exact reason that it's nice for other people to know you have asthma, and be able to pick up on the signs you are having an attack.

Mom lead me to my old bedroom. The inhaler was in the same spot. I took six quick puffs. Mom watched as I did this and I waited for her to lecture me. She didn't. She was probably happy she could help. The breath came back. It is such a great feeling when you all of a sudden can catch your breath. I took six more puffs for good measure.

Sure this is against recommendations, but studies show eight puffs of an inhaler without a spacer is equivalent to one breathing treatment (four puffs with a spacer is equal to one breathing treatment).

So, anyway, that's what happened to me last night. I suppose I could have avoided sitting by the fire, but everyone else was sitting around the fire and I didn't want to be the party pooper.

One more confession by your humble RT/asthmatic. I also drank beer last night, and that probably didn't help matters much. Drinking always causes me to increase my inhaler use. Although it has never stopped me from being normal and having a little fun from time to time.

After all, the goal for us asthmatics is to live a normal active life. And that's exactly what this humble RT plans to do.

So, after this was all done and I was feeling better (and again sitting on the bench by the fire drinking a beer), I leaned over to my mom and said, "Pssst, mom. By the way, your inhaler in their tastes like rotten mints. I think it's expired."

It was a goofus asthma day all the way.

Breathin Stephen's greatest accomplishment

Those who have been reading my blog know I've been following the Antics of Breathin Stephen, the hardluck asthmatic. He's our severe, persistent asthmatic who, despite his yucky lungs, continues to keep active.

While he's not faster than a speeding bullet, and not able to leap tall buildings, he is able to participate in marathons, including the crem de la creme of marathons: the Boston Marathon. In fact, not only did he participate in the Boston Marathon this year, he crossed the finish line. That's 26 miles on bum lungs. Amazing. Superman-like.

He's a true inspiration to all of asthmatics that anything is possible, no matter how out of control your asthma is.

I promised I'd give more detail about his feat at the Boston Marathon. So, without further adeau, I would like to provide you with a full account of his amazing feat. Click here and you can read all the detail about Breathin Stephen and how he competed the Boston Marathon.

(To get a little more back story about this asthmatic superhuman, click here. You'll be impressed at how much he can do with his brittle lungs.)

Slippage of the Gallant Asthmatic

I have written about the gallant asthmatic on several occasions on this blog, and how every asthmatic should strive to be like him. Yet, I have also written (see here) how perfection in itself is not obtainable.

That said, it should always be the goal of all asthmatics to strive for perfection -- to strive to become gallant asthmatics. The best asthmatics never stop trying.

That said, even the best asthmatics are prone to slippage. Before you read on, perhaps you'll want to freshen up on what slippage is, I wrote about it in greater detail here.

In short, slippage is when you slip out of your normal character. When you do something that isn't you. When the taciturn, well respected uncle gets drunk and runs around outside screaming. That, my friends, is slippage.

Slippage is normal; we all do it from time to time. However, most of the time our slippage moments are harmless. Sure they might embarrass us in retrospect, but they are usually harmless.

But these moments can also be harmful. For example, the teacher who slips out of character and cusses at his student. Not only is this type of slippage stupid, it could cost him his job.

Or consider the well respected member of the community getting drunk and running over the neighbor's kid. That kind of slippage is obviously not good.

Now, consider the asthmatic who has worked so hard to educate himself about asthma, work with his physician, and get on all the right medicines. He then takes all his meds compliantly. He, in essence, has become a gallant asthmatic.

I can provide you two examples of this. First, I wrote about myself and my battle with bronchodilatoraholism. As I became educated I turned into the gallant asthmatic I am today (or, as I said, I strive to be a gallant asthmatic).

Second, I wrote about the Jen, the Sometimer Asthmatic. Jen is the prototypical asthmatic who decided on her own she didn't need to take her meds unless she was having an attack. Then one day her asthma hit her hard, and she learned her lesson. Jen is now striving to be a gallant.

Now for some slippage. I have recently been very busy at work. One day I realized my Advair had nothing in it. Then my Singulair ran out. All of a sudden I was sneezing and coughing and (as a sign of my bronchodilatoraholic past) I found myself puffing on my rescue inhaler more often.

Yes, I was participating in slippage.

My friend Jen came to me today and said, "Rick, you are going to be disappointed in me, but I have let my Advair inhaler go empty. I haven't taken it in two days. And, worse of all, I can tell the difference."

Yes, Jen is participating in slippage.

A little slippage is okay so long as we catch ourselves and quickly get back into our normal character. In my case, and in Jen's case, that normal character is in the mold of a gallant asthmatic.

Sad to say, though, as I wrote above, sometimes slippage can be serious. I had an asthmatic patient recently in the emergency room who, when he was feeling better, told me he slipped up. He forgot to take his medicine for two weeks. "And now this," he said.

He promised me he would never slip up again. Well, I have said that too, and so has Jen.

What makes asthma such a hard disease to live with is that most of the time the asthmatic feels no symptoms. It's easy to forget we have asthma. It's easy to slip into the mould of a Goofus Asthmatic.

To be a Gallant Asthmatic is a never ending battle. To avoid making that unnecessary trip to the ER, we must always strive to be the best asthmatic we can be.

Yet, as we can all attest, a little slippage from time to time is normal. Yet the periods between these weak moments should become further and further apart.

The modest asthmatic

Yesterday we discussed rare and irresponsible Actor Asthmatic. Today I would like to bring light to the Doubting Thomas Asthmatic.

Most RTs and RNs can recognize them as soon as they walk into the door. Usually they are men who come to the ER with their wives because, "she made me come in. I didn't even want to be here. I'm fine."

Then you listen to them and they have all the tel-tale signs of asthma. We really shouldn't limit Doubting Thomas's to just asthma either, as we know there are a ton more COPD and chest pain patients who are simply too modest to come into the ER.

There's a saying we like to use in the ER where I work, "The modest patient stayed home with chest pain and died."

Over on my asthma blog I wrote about the modest patient, of which we aptly titled the Doubting Thomas. For more information about the Doubting Thomas click here and I will morph you over to my other blog.

The Doubting Thomas Asthmatics
by Rick Frea Wednesday, November 19, 2008
See the accompanying comic!

Thomas was the apostle who did not believe Jesus had been resurrected. According to the Bible, (John 20:24-29) he was not convinced until he actually saw and felt the scars of Jesus.

Since then, anyone who refuses to believe something without direct physical proof is called a Doubting Thomas. And, therefore, an asthmatic that refuses to believe he has asthma is rightfully dubbed a Doubting Thomas.

Believe it or not, I've seen my fair share of these folks in my 11 years as an RT. It's neat, because they will come into the ER for an unrelated reason, the doctor will listen to them and order a breathing treatment, and then I enter the patient's room thinking I'm going to do another breathing treatment just because the doctor didn't know what else to do.

Just recently I had a pudgy, balding male named Carl, mid 30s, lying supine on the ER bed. He appeared to be breathing normally. I gave him my usual line, "Hi. I'm Rick from Respiratory Therapy. Are you having trouble breathing?"

"No," he said, "I feel fine."

"Okay, so why am I giving you a breathing treatment," I think to myself. Then I say, "How come you came to the ER tonight?"

"Um... because I was just not feeling right. I also have a little chest pain."

I pulled my stethoscope from my lab coat and pressed the bell on the patient's anterior chest. I hear wheezes. "Can you please sit up so I can listen to your back?" I listen to his back. "You definitely have wheezes in there. Do you have asthma?"

"Not that I know."

I hand the patient a nebulizer that I had already filled with one amp of albuterol.

"What's this for?" The patient looked at me awkwardly.

"This is for people with breathing trouble," I said, "The doctor thinks it might help you breathe better."

"Well, I'll take it, but I'm not having trouble breathing."

I plug the nebulizer tubing to the flowmeter and the neb sputters to life, releasing its cool white mist into the room, and hand it to the patient who spends several minutes inhaling the mist.

I stand coolly by until the nebulizer sputters, a tell-tale sign that it's finished. I turn off the flowmeter, and pluck the nebulizer from the patient's mouth. "So, how do you feel now?"

"You know what?" he said, taking in a deep breath and smiling, "I think I feel great. Wow! I don't think I've ever felt this good in my life."

Ah, and that last sentence -- "I have never felt this good in my life"-- following a bronchodilator breathing treatment -- is a tell-tale sign of a Doubting Thomas asthmatic.

"I bet you've been short-of-breath for days and you didn't even know it." If you ever hear an RT or doctor ask this question, you know he is thinking Doubting Thomas.

"Actually," the patient said, "I've had this regular cough for years, especially after exercising. It got so bad I had to quit exercising a few months ago. I just thought being a little short-of-breath was a normal part of aging."

Bingo! That last sentence confirmed it for me: This man is definitely a Doubting Thomas.

"You should never have trouble breathing," I said. "If you do you should always see your doctor, because there's no reason anyone should ever have to suffer this day and age."

"What will my doctor do?" Carl asked.

"First of all, the ER doctor is going to prescribe a rescue inhaler that works just as well as the breathing treatment you just had. You can use it up to every 4-6 hours for asthma symptoms.

"Then he's going to recommend you see your family physician so to get you on an asthma management plan that's right for you. This plan may include prescribing long term relief medications that actually work to prevent asthma."

The New York Times wrote a story, "Asthma Medications: Not a Clear Advantage," about former Olympian gold medal swimmer Dara Tores. She had all the classic signs of asthma, even a family history, and yet she chose to ignore the signs.

One day a friend told her she had all the classic signs of asthma, and she went to the doctor. Once on all the right asthma medicines and her asthma was controlled, the article states, she realized "how much, and how needlessly, she had been suffering."

Carl was lucky his asthma was discovered before he had a life threatening attack. If you think you are a Doubting Thomas like Carl, don't wait until something really bad happens before getting help.

The first key to getting help is admitting you have a problem. The second key is to see a qualified asthma physician and getting yourself on a program to manage your asthma.

According to the Gospel of John, after Thomas touched the scars of Jesus, he professed his love of Jesus and was later known as Thomas the believer.

Similarly, any Doubting Thomas who faces his illness, seeks to learn the truth, and is treated accordingly, will no longer "needlessly" suffer.

Exaggeration of asthma

We have this patient who comes in on a regular basis and fakes her asthma. It's to the point now that even the doctors are frustrated with her.

But what choice do they have but to treat her as though she were really having bad asthma. What if she was sent home and died. There's a big lawsuit waiting to happen. So, she gets admitted with the diagnosis of "exacerbation of asthma."

We RTs like to call it, "exaggeration of asthma."

There have been many times I've stood outside her room listening to her talk on the phone as though she were home, and as soon as I walk into the room I can hear a forced, audible expiratory wheeze.

"How you doing?" I say.

"Aweful. I was hoping I'd go home today, but I don't feel any better."

"Yeah right," I think. "You like getting waited on hand and foot."

I'm sure all asthmatics have faked asthma from time to time, but I highly doubt there are many asthmatics who actually want to be admitted.

It's stupid too, becasue there are side effects to all that medicine that gets pumped into you for no reason. Or perhaps she really is having bronchospasms, but it's because of her own choice to be noncompliant.

This was evidenced during her most recent visit, when she was having bad stomach pains. Now she's on stomach medicine too.

I wrote about Asthma Actors on my Asthma Blog over at MyAsthmaCentral.com. Go ahead and click here and I'll morph you on over there.

Some Asthmatics are Good Actors
by Rick Frea Wednesday, November 12, 2008
See the accompanying comic!

Believe it or not, there are a few asthmatics that really do have asthma, but they exaggerate their symptoms to take advantage of it to the full extent to get what they want. We call these asthmatics the "Actors."

A while ago I had a patient I will refer to as "Carrie" who was admitted frequently with exacerbation of asthma. We RTs knew she was a great actor, so we referred to her diagnosis as "exaggeration of asthma."

When Carrie was a little girl she was adamantly against going to Aunt Bessie's funeral, but her dad was making her go.

"But I can't breathe," she said, faking a gasp.

"Oh, my poor baby," her dad said, "You can stay home."

"Aha," she thinks as she watches her dad's truck roll down the driveway. "This works even better than batting my eyes and begging."

A year later, when she learned she was going to have to play dodge ball in gym class, she took a couple puffs of her inhaler in front of her teacher and panted a little.
She was dismissed from class. (I did this once myself. The two class bullies who wanted me dead were threatening to throw the ball at my head.)

One night in college Carrie had a ton of homework and three tests to study for. She ran two laps around the dorm and called her professor before she caught her breath.
Her professor told her to reschedule the exams and take it easy.

Years later, as an adult, she had five kids running around her house and she was getting very stressed. Not only that, but she just found out her husband was having an affair with his secretary. So she quit taking her preventative medicine and bought a cat and a dog knowing she was allergic to both.

When she became short of breath she did not bother taking her inhaler, by golly. What she did instead was have her husband take her to the ER. When the ER doctor sent her home, she simply repeated the steps above until she finally won herself a deluxe hospital suite complete with her own restroom and maid service.

Two weeks later she was fully rested and stress free and returned to her family with all their love and sympathy she earned from being sick.

Shortly after, she returned to the ER. Again she was admitted. Only this time, her respiratory therapist starts to catch on to her. One day she was bored and decided to play Good Samaritan and help her roommate walk to the bathroom. She was unaware that Rick, her RT, was standing outside the door watching her.

"Hey!" he said. She jumped. "You must be feeling better."

"This is hard for me," she said, suddenly faking a wheeze, and closing the bathroom door behind the naked rump of her elderly roommate. "But no one answered her call for help, so I thought I'd help her."

"If you're having trouble breathing, you shouldn't be getting out of bed. You need to be taking it easy."

"Yeah, well," cough-cough, "I think I need a treatment now."

He educates her on taking her medications correctly and avoiding her asthma triggers, but it really doesn't matter. Six weeks later she fools her doctor again.

The problem with actors is a good doctor has no choice but to give a patient the benefit of the doubt. He has to treat her as though she were really sick, and that usually means high doses of oral steroids, which come with side effects. Now she has asthma, stress at home, a puffy face and anxiety from the steroids to boot. She is a mess.

We RTs definitely have empathy for actors, but it gets difficult to take them seriously after a while -- however we always do. Perhaps all of us asthmatics have a little Carrie in us at times. Lord knows I've exaggerated my asthma a time or two, but usually I felt guilty in the end. I also acted once when my dad wanted us boys to stack wood. However, I only did this once because I felt guilty using my asthma to get out of work. I imagine it's guilt that prevents most of us from becoming full time actors like Carrie.

But guilt shouldn't be all. Asthma is not a game. Faking asthma is just plain unwise. The most these folks can expect to gain is a bunch of people feeling sorry for them.

Even an imperfect patient can be a gallant

As an RT, sometimes I get the feeling that some people in the medical profession expect their patients to be perfect, as the gallant asthmatic is the perfect asthmatic.

Yet we all know that no patient is perfect. Hey, we all forget to take our medications from time to time as we get trapped in the daily swing of life.

So, that in mind, just because you are not a perfect patient does not necessarily make you a goofus. While the ideal gallant is the quintessential perfect patient, there is yet hope that you too could be a gallant.

That in mind, all you lungers and chronic patients click here and I will morph you on over to my asthma blog over at healthcentral.com.

Being the Best Asthma Patient You Can Be
by Rick Frea Tuesday, October 14, 2008 @MyAsthmaCentral.com

Gallant and Goofus Asthmatics lie at the opposite ends of the spectrum. While a gallant asthmatic does everything right, the Goofus seems to do nothing right at all.

While a few asthmatics are true Goofuses, it is my humble opinion that the majority of asthmatics strive to be gallants, but do not quite meet those expectations.

Think about it. To be a true Gallant, you would have to do everything your doctor says to a tee, including NEVER missing a dose of your medicine and always using a spacer.
Not only that, the true gallant would never go someplace where there are things that might irritate his asthma, like smoky bars, a home with pets, or his friend's cabin in the woods.

Likewise, the true gallant would never have to wait for his wife to tell him to go to the emergency room -- he'd make that decision himself before his wife even had time to be concerned.

While it was fun telling you the story of Jake Gallant, we know he is a rare breed. Like Superman and Batman, he sounds really cool, but he is a character who only exists in the comic world.

That said, you can consider yourself a gallant asthmatic so long as you make a "Gallant" effort at being the best asthmatic you can possibly be. In reality, you can still be a gallant asthmatic even though you are flawed.

Personally, I know many asthmatics who are gallant/martyrs. That is, they try to take all their meds the right way, but when they get sick they need someone to tell them to go to the ER.

Just to provide an example here, I had a patient this week who was admitted with an exacerbation of asthma. Her name was Mrs. J.

She said, "I started feeling asthma symptoms three days ago, and I thought I could manage it on my own at home. Plus I didn't want to be a bother."

Sure, right now you think that if you couldn't breathe the decision to go to the ER would be easy. But when you are in that situation, you start to doubt yourself. "Am I really that bad? Oh, man, I really don't want to go to the ER. Maybe I'll get better if I just wait it out."

A gallant would never do this. A normal asthmatic (like many of us) would.

Some asthmatics are gallants/hard-luck asthmatics because even while they take all their meds as prescribed, they still end up admitted to the hospital from time to time.

Say all the other guys are going to hunting camp and you just want to be one of the guys. You know the campfire smoke irritates your asthma, and so does the musty cabin. But you still want to go.
The true gallant would stay home. A normal asthmatic would decide to be one of the guys, so long as he was feeling good.

A normal asthmatic may forget to blow into his peak flow meter every day. He may also decide it's simply too much work to keep an asthma diary.

For the record, the Gallant Asthmatic I described in a previous post is the ideal standard for every asthmatic to strive for. While it is not possible to be perfect, a person can consider one's self a gallant so long as he or she strives to be the best asthmatic he can be.

It's normal to want to sweep your own leaves, repair your own house, or clean your own garage. Heck, I'm a gallant and I do all of these things. No asthmatic wants to live in a bubble.

And besides, the goal of taking your preventative medicines in the first place is to allow you to live normal lives, which is something that most "normal" asthmatics should be able to accomplish.

I highly doubt any asthmatic is a true Goofus either. When I was a kid I used to take my medicine, until I was feeling good and got busy with other things. I really wasn't a Goofus asthmatic, but a kid who just wanted to be normal.

Chances are you are a normal asthmatic too who just wants to live a normal life. So long as you are making a gallant effort, you can still consider yourself a gallant asthmatic.