Opioid Withdrawal When You Already Have Asthma

I have asthma. I have had it a long time. There are rescue inhalers on every desk in this house, which tells you most of what you need to know about how well controlled it is, and I had stopped noticing that the way you stop noticing a stair that creaks.

Withdrawal changed that in about a week.

Here is the part nobody explained to me, and I had to work it out myself afterward. Coming off opioids abruptly sets off what is essentially a sympathetic storm. Heart rate up. Breathing faster and shallower. Chest tight. Everything in you switched to alarm and held there.

Do that to an ordinary set of lungs and it is miserable.

Do it to lungs that already narrow under stress, and you have stacked two things that pull in the same direction.

I am not going to tell you what that adds up to clinically, because I am not a doctor and I have been careful through all of this not to pretend otherwise. What I will tell you is what I can count.

Puffs a day, going up.

That is the thing about a rescue inhaler. It is not a feeling. It is a number. Nobody can tell you that you are exaggerating a number, and you cannot talk yourself out of one either, which matters when you have reached the stage of wondering whether you are making too much of all this.

If you are in this and you have asthma, or COPD, or sleep apnea, or a heart condition, count something. Puffs. Resting pulse if you have a watch, and you probably do — mine has been recording it for years without being asked, which means I have a baseline from before any of this started and a line after it. Peak flow if you have a meter. A pulse oximeter is about twenty dollars.

Write the number down the same day, every day, even the days nothing happens.

Two reasons, and the second is the one I did not think of at first.

The first is that you may need it. A number with a date on it is worth more than the most vivid description you will ever write.

The second is that it gives you something to do at three in the morning that is not lying there taking inventory of yourself. You take a reading. You write it down. It is a small, finite, completable act, and there are not many of those available at that hour.

I did not start counting until somebody suggested it to me. I wish I had started the first week.