I had a letter from my cardiologist today, it seems I have frequent episodes of PAF of which I was totally unaware although I felt rubbish all week and thought I had a bug! However on the evidence I don't need a pacemaker YAY! but he wants to try Bisoprolol BOO.......Thanks to posts from other members with asthma I know there is an alternative betablocker so not planning to put up with horrid side effects. Diltiazem was also mentioned, must ask why it is considered inferior to Bisoprolol. Still waiting for results from echo which hasn't been booked yet but not expecting anything dramatic to turn up.
A big parcel of info from Cambridge Tourist Information arrived in the same post so now we can plan our holiday 😀
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Buffafly
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Diltiazem is a Calcium-channel blocker and sometimes given in combination with a beta blocker so it is not 'inferior' I have read that a combination of drugs works better for some people .
All the drugs available for AF in the UK are explained on the NICE website.
I certainly am feeling better and lots more cheerful! I took Diltiazem before, on its own and in combo with Propafenone, and had no issues on a low dose but Bisoprolol is definitely the drug of first choice.
All in all, sounds like good news to me. Bisoprolol always seems to be the betablocker of choice but I recall the leaflet expressly warned about the effect it had on asthmatics so if that’s still the case, push hard for an alternative. I have taken Diltiazem for around 3 years with no problems but as we always say, we are different therefore react differently to different drugs!
Thank you, I just read the NHS and NICE pages and wasn't encouraged but I am willing to give it a go, tiny dose to start, possibly with Diltiazem added if necessary. I shall remind myself how horrible I felt during and after episodes of AF with no meds available 🤔
Hi Buffafly. The US beta blocker closest to bisoprolol is metoprolol. I no longer take any cardiac drugs as I had a "pace and ablate in 2016. But before that I took diltiazem and tried to take metoprolol as my beta-blocker. MANY problems with asthma including trips to the E.R. When I was visiting family in Florida the cardiologist could not seem to wrap his head around my not wanting to take a drug that exacerbated my asthma if it would help my heart. Duh! I refused. I almost wished a few asthma attacks on him so he would 'get' it. Back in Atlanta where I live my EP understood and worked with me on my drugs even to the point of my preferring the ablation and pacemaker to taking the drugs as I had many side effects. I seem not to handle many drugs well and would prefer not to take them when possible. So I would say stand your ground re refusing bisoprolol. It may be the 'drug of choice' but if you have asthma it is not YOUR drug of choice. Hope things begin to go smoother for you. xx Take care. irina
Thank you, I agree with you about drugs. I seem to need much smaller doses than other people to have a good effect while the normal dose makes me ill in a different way 😖 However, although my cardiologist hasn't pointed this out, I used to take Propafenone which is also not recommended for asthmatics, so it is reasonable to give Bisoprolol a try as my asthma isn't bad. One useful thing that came out was that I was having frequent episodes of AF, which indicates that my ablation has well and truly failed and backs up my decision not to have another one at this point, though an EP would probably argue that I just need a touch up here and there! I don't know under what circumstances pace and ablate is offered here, not sure if everything else has to have failed first.
Update, saw my GP today to start my prescription and she wasn't happy about prescribing the Bisoprolol as it's technically her fault if things go pearshaped, so she's prescribed a low dose of Diltiazem instead.
I hope that works for you. BTW, I gave up dairy several years ago on the advice of an emergency room doctor and it has helped my asthma symptoms tremendously. With the problems I'm now sorting out concerning my adrenal glands I can't help but believe all the years I took steroids for my asthma has contributed to the adrenal problems. Have not had steroids for 3 to 4 years but probably the residual damage is still there.
Everything is a balancing act if you have several conditions and it seems to get harder and harder! I can't digest milk very well anyway but I do eat hard cheese, very difficult to be semi vegetarian if you don't.
Hi Buffafly - I am the same as Finvola - changed from Bisop to Nebivolol 3 months ago because of breathing problems and feel so much better. I also take Diltiazem, have done for 3 years, I have had no problems with them.
Oh I’m so glad about no pacemaker, Buffafly! Sorry about the AF of course- but hoping and trusting it will be easily prevented with the right meds. And that you’ll be feeling tip top soon. Xx
Good news about the pacemaker. I don't think diltiazem is considered inferior, more that, as my cardiologist put it, bisoprolol has prognostic value (i.e. studies show people on bisoprolol tend to do better long term compared to those on diltiazem). I guess it all depends on the heart and lifestyle the drugs are to address.
I'm on bisoprolol, and have asthma and it's actually not too bad, although I do go through spells of random breathlessness, particularly in the evening, but we (my cardiologist and I) aren't sure whether that's my heart, lungs or the bisoprolol. I hope we can tease this apart at my next appointment.
Let me know if you need any further advice for your holiday in Cambridge, I spent 15 happy years there!
Thank you for all that! I always wondered why Bisoprolol was favoured and now I know, but I wonder if asthmatics do better long-term? My GP said at one time Bisoprolol was considered a no-no, then they thought maybe OK if you had mild asthma, now back to 'be very careful' and I'm not sure if I understood her correctly but she seemed to be saying that betablockers stopped the airways relaxing even with asthma treatment and though I might be OK day to day it was the attack caused by respiratory illness she was worried about. Considering my history (won't bore you with that) I am on her side!
We have looked at the Tourist info on Cambridge and decided we need to stay at least a day longer than we planned. In the past because we had a motorhome we would often pay a short visit saying we could always come back but I have realised that was a mistake. I'll remember the offer of advice X
It’s good you don’t need a pacemaker, not so good you are still getting AF but good you are not too symptomatic. I was switched from bisoprolol a couple of years ago to Diltiazem as I wasn’t coping with Bisoprolol very well. No side effects that I have noticed except a little swelling of the legs but I take furosemide that counteracts that. Enjoy your hols 👋
Actually I am very symptomatic, episodes usually flatten me and I feel bad for the following day but I must have been having the recorded ones at night or possibly short ones, it's a puzzle!
Hi Buffafly I think some of us who have very symptomatic episodes of P-AF and feel ill afterwards wrongly assume that because of this we always know when we are in AF.
I was shocked to find on a number of occasions when routinely monitoring my blood pressure AF registered on the BP machine and was confirmed in my pulse although I felt ok .
I think this ambiguity is why AF is so dangerous and anticoagulants important.
...it also makes me wonder how long some of us have really had P-AF. Did age or illness prompt the sudden appearance of symptoms making us aware of the existence of something that had been lurking for a long time.
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that's good news and could be worse . 
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