Paroxysmal AF and Asthma

[PAP48]

Here I am again, asking questions about PAF! I also have bronchiectasis and asthma. I hadn't had an AF episode since mid April which was great. However over the last couple of weeks I have been having frequent asthma attacks. It came to a head on Sunday/Monday when I had been up most of the night with asthma and on Monday during most of the day. I had been using my salbutamol inhaler with spacer throughout the day, then before bed to try and knock it on the head, I took 2 prednisolone tablets. Around 12.30 at night I woke up and knew something was afoot and low and behold off I went into an AF episode in all it's glory! I immediately took my PIP of 100mg flecainide and within an hour and a half all was well again. Does anyone else have asthma as well as PAF and how do they cope with the salbutamol inhaler during an attack and does it affect PAF episodes. Thank you very much and hoping you are all well.

[BobD Volunteer]

Such inhalers can bring on AF as they tend to accelerate the heart.

[PAP48 in reply to BobD]

Thank you BobD - yes they can, I think I must have overdone them in the effort to ease the asthma.

[baba]

You need a medical review. Asthma is a much more serious condition than AFib.

[PAP48 in reply to baba]

I am always under review baba, through respiratory team and consultant. I have a consultation with my respiratory nurse on Friday and will discuss with her. Thank you for your reply.

[JudiHalf]

I have both PAF and asthma and can only have one puff at a time on my salbutamol inhaler because my heart races after 2 puffs!

I’ve just had 2 courses of steroids and have just started with the steroid preventer inhaler.

Luckily it hasn’t kicked off my afib, I had problems with my lungs since contracting the virus. (Which can’t be named) in May and I’m only just recovering now!before that my asthma was mild so didn’t need the steroid inhaler.

My GP said I could take up to 10 puffs on my blue inhaler in a bad attack and I thought that would probably finish me off!

[PAP48 in reply to JudiHalf]

I agree JudiHalf, I think I overdid the inhalers, continually taking puffs and then with the steroids it set everything off. Thankfully the asthma has settled down now but am going to discuss with my respiratory nurse on Friday who has direct contact with my consultant. Thank you.

[Ppiman]

I don't but I did spend very many years working in the pharmaceutical industry involved with asthma and COPD. It's possible the salbutamol isn't being your heart's friend here. Like beta blockers on the heart's receptors (beta 2), that drug is fairly selective on the lung's receptors (beta 1) but not wholly. Hence both drugs can exacerbate problems other than help them: salbutamol mildly affects the heart (and elsewhere); bisoprolol mildly affects the lungs (and elsewhere).

Inhaled low dose steroids seem to be a better choice for lung related issues, overall, although they bring their own side effects in train. It's definitely a health area that is still not ideally treated yet, much as heart arrhythmias aren't.

My own AF is about as frequent as yours, and only the last time went to 150/180bpm but I did cope and even got to sleep with it. Does it incapacitate you? I wouldn't want mine to be worse but the bisoprolol seemed to help after a few hours.

Steve

[PAP48 in reply to Ppiman]

Hi Steve, thank you for such an informative reply. If I have a Afib attack in the night then, no, I am not incapacitated but if I have them during the day, which is rare, they do. Overall I don't get them very often, thankfully.

[Ppiman in reply to PAP48]

That sounds similar to me. How do yours make you feel during the day? Part of my problem is likely anxiety as I find I can't untangle the effects of that from the physical effects of the racing heart.

Steve

[PAP48 in reply to Ppiman]

If I have an episode during the day, I do feel as if I can't (or don't want to do anything) which, as you say, is probably anxiety and I feel as if I'm afraid to move which I'm sure is silly. Sometimes my husband takes me out in the car to take my mind of it and that really does help. Not thinking about what's happening seems to stop the episode.

Penny

[Ppiman in reply to PAP48]

Well now, that’s pretty much how I felt when I had atrial flutter in 2019. The cardiologist I saw did explain to me that the arrhythmia wouldn’t hurt me but does make me feel like it will, which I suppose anxiety? That did help a lot, but the reality for me was that within, what, a quarter of a mile of walking, I just didn’t feel it was safe to carry on.

The key thing, I think, is to get the racing heart to slow down. Luckily, for me, 1.25mg bisoprolol currently works well (in hospital, twice when I had severe trouble, 5mg did the trick, too).

Steve

[bassets]

I have the same problems but use Relvar Elipta instead. I haven't noticed any link with Af and it is more effective time than Salbutamol for me.

[PAP48 in reply to bassets]

I also use Revar Elipta together with Spiriva on a daily basis. Do you take Relvar as a replacement for Ventolin or similar? I've never heard this before but will ask my respiratory nurse when I speak to her on Friday.

[bassets in reply to PAP48]

I have Ventolin but rarely use it. It's there if I need it. Talking to your nurse seems a good idea.

[Nodoubt2]

I have both Asthma and AFib. My asthma was always mild until I had covid 3 years ago ( I have since had it 4 times). My asthma has def got a lot worse and I was switched to symbicourt in October last year . I am beginning to wonder if that has in anyway kicked off my AFib - to my knowledge I had my first attack in December last year. Am seeing my cardiologist this afternoon and intend to raise this with him

[PAP48 in reply to Nodoubt2]

Thank you for your reply Nodoubt2 , I'll be very interested to know what your cardiologist says. My cardiologist has not made mention of my chest drugs causing any problems.

[Nodoubt2 in reply to PAP48]

Hi there

So had a good meeting with my consultant. Long story short he doesn’t think the heart meds are affecting my asthma - or my asthma meds affecting my heart. He has now taken me off Amadrione ( thanks goodness) but I will be staring Felcainide in 4 weeks ( the the Amiodarone is out of my system)

My chest / cough is totally clear at the moment and my asthma med doesn’t seem to be giving me any heart palpitations. Crossing fingers the flecanaide will work for me without too many side affects

[PAP48 in reply to Nodoubt2]

Hi, actually spoke to my respiratory nurse today who said much the same as your consultant about the asthma meds affecting my heart, more likely to be the asthma combined with my bronchiectasis putting pressure on my chest apparently. I've been taking Flecainide for a while now with no adverse affects, together with Adizem, a channel blocker. Good luck with the new regime, be interested to know how you get on.

[Nodoubt2 in reply to PAP48]

I will keep you posted for sure . Am so happy to be off Amiodarone but a little fearful re Flecainide - have seen mixed reports on here . Hopefully I will have no problems and it will keep the AFib at bay. My channel blocker is Nebivolol ( well I think that’s the same as a beta blocker but maybe not?) I’m so new still to all of this. Take care

[Thomas45]

I now have permanent but asymptomatic AF, and have been asthmatic for at least 48 years. Prior to permanent AF I had for about 20 years paroxysmal.In those years a common cold would soon turn into infected blocked sinuses, and a chest infection, causing asthma. I had many occasions during very long nights trying to breathe, when I should have called for an ambulance.

After a couple of years my Flecainide dose was increased to the maximum dose of 300mg daily, not PIP., and I was prescribed a stronger preventer inhaler for which I've been sent a Steroid card to keep with me. I very rarely use my reliever inhaler the days

I was told to stop taking Flecainide when my AF became persistent/permanent.

I did have emergency admission to hospital about five years ago, when my lungs just began to close down without infection, which was deemed to be a reaction to a beta blocker which I was being weaned off at the time. I had been prescribed the beta blocker, despite my telling a hospital doctor that I was asthmatic, when my AF caused my heart rate to go over 190 BPM during an operation to remove my appendix.

[PAP48 in reply to Thomas45]

Thank you Thomas45, sounds as if you have had a pretty rough time over the years. Thankfully, everything seems to have calmed down now but I have an appointment to speak to my respiratory nurse on Friday and will talk it over with her. Keep well.

[Snowgirl65]

I don't have asthma, but do have seasonal allergies. My GP last year prescribed prednisone which immediately sent me into a-fib. I can't take steroids.

[PAP48 in reply to Snowgirl65]

Thank you Snowgirl65, I suspect it was the prednisone that caused the Afib combined with numerous puffs of Ventolin. Thankfully, things have settled down now but I will ask the questions on Friday when I speak to my respiratory nurse.

[Snowgirl65 in reply to PAP48]

Good luck in that -- I hope you find a solution.

[Buffafly]

First thing, you should have gone to hospital.

Second, who on earth let you have steroid tablets knocking about the house? I assume that’s because of the bronchiectasis? I don’t know how that would affect asthma treatment.

I have asthma and AF and take two daily doses of a combined inhaler similar to Symbicort which I can increase in a situation such as yours but after a week (or sooner if not effective) I am supposed to seek medical advice.

It sounds as though you need an urgent review of your treatment plan bearing in mind Baba’s correct comment.

[PAP48 in reply to Buffafly]

I have a rescue pack of Prednisolone as prescribed by my Consultant with strict instructions how to use them. I am under constant review with my respiratory team who in turn, have direct contact with my consultant. I am awaiting a test result which I will get on Friday and will speak to my respiratory nurse then. It's very unusual for me to have asthma for a prolonged period but thankfully things have settled down. Thank you for your reply.

[bassets]

I hope things calm down and you feel a lot better soon.

[PAP48 in reply to bassets]

Thank you so much. Take care and keep well. x

[bassets]

You too x