I met with my cons today as I completely changed my meds recently and I think hospital was checking I was still alive and had reacted well to the medicine. I haven't seen this particular cons before (there are 4 in the department and I have now met them all).
Throughout the appointment he said some interesting things:
1) Cold air doesn't affect lungs. He said he was part of a study (over seeing it I mean) where asthmatics were exercising and given either hot or cold (-3degrees) air. Apparently they exercised better with the cold air. Now during winter I thought it was the change from boiling hot in the house to freezing outside that made our lungs freak out but actually because we shut all the windows, never open them and turn the heating up which makes mould spores etc. breed and we react to the spores.
2) Asthmatics tend to over breathe when exercising.
3) Asthma inhalers do not have any effect on babies when you are pregnant (I didn't ask he decided to tell me but I was interested to know). Of course you don't want to stop taking the medicine as you don't want to be low on oxygen when pregnant but he said the inhaled steroids stay on your lungs. He said there was a study in Finland on this....
Also he was saying some womens asthma improves (like his daughters) and some get worse however I did already know this.
4) I am not allowed to scuba dive. The dry air in the chambers of gas they take scuba diving can wreck havoc on sensitive lungs. Also would never want to have an attack 10m under water.... my worse nightmare.
5) I am never allowed to be in the army, be a police officer or fly a plane. I did guess as much for first two and he hasn't crushed any dreams there but it is good to know.
I'm sure there is more but I can't remember right now
Hmm, interesting! I'd like to see more on 1) - atm his reasoning doesn't convince me as I am triggered by SOMETHING when it's cold outside and I've been ok inside eg I really set things off earlier this year rushing around in the cold. May well be something there re mechanisms but I don't buy his explanation about the mould etc as then why would I (and I assume others) be set off more in the cold air? At school, I could exercise indoors when I couldn't outdoors. So would like to hear more from him about that one... Plus I am worse in cold houses - if the bedroom is cold at night it affects my breathing and sleep even if I'm warm, and I have a mildly asthmatic friend who is the same.
2) I can believe, heard that before, think I do.
3) I vaguely knew - though woke up this morning to hear lovely news item on how uncontrolled asthmatics find it harder to get pregnant. Lucky I have no plans to atm...
4) Sadly knew this one too - but we can snorkel!
5) same - and same!
How was the appt otherwise? Anything useful for you?
i wonder if cold air also tends to be dry air? I must admit, im not sure i believe this one properly, even in summer i feel it in the freezer dept of the supermarket. my breathing is worse (like E) on cold nights, where the windows are more likely to be shut than in the day. Adn in winter, i feel better for a full day iondoors. I have to say i thought even healthy lungs had some degree of bronchospasm with cold air - maybe im misremembering that! the rest is really interesting though
I'd be interested to see how the study was done as I know not all asthmatics are triggered by cold air though some of us certainly are - but presumably for some it's more of an allergic component and winter I know can be some people's best time (JF?) which suggests for them it's not an issue. So wondering if the participants were actually asked about triggers etc specifically, or selected as those who said they were triggered by cold air? If not, you might get a masking effect whereby actually it DOES affect some people but the effect doesn't reach significance because triggers weren't a selection criterion and so for some it really didn't have an effect. I often wonder if this is why the studies on the use of magnesium don't always show much ie it helps some but not others but the studies don't (or can't) differentiate between those it's useful for and those it isn't. Meta-analysis on the cold air study would be good.
Soph - I also get the freezer compartment thing! And I'm definitely more able to cope with cold air etc if already doing ok, but if I rush around it and I've been even just a little bit struggling I can make things a lot worse.
I would like to know why I have perverse lungs which not only dislike cold air but also warm steamy air...
I'm not sure I believe the cold air study. Even though winter is my best time (December/January) I react to cold air. I am ok for a few seconds and supermarket freezers are fine for me but any longer than that I need a scarf until I have warmed up. Cold air and any temperature wind affects me the same way, deep in my lungs. I always assume Dec and Jan are best for me because of having the least allergens.
I am inclined to agree with you all. My cons is from a family of asthmatics (not sure if he has it himself but don't think so) so he has a lot of first hand experience however here I think he needs to do more research. I never knew cold air was a trigger when I first came to uni (asthma was only just kicking in then) until I got very ill as the weather plumetted and starting asking the doctors so I figured out it made me worse as I noticed a tight chest more and more in the cold. Maybe the study was on asthmatics who don't have the cold air trigger (lucky buggers). Philomela I am the same as you, if I rush in the cold I just get more and more out of breathe but if I did this in warmer weather I would be fine. I have to remember to slow down but sometimes I rush because I just want to get into the warm...
Also I can run in summer/late spring/early autumn granted I am going through a good time. I cannot for the life of me run in winter, the air just doesn't wanna go in or out.
Another thing, getting back into the warm is a relief on my lungs, doesn't make them worse.
Philomela, for 2), if he is suggesting I was over breathing then I am confused why I would over breathe that particular time when I've been fine all the other classes this year.
Regarding 3) I also read that article but I do not trust the Daily Mail, wasnt that the same newspaper who said that asthma wasn't a disability? However the article did worry me slightly as it was mentioning a big decrease in chances of getting pregnant after 30 (i know it decreases anyways) but I don't think I want kids in next 10 years. I think I will just wait and see.
Soph, I have never noticed the freezer department thing, I never even considered it being an effect. I don't think I am ever there for long enough, my lungs seem to need time for things to set them off - a good thing of course.
I have heard both that the cold can affect you and also that it is the change from the extreme heat in the house from heating blasting to the freezing cold outside. Any thoughts on this?
Apart from all these facts the appointment was a good one, mainly seeing that the dose is suited to me. It turns out the cons+nurse had a back-up plan if it wasn't going well which I am pleased about. The cons told me he has every faith I won't have a hospital bad attack or any attacks at all....... unless I have a cold, which of course is unavoidable. This made me laugh.
I have remembered another thing he said.... He said antihistamines mainly are for seasonal allergies rather than an allegy like dust. Also that montelukast(which I am on) helps in treating the allergic part of asthma so I should do a trial without antihistamine. I have had a few google searches and everything on antihistamines is a little vague. will be nice to have one less drug though..... I never really questioned it when it was given to me.
I have to say that even though winter is usually a little better for me, there is a distinct difference in my asthma during the summer months (when it is very allergic) and winter (when cold air and illness is a trigger). For me, it is changing the air temperature that plays havoc with asthma. I was outside today and started to cough but it was when I went into the warmer air that I really started to struggle.
Unigirl - I am glad the appointment was a good one. You seem to have found a very thorough cons. I'm not an expert but I have always been given Monteleukast on the basis I have allergic asthma and my sister doesn't take it as her asthma has no allergic component. I only routinely take antihistamines in the hayfever season but I do have them as required for other allergies in the winter (for example, I am staying round a friend's house with a cat tomorrow so have taken them now to help with this or if I have been dusting, I have Piriton if I start reacting). I do still have a nasal spray which helps with pnd. I'm not saying this is for everyone but perhaps is an option to discuss (I have severe allergies so am managed at an allergy clinc).
I was also put in monteleukast for allergic asthma, that's one of the things it's licensed for. Works for me, I've been able to reduce my antihistamines this year
I was put on montelukast when it was thought I DIDN'T have allergic asthma -my GP tried it as he said he'd seen it work where there was a strong exercise-induced component which I seem to have. I'm till confused about whether I have allergic asthma or not but this year I developed hayfever and tree pollen plus other things do seem to set me off, so perhaps that's why the montelukast seems to work for me. However, it needs help -the same GP suggested trialling antihistamines as well since the montelukast on its own, even double dose, doesn't seem to get on top of the allergy aspect of things.
JF - makes sense re winter being best time - just fewer triggers to contend with then!
Philomela, for 2), if he is suggesting I was over breathing then I am confused why I would over breathe that particular time when I've been fine all the other classes this year.
I didn't realise he meant specifically - so maybe not for you? I just thought he meant in general which I could believe, though I think I've got more on top of it now after physio and it's definitely not the only thing that sets me off re exercise ie the asthma is doing it as well. Your cons seems good but perhaps a little over-inclined to generalise at times as we don't all have the same triggers! I have noticed sometimes that even really good doctors/nurses can have a tendency to assume some things trigger everyone which doesn't seem to be the case at all though clearly there are some very common ones. However, it doesn't make sense to me to assume that X trigger will automatically set everyone off!
my thinking is that I am allergic to dust so I am around it all of the time so maybe I would need something to stop the allergic part of my asthma.... the montelukast should do this by now on its own? I am definitely going to try the trial without antihistamine (not this week I am far too busy).
Kayla when you say you have severe allergies,is this just lung-wise or nasal/head too?
I agree with you philomela that he is over inclined to generalise. this particular cons kept mentioning wheezing which I said I don't do. he did seem to realise and correct himself but still it was a kind of asthma=wheeze type thing.
1) Me too - re freezer department.
2) Might depend on the study/sample population.
Along with Philomena - I think some meta-analysis is in order I think before firm conclusions could be drawn. For example, this study comes to a different conclusion:
Ludvıksdottir, D; Janson, C; Bjornsson, E; Stalenheim, G;Boman G; on behalf of the BHR Study Group. ""Different airway responsiveness profiles in atopic asthma, nonatopic asthma, and Sjogren's syndrome"" in Allergy, 2000. Available at onlinelibrary.wiley.com/doi...
The above study compared atopic asthmatics, non-atopic asthmatics, Sjogren's syndrome patients, and ""healthy"" controls. The study looked at their response to three different challenge tests, including cold-air challenge. Positive responses to challenge tests aren't unique to asthma. The purpose of the study was to consider if different sample populations have different patterns of responses.
70% of atopic asthmatics had positive cold air challenge tests compared with 30% non-atopic asthmatics, 10% Sjogren's syndrome and 0% healthy controls. Because of sample sizes, the differences between atopic and non-atopic asthmatics were too small to be considered statistically significant. However, when atopic asthmatics were compared to healthy controls, t The cold air the magnitude of the change due to cold air was statistically different from healthy the healthy controls (p < 0.01, i.e. 99% probability of not being pure chance).
They also found that cold air challenge had a statistically significant correlation with Methacholine challenge test results (r = 0.83, p < 0.01) in atopic asthmatics, but not in the other groups
Dust is difficult to avoid - have you discussed stopping the antihistamines with your cons/gp. It may be an idea to this before - what would they suggest if you found dust triggering your asthma ((I'm assuming it is an asthmatic response). If it is not just asthma (itching eyes etc) would they recommend a quick acting antihistamine (like Piriton) as well as your reliever. Monteleukast does seem to have a big impact on my asthma response to allergens but I still get itchy eyes when around dust which I treat with Pirton and then take my reliever if it triggers my asthma. (I seem to have waffled here, hope it makes sense)!
I see an allergy cons separate to asthma. I have several allergies of different degrees (my cons once said that I could be a case study of atopic conditions). A quick run down would include:
Tree nuts - anaphylaxis reaction but makes my asthma bad for several days after (this is one of the things that makes a non-wheezer wheeze)
Latex (and lots of fruit linked to latex eg strawberries, kiwi etc) - not as severe but gives me hives, swelling, itching etc and sometimes makes me wheeze.
Penicillin - hives
Hayfever (grass, tree and spores)
Dust, cats and dogs - nasal/sinus and asthma difficulties
I also get eczema which is triggered by just about everything (and bit like my asthma).
Beth I had a quick scan through that study and it is very interesting. I have his email so maybe I can send him the study heheeee
Sue I don't know what he would say. Sometimes I can't be bothered arguing as I can just tell I won't change someones mind. Also he was very good apart from this, I have recently upped my medicine so hopefully I will be better during this winter and also he has talked through with me ways I can adjust my medicine if I get worse so I am happy with my appointment overall. However, it is good to know others are experiencing the same as me with the cold. I would rather know what exactly is affecting me so I can try and adjust accordingly.
Kayla, it was my cons who suggested a trial without it. The only thing is, if I get worse I may assume I am worse because I don't have antihistamine rather than thinking it's due to anything else (cold, illness etc.). Yes the dust triggers an asthmatic response. Apart from my lungs reacting, I do not have any other allergic reaction (apart from the teeniest bit of eczema on my hands but thats usually caused by cold weather). I am confused as to how much affect antihistamines have on lungs....... do they mainly target eyes/nasal allergies??
Very unlucky with the allergies there!!
On another note...... is anyone else feeling increasingly tired as the weather gets colder..... I had 11 hours sleep past two nights and I am shattered. And I don't think over tiredness is a problem for me.
It is a nightmare trying with/without meds and to be totally sure any deterioration is caused by it. I stopped Spiriva a few months ago to see if it was working and my asthma went downhill. My gp laughed when I said that even my infant class would tell you it is not scientifically a fair test as I also had a cold and had just finished a course of oral steroids. In that case we just repeated it when I didn't have a cold (timing is everything) and then, when I did go downhill, started it again and asthmaicked up. I am happy to conclude for this that Spiriva does helps my asthma.
It is my understanding that antihistamines will help any true allergic reaction (ie where histamine is produced) but not sensitivities so it would follow that it would help an airway reaction as well as nasal reaction. My cons has said that I could take them all year round (just reduce in the winter) but I don't always feel a massive impact when taking them. I avoid medicines, latex and nuts (with Piriton/epipen/inhaler used as emergency medications/relievers) and find a nasal spray helps with the nasal symptoms. As I said before, if I know I am going to somewhere extremely dusty or with animals then I take antihistamines before I go. However, this is my personal preferences which have been discussed with a specialist allergy cons after nearly thirty years of allergies. I would try without antihistamines on a week where you are otherwise well and see what happens (as your cons has already approved this). Then discuss ways forward with your cons.
Hope this helps. Let us know how you get on.
PS although I don't necessarily agree with your cons on cold air, your cons does sound very thorough/helpful compared to my recent experience of referrals (especially considering that we sound quite similar in terms of severity/symtoms).
Oh dear Kayla sounds very annoying. Glad you got there in the end though. Is Spiriva another inhaler? Haven't heard of this one before. Trial and Error is very handy but I can imagine incredibly long-winded and annoying, especially if you are better on a med and have to try going without.
Well I am going to aim to start next week as like I said I am very busy this week and don't have time to be ill. Shame the weather is getting colder though, could do without that.....
Thank you, what was the problem with your recent experiences? Hope this is sorted for you soon.
Spiriva is a long acting versio of atrovent. My old cons recommended atrovent which helped (as I responded well to this in hospital) but didn't really help with nighttime/early hours when my asthma is historically bad. It is usually used in COPD and my GP thinks he is being radical in prescribing it but it seems a lot of people on the forum use it.
My problem was that after being referred (was under a cons in my teens when my asthma was terrible) I went to had three appointments (one was an emergency one my GP asked for when the trial with symbicort resulted in a total lack of control) in which they confirmed I had asthma, changed my diagnosis to severe cough predominant (which I thought was helpful for OOH care but turns out is not) and said it w allergy related (really with my history!) and then discharged back to GP with a list of medication to try. They also suggested considering desensitisation but my GP said immunology would not even consider it as I have too many allergies. My GP was not happy and we have been through the list but is reluctant to refer back. Sorry if that turned into a rant!
Cold air - hate it! Went out to the theatre last night and spent the whole show and then night coughing!
I am on antihistamines for allergic asthma. I am on loratadine all year round. My main allergen is pollens but I also react to dust mite. If I have ever missed one (I never do now!) my ventolin barely works and I need tons of it. Unfortunately for me, montelukast has no effect.
My sister attended an allergy clinic in recent years and she was told loratadine is the best antihistamine for respiratory allergic responses. (Although she doesn't have asthma.)
Well if it works for you then excellent
Oh dear, its not nice bouncing around is it. The unknown is the most annoying part. I sort of had to fight to get an asthma diagnosis but now i've had enough experience/ enough tests done to throw in peoples faces if they even try and deny I have it. I obviously don't want it but I feel being asthmatic and having people try and deny it is a scarey thing. Don't want to be ill and people are confused what to do with me.
Ah that's annoying, I hope you still enjoyed the show. I'm not really a cougher it seems. Even last time I had a cold and green phlegm was coming up I wasn't coughing, it just sort of made its own way up hahaa. i'm more of a tight chest/ heavy breathing kind of thing.
Thanks JF, will have to make a note of that. I don't think I have pollen allergy as far as I know...
oh another thing I remembered he said (I have a slow memory) was that a spacer works better with inhalers like ventolin is because it shoots out at a high speed and it ends up hitting the back of your throat where as with a spacer and turbohaler you inhaler at a normal breathing rate.
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Inhaled bicarbonate
