Realising that I have a problem

During the past 8 days I've been signed off work with ""bronchitus"" . I'm increasingly convinced that this is not bronchitus at all but my first bad prolongued asthma experience.

None of the things my GP surgery have told me bear any relationship to the pattern of asthma that I experience. I have to work hard to maintain life on a low income, so I've colluded with the fact that so long as I'm well enough to go into work, I'll pretend that I don't have a problem.

A friend whose daughter had asthma was the first person to suggest to me that I should discuss this possibility with my GP. That was 4-5 yrs ago. My GP was happy to provide the brown, green and blue inhalers and to draw me a diagram of when each would be appropriate - only..... I felt embarassed to tell her that my breathing problems come on infrequently but fast..... the little diagram of how to escalate from one inhaler to the next every 3 days bore no resemblance to my actual experience.

At that point I had the inkling that my GP surgery isn't well informed, or motivated, about treating asthma, and I colluded with this thinking that I could manage by using my own common sense.

Through reading on the Asthma UK site as my breathing problems increased over the past year, I increased my own awareness about asthma. First I learned that my type of asthma pattern may be due to allergies, and I enlisted the local pharmacist to help me find an anti-hystemine that worked for me. Now I am learning that coughng can be an asthma symptom in itself, that asthma isn't necessarily related to wheezing.

By the time that I realise my coughing is compulsive and escalating in intensity, I always prefer collapsing in a bathroom of steam rather than going to the emergency room. It never seems practical to wait in a cold emergency room for perhaps several hours when I am either throwing up, or pissing myself, because of the force of my coughing.

I take what I can to stop the coughing, and get through it...... but recently I am trying to face that by doing this I am avoiding, rather than solving the problem.

Things that have helped me at different times have been: inhaling steam, chewing root ginger, taking honey, suppressant cough medicine, cough sweets. For several years I did breathing exercises every day as part of my martial arts practice.

I find full compliance with the regime of asthma preventers before the emergency use of relievers problematic. I did use preventers for a whole year, and didn't notice any improvement whatsoever in my asthma onset - which is always cause by either a virus or known allergies. I still don't fully comprehend what the active agents in the inhaler medications are supposed to achieve. Up to recently I took breathing for granted.

More and more surgeries at my GP practice are being manned by inexperienced young men and women who ask me the same ritual questions which don't have any relevance to my actual symptoms. They do now check my oxygen levels, which seem ok, but usually the appointment time is midday when my asthma is much less active than in the early morning or late evening.

I'm trying to work a sensible path through this and would welcome any support or suggestions!

Lilian

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Hi Lilian and welcome,

It can be hard to get good advice and treatment when you suffer from asthma which doesn't present in the classic way and it is something that I have struggled with for years. For me the biggest problem is that I don't wheeze and I have been known to take print outs from journals which state that not all asthma wheezes! However, I do think it is important to get a GP on side to help you manage this.

Firstly, what have they done in terms of diagnosis/monitoring? Have you done spirometry, monitored peak flows over time etc? If not then I would suggest this might help to pick up patterns/confirm asthma etc. You could also keep a symptom diary of when symptoms occur, what happens, possible triggers and how they are resolved. This was really valuable in helping my GP see the bigger picture and not just how I present at the surgery. Again, I had huge problems of turning up to see the nurse in the afternoon, after taking lots of reliever throughout the day and then being *ok*. I once joked that I should phone someone up at night (when I am most symptomatic) just to show how I am then! However, this variation is important in asthma.

Preventers are important in asthma management as they keep the airways from becoming inflamed. If they are not helping, it is important to look at why. It might be there is something other than asthma going on as there are lots of things which cause chronic cough and make asthma worse (in which case monitoring as above would help). It might be that you need something else as there are lots of different medications out there including different types of inhalers. I also find Montelaukast helps and it is particularly recommended for allergic asthma. Unfortunately, finding the right combination of preventers can be a bit like trial and error but I your GP should be able to help. I presume you have found an antihistamine that works for you which is good. Do you know what you are allergic too? Again allergy testing might be something to ask for. There are also some good nasal sprays if you still get nasal symptoms which my allergy consultant prefers to antihistamines in asthmatic patients as it helps post nasal drip which can be a real problem.

Finally, it is good that you have found things which help your cough (I often sit in a steamy bathroom throughout the night) but don't be afraid to seek help if you need it. I have never been made to wait in A&E when struggling to breathe (not even for triage) which I think must be part of their protocol because last week the receptionist was sounding quite twitchy that she had an 'asthmatic lady waiting for nearly five minutes' when I wasn't even really that bad. Although I wouldn't use A&E if I didn't have to, I think it helped some of the GPs who initially dismissed my asthma to take it a bit more seriously.

I do think it is important to have the support of medical professionals. Is there an asthma nurse you could talk to at your practice or a doctor with an interest in respiratory? I have found a small number of GP and nurses who understand my non typical asthma and will now fight to see these. The AUK adviceline is also excellent as a source of advice (both with management of asthma and the practical side of dealing with difficult doctors etc).

I hope this helps. Your asthma sounds quite similar to mine and yes I did have to fight for good advice/treatment but it has been well worth it as I now receive really good care.

Take care