Just diagnosed and really confused!!!!!

Hi

This my background. I have a history of getting chest infections, which involve feeling bunged up not being able to or find it very hard to get rid of phlegm. I try an exercise as often as possible usually about 3 or 4 times a week, by running going to gym or lift kettlebells in my home. This year has been the worst for chest infections. just before Christmas day i started to come down with an infection usual symptoms, shortness of breath, not being able to take a full breath, feeling weak, sweating a lot while doing any kind of exertion, unable to bring up phlegm properly in morning feeling bunged up. any phlegm i brought up was greeny colour.

Didnt see doctor for a month as hoped it would go away. Eventually saw nurse practitioner who said she could hear crackling from my lungs and prescribed antibiotics. waited a month didn't clear up saw a different nurse practitioner who said she couldnt hear crackling wouldnt prescribe antibiotics and told me it should clear up by itself. A month later i felt worse managed to get an appointment for an actual doctor who prescribed antibiotics again and it eventually cleared up. During this time I was unable to exercise, lost a lot muscle mass, strength and fitness going from military pressing 50 kg doing 8 reps and 4 sets with reasonable ease to struggling with 30kg. Once I felt up to it i started doing a lot of cardio to regain fitness. I felt i was doing quite well being able to run a mile and a half in about 10 mins ( not record breaking but decent for someone my age and just recovered from a 4 month long chest infection)

So this period of feeling well lasting about maybe 2 months. Then i felt the symptoms again, this time i started to get small pains in my chest went to see the doctor but yet again would have waited for 3 weeks for an appointment or see nurse practitioner, I saw the nurse, She examined me told me i did not have a chest infection said it may be viral not bacterial ?? and it'll prob go away in a few weeks, stated she will not give me antibiotics. But she did arrange a spirometry and rebreather test, she never really explained why, was just short and sharp with me. Sat test 2 weeks later while still feeling like i had a chest infection of some kind. Was told the test showed I did not have asthma or copd. The print out stated my lung age was 22 yrs old. Quite impressive for someone at 37 yrs old and was a smoker for 20 years ( i gave up 4 years ago) makes me doubt the accuracy of these tests! Was told effectively to go on my not so merry way. I complained that i cant take full breaths, i have been told i don't have a chest infection, don't have asthma or copd, so what is it? I need help here, was advised to make an appointment with their breathing specialist, didnt even know they had one, why i wasnt refered to him in the first place, who knows. Although I did feel i could breath easier about an hour later and bring up a reasonable amount of phlegm, may have been the inhaler puffs i tool as part of test? I couldn't tell a difference straight away though.

Made appointment waiting near a month to see him. Still feeling unwell etc. He stated it might be asthma as he cant think of anything else, fair enough gave me a reliever inhaler, advised me to do a peak flow diary. I did notice an improvement in being able to breath easier and able to get rid of phlegm and felt less blocked up. However this is where i'm getting confused. On this blog people are talking about their peak flow is 200,300, 400 etc. Now when i do my peak flow it is usually about 490-540 in morning, after taking my reliever inhaler i can then blow anywhere from 50 to 100 ml more, the max i have had my peak flow with inhaler is 600 ml and without inhaler 560ml.

However in general my peak flow will be about 500 ml in morning and after inhaler going to 570 - 600ml which is a typical morning. Which my peak flow at night typically 530-570 without inhaler. Their is a difference, but still seems kinda high compared to a lot of people on blogs or info online that i have read.

Weird thing is I can feel a bit out of breath and still produce a good reasonable high peak flow, for example I walked home from work the other day felt out of breath but still blew a peak flow of 570. Some days i feel out of breath all day, but still get a high peak flow.

At my next appointment the doctor was just going to keep me on relievers and stated i will prob be put on steroid inhalers in the future eventually. I queried this because I spoke to one of the asthma nurses from this website who told me if im taking my reliver more than 3 or 4 times a week I should be on steroid inhaler. And what i described to her about not being able to bring up phlegm etc she said it sounded like that was a flair up and not sure why doctor not prescribing steroid tablets as they work quicker. I have been using my reliever about 3 times on average a day. When i explained this to the doctor he said it was a fair comment but using a reliever 3 times a day is not anything to be concerned about, so i requested a steroid inhaler just to try it and he agreed but he didnt feel it was necessary and stated when i felt i had a chest infection it may have been a flair up or a chest infection, but i was told before it was not a chest infection, and was sent down the asthma path, its all a bit confusing.

Anyway, I was issued a steroid inhaler Qvar 50mcg and told to take it twice a day i just started 4 days ago, and i have felt like i can take a full deep breath but it seems to feel laboured to do so and will cough a lot after taking the deep breath, but my peak flow is still high. My throat is quite sore and feels a little swollen, this might be because of the steriod inhaler. When i exercise now i take my reliever inhaler before exercising but still feel myself getting out of breath quicker than i really should be. Maybe i'm expecting too much of myself, who knows.

Do i actually have asthma? How long does the steroid inhaler take to work? I have never found myself getting wheezy which is a classic symptom but sometimes i cant catch my breath while exercising and other times i feel fine. I seem to get a lot of chest infections or colds or non chest infections according to the nurse practitioner. And is it normal to be able to get a high peak flow result and still feel a bit breathless.

Any advice would be much appreciated.

[Hidden]

Ok, Ive had 2hrs sleep - so i will do my best to be clear and coherent (with all the usual disclaimers about me not being a doctor!!)

Firstly, i'll adress peak flow because it is a personal pet peeve of mine. With peak flow and asthma (ie not COPD) the actual number is pretty much irrelevant, its about % of personal best. So my best, like you is 600. This doesnt mean that when I am at 300 my breathing is the same as someone who normally gets 300, it means I am having an asthma attack (going by peak flow alone - which you shouldnt even do!). So you look at % change, and % of best normally. So the ""green zone"" for a best of 600 is anything over 450 - so 75% and upwards. The ""the yellow zone"" would be 300-450 and the ""red zone"" would be lower than 300. Going by peak flow alone you would expect minimal symptoms in the green zone, in yellow you would be symptomatic, it'd be advised to stop any activity/trigger exposure, and take your reliever, persistently being in yellow zone might be a trigger to start oral steroids or increase inhaled steroids despending on your particular asthma management plan, and red zone would be an 'attack' and would trigger your protocol for an attack (The general AUK guidelines would be 2 puffs of salbutamol - blue inhaler - or other reliever, every minute up to ten puffs and if no improvement 999 - i believe that is correct - it'll be in the 'knowledge bank' at the top of the page). However it is also very important to note that you should always go on symptoms before going on peak flow. A few people have PF readings that don't really correspond well to symptoms, and high exercise tolerance is one of the factors that may mean you're someone with a less responsive peak flow! WHilst your peak flow variation is within the top 25%, you are still getting a fair amount of variability (peak flow diaries should have minimal 'wiggles') and you are getting them in a typically asthmatic fashion (ie lowest in the morning, highest after reliever) which doesnt mean 'yes you have asthma' but is a symptom to put in the 'for' pile for asthma.

These days GPs are very careful about prescribing antibiotics (abx) and often do get very defensive about it as so many people come in demanding abx for any symptoms (my sister is a GP and has been asked to prescribe abx for headaches, insomnia and back ache!) so it is possible she was being short and sharp because of that. Many nasty feeling infections are viral - which is really annoying because there isnt a lot that can be done. It also is worth noting that whilst it used to be thought that green phlegm = bacterial, that is known to no longer be the case, i think they usually diagnose bacterial based on exactly how nasty your lungs sound - the classic 'crackling' noise (which i find gets so loud i can sometimes hear it when im lying in bed!! ewww!!) If possible it is better to avoid abx - you simply build up the resistance of some of the bacteria in your body. If you do have infections and are struggling to bring up the gunk in your lungs it might be worth discussing a drug called carbocystine which is designed to thin the mucus and make it easier to cough up.

Steroid tablets are pretty nasty to be honest. In short courses (usually three days to a week) they're reasonabley harmless - you'd probably be tempted to try and eat your own body weight, and stop being able to sleep, possibly get a bit grumpy etc but in terms of dangerous side effects they're not too bad in short, occasional bursts. Doctors tend to be reluctant to prescribe them given that they can have such evil side effects when taken too frequently. They can stop the body producing its own steroids (for me after years of constant useage i can now probably never stop steroids - even a 24hr sickness bug needs me to give myself injections of steroids to make sure my body has some!), it can make you gain wieght (well - indirectly, they make you very hungry and crave fatty foods, and retain water, and when you do gain weight it kinda deposits itself weirdly), its not good for your bones either! as well as a multitude of other potential long term problems. if you can safely avoid oral steroids a doctor usually will try to! Inhaled steroids are highly effective in treating asthma as the steroids only get into yourlungs rather than into the bloodstream and then lungs (like the tablets) so much lower doses can have a significant effect as they're getting to the source of the problem, and less gets inti the body in general making them less side-effect-y. They usually take about two weeks to work, and need to be taken constantly, even when well, unless your doctor advises you to only use them during periods of infection which is relevant for some asthmatics. Make sure you're washing your mouth out properly after taking the steorid inhaler and it might be worth asking if you can be rescribed a spacer device which will help make sure you're getting the best possible dose of your steroid inhaler and also minimise the side effects in your mouth! the feeling of a full breath making you cough is also one to put in the 'for' asthma pile!

Having smoked for 20 yers may well explain the freguency of chest infections, and also could mean that you take a lot longer to 'bounce back' afterwards. It is important however to make sure infections aren't getting out of control as that can cause problems in itself. Do discuss with GP what to do about frequency of infections and also the difficulty you have getting appointments, you should really be able to see a doctor before 3 weeks, nurses are usually fantastic at what they do and frankly i'd personally usualy prefer to see a nurse than a doctor, but they have less training than doctors do and often less experience with 'weird' things, so if things are a bit atypical with you at the moment it can be helpful to see a doctor! Next time you're in an appt and struggling and feel like they are saying no asthma, no COPD, no chest infection, then do discuss what they do think the problem is - it might be that they think its a viral infection which is nasty but will clear up on its own! Its also worth taking the time to discuss what things you can do at home to help. I often find that when they are being a bit 'off' with you, especially if you might be wanting abx etc. then discussing 'home remedies' can help them be a bit more engaged, as a patient who is willing to try whatever, as long as it makes them feel better!

Hope some of that is helpful to you! as i said, im very tired! lol! Hope you feel better soon!!

Soph

[Hidden]

Hi soph.

Thanks very much for replying, I have taken your advice on board and found it very useful. The whole peak flow thing makes a lot more sense to me now.

I really appreciate the time and effort you went in to.

Thank you

Woolfie