What constitutes an attack?

Hi,

background: still learning to live with this, asthma hit last year, probably heightened hormonal sensitivity to allergens with perimenopause/ menopause. But I also get exercise induced asthma so take a couple of puffs in advance. Been coughing a lot all summer, completely stuffed nose etc, but coughing in reaction to cold swimming pools as well. Am on max dose of seretide, singulair, antihistamine. I have been supposing that these daily episodes are perhaps 'normal' given seasonal challenges, and just something one has to live with . However, I've read that if one has to use ventolin more than once a week then the asthma is not under control, but I am definitely using it on a daily basis, is this the case with others here?

In the last few days, I have had two really quite scary wheezy, coughing attacks. But conversely on both days my morning peak flow has been at pre-asthma diagnosis personal best (it has taken 18 months for the peak flow to slowly rise back up since flare up and diagnosis). Usually with coughing fits, they start with a tickle/itch at the back of the throat but on these two occasions, yesterday and Friday, it started like a gradual tightening of the windpipe, as if I was being winded, slowly strangled, and then fairly uncontrollable coughing to the point of retching and calmed down EVENTUALLY by about 6 or 7 ventolin puffs. No obvious trigger except a migraine at the weekend would suggest I am probably very hormonal this week.

Were these two asthma 'attacks', as opposed to daily asthma episodes? And should I go to the GP, as the advice on this website suggests, within 24 hours?

How are others here defining being under control? Can I expect to be under more control?

I know everybody is different, that asthma is unpredictable, but would welcome hearing from others what a daily normal might be for them, whether asthma is always present like mine seems to be, or whether there can be asthma-free days. And if I should be seeing a GP, given increasing severity of 'attack' ( you can tell I don't like that word )

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Edited to add: I am aware that there are members here that much more severe and brittle asthma, and that mine seems relatively mild in comparison. I am however increasingly preoccupied by asthma episodes, and they are governing activities and daily living to quite a large extent these days, and I don't know anyone with asthma in real life to discuss it with, so would very much welcome hearing from others. Thanks!

[Annista]

Winnie

I know exactly where you're coming from here. I still sometimes don't recognise an attack immediately, especially as they don't alway present in the same way. I'm usually a cougher but sometimes I get the 'elephant on the chest' thingy or breathlessness.

There are other people on the site who have much more knowledge than I have and it is likely that somebody has experienced symptoms similar to those that you describe. However, I think that you really need to see your GP or asthma nurse about this because what you are describing does not sound like well controlled asthma and if you keep struggling on you could find yourself n a lot of trouble. I have ended up really ill more than once because I didn't realise that I was being affected by an environmental trigger until I was in big trouble.

Look after yourself.

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Thanks Annista,

I did in the end go to the doctor this morning, just back. Am more than a little depressed by the visit. Was not my usual doctor, but one I didn't know. He suggested it is bronchitis, on top of asthma, i.e. a more chronic condition. Based on the symptom of a chesty cough, a productive cough, lots of sputum on a regular basis. I told him that previous two chest consultants had diagnosed asthma, because of raised IGE and symptoms, and said my spirometry was on the whole good, and definitely not COPD, to which he replied well, it doesn't matter the label 'asthma/ copd', they are on a spectrum/ continuum. That asthmatics can develop asthmatic bronchitis which falls under the COPD definition.

Has anybody else had this diagnosed?

Conversely, anybody else have a very productive cough and 'just' an asthma diagnosis? I thought coughing up sputum (sorry, graphic) IS a symptom of asthma. However, there is a family history, or at least a couple of aunts, with bronchitis, so maybe age has caught up with me.

He then prescribed me a higher dose of Seretide of 2x500 twice daily and to follow up with the asthma nurse and my own GP in a few weeks. I was always under the apprehension that max Seretide dosage is my current dosage of 2 x 250 twice daily, and an internet search would seem to confirm this, so I am nervous and anxious about following his prescription. but don't know who to check with...

Anybody else been on such a high Seretide dose??

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Hi!

Yep I have brittle asthma and only asthma (vitamin d deficiency as well) which been confirmed by the resp consultants and also I get lots of nasty sputum due to the lots and lots of infections I get (even now I have an infection ) and had about 10 or maybe more this year . But I get all kinds of symptoms like tight chest breathing difficulty and wheezing and what I call as coughing attacks. But I am not a dr so you should discuss with your drs. But from my personal experience gps are not very reliable. My cons sent them a letter saying I need my uniphyllin doubled and they ignored it. Once when I ticked my repeat prescription they tell me I never had asthma and that I never had my meds before!? Even though I been in itu with asthma attacks. And been referred to Brompton . And they tell me i dont have asthma.

Regarding the seretide i had 3x250 twice a day but it made me shake so they swapped it for 1x500 twice a day then it got put up to 2x500 twice a day then back down then the gp said last time that it needs to be rewieved to see if it needs to be put up again.

Hope this answers some of your questions

Get better

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I'm glad you went to GP as these symptoms are not normal for you. I'm the same as you, in that my lungs are quite productive sputum wise from the asthma. If it's coloured or foul tasting then I start my antibiotics for the infection. I also take 2000mcg/200mcg seretide daily and this makes a difference to me compared to the top lisenced dose of 1000/100. It might help you get a bit of control, but I would suggest that when you go back to ask to try other things, like montelucast or theophylline if you haven't tried these already and having a normal dose of seretide rather than being on the high dose. I think if you were to stay on the off lisence dose then you should probably do it under the guidance of a cons. Phoning the asthma nurses here would also give you some answers and they'll be able to guide you about what to do next.

I hope you're feeling better soon

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Thanks Lou,

I did actually see co-incidentally the asthma nurse today as well, as i was due my flu jab and she administers them, so we had a bit of a chat and she thought to delay on the flu jab in case i was going down with something. I will see her again in four weeks to see how well I am doing on the new Seretide dosage, although she thought perhaps i should be on Pred instead (but last year's steroid course sent my thyroid way overactive, was nasty combination of steroid hyperness and hyperthyroid panic/ anxiety for a while, very unpleasant, so hoping to avoid oral steroids again). Am currently also on monetkulast. Doctor this morning did mention Theophyline but thought to try the increased Seretide dosage first. I will follow up your idea of speaking to the nurses here, as am still feeling a touch anxious about the Seretide increase given the asthma nurse's doubts and your cautions. Thanks again.

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btw. just to clarify that the doctor made the bronchitic 'diagnosis' having heard me cough after he asked me to do a peak flow ( I often trigger a coughing fit doing a peak flow, maybe I am being too competitive… with myself!). And my cough does sound quite chesty when its triggered like that - those of you who have sputum, is it a deep chesty cough?

Sometimes the cold freezer section of a supermarket can make me cough and I have to tell any bystanders that its ok, I am not infectious, just asthmatic! Does this public coughing, making a spectacle of oneself happen to others?

It is really really helpful hearing from you all, thanks, it makes one feel less alone and well… somehow more normal. I did come away feeling quite low from the doctors today.