Newbie to forum would like some help,do i have Asthma or is there another underlying problem.

[digg]

1. Have just started seeing Asthma nurse (nov 23rd) after years on and off of a dry hacking cough i have been put on meds Salbutomal 100mg & Budesonide 100mg and still wake up with a tight chest after over 2.5 weeks on meds.

2.Have been keeping peak flow levels and so far the average is 470 morning and 550 afternoon, how ever i kept peak flow reading with DR weeks prior to meeting Nurse and the readings are roughly the same...why no change...even after inhalers.

3. For some reason and this is been happening for a while i sometimes SNORT several times to get air at night and sometimes can feel sick and nauseas and if i try to be sick all i bring up is saliva.

This is all new to me and reading the forum has been a great help, worried and anxious.

Digg Aged 55

[damascena]

Your peak flow sounds like it's as good as it gets. My all time highest is 450! Maybe you need to try a different inhaler? I'vehad to try different ones until there was one that worked.

Do remember that asthma can cause acid from stomach to go up.

[digg in reply to damascena]

Thank you for your reply..take care.

[PPxwoods]

You need 2 tests to determine your level of asthma

Ling function respiratory test

This is non invasive

Also a new test called FeNO

This is now recommended by NICE

( national medical recommendation)

A high FeNO means that your asthma is not been controlled properly

In the ideal situation you should have

adequate meds to sustain a normal

life - 95% of the time

Under treatment of asthma is quite prevalent

ppxw

[digg in reply to PPxwoods]

Hi PPxwoods,

That is some interesting information i had never heard of a FeNo test before, although i can imagine that when i visit the DR surgery on Wednesday and ask him about the test i can imagine him just bulking and thinking of the cost to the NHS.

Is really straight forward to get a FeNo test (has any one on the forum had any difficulties getting a test) is the test available on private health(?) hopefully i will not have to take that option but i am willing to take that option if needs be.

The fact that asthma can be managed 95% is some what good news, i still feel as though i an a long journey of learning.

Thank so much for taking time out to reply.

take care.

Digg.

[Lysistrata Administrator Community Ambassador in reply to digg]

FENO testing is not that easily available as the machines they use are expensive and therefore not easily available in primary care. I'm not a doctor but personally with my experience of asthma (which seems to be piling up), I am not impressed with NICE's recommendation on this. As mentioned the machines are expensive and many GP surgeries are not going to have the funds. It is also possible to have asthma or uncontrolled asthma without raised FENO. I have had it done in ny specialist tertiary centre (and nowhere else, even in other hospital asthma clinics) with the clear direction that it is for detecting airway inflammation that responds to steroids and not for diagnosis.of asthma (recent research has shown a lot of variation in asthma and not all asthma responds to steroids). This is in line with other tbings I have read.about evidence on FENO. Who is providing the education in primary care on how to interpret the FENO test correctly?

I agree the lung function tests can be helpful and that can be done at the GP surgery. A reversibility test may be especially useful - this is where you try not to take your blue Ventolin inhaler for.a few hours before, do the test then take Ventolin and do it again to see if it changes. Worth remembering that asthma can vary so it might be normal if you feel ok when you do the test. Always worth doing the reversibility test part even if they say no need as the first part is normal.

[PPxwoods in reply to digg]

Digg

A FeNO test cost very little

All asthmatics with wheeze

Secrete a gas called Ferrous Nitrate

gas in higher portions than a normal person

If the asthma is controlled the FeNO

will fall into a normal range

This test has now been approved by the NHS And is recommended

by NICE

Your GP will know about NICE

it is a statutory body that make recommendations re tests and new drugs to the NHS

The respiratory dept of your local

hospital will do the test

40-60 of asthmatics can be mid diagnosed either way

This new test helps to improve the decision making and the Med regime

Look it up in google !

[digg in reply to PPxwoods]

Seen the doctor today and when i mentioned about lungs tests said the the only ones that we preform at this surgery are ones for smokers (?)...also did not mention about doing a test for allergies which may trigger asthma, strange really when she confirmed that to me that i have asthma, personally so far i give the support i have so far is not so good.

Stressed

Digg

[Hidden]

Yes FeNO is useful for patient eosinophilic/allergic asthma. It is not useful assessing and monitoring non-allergic asthma. It is now expected that GPs use this test for diagnosing asthma in patients with intermediate probability of asthma. However, they might not have bought the equipment yet as it is a relatively recent requirement from NICE.

Also inhaled steroids do not work that quickly. The airways a relatively steroid resistant if they are steroid naive/inflammed. You need to be taking inhaled steroids for at least 6 weeks before you can say for sure that they do not work. You also need to make sure you are using a spacer device.

Peak flows vary from person to person. Remember asthma is not just the narrowing of the airways but also inflammation of the airways itself resulting in blockage inflammatory debris within the airway. Maybe your peak flows reflect persistent airflow narrowing due to ongoing airway inflammation.

You need to speak to your asthma nurse and ask what your predicted or best peak flow and discuss your concerns regarding you inhalers and symptoms.

[digg in reply to Hidden]

Thank you for your feed back, i am off to see the asthma nurse tomorrow with loads of questions i need to ask.

Just rang up Asthma uk who also suggested a spacer which i think is a good idea since starting on my i am starting to lose my voice and i think that the powder is just hitting my throat...was not showed how to use inhaler....got that from utube.

It's the anxiety that is starting to get to me now if the nurse gets a plan together getting me tests etc and sorting my meds it will help a great deal.

Regards

digg

[IChoose]

Have you been checked out for heart disease?

We discovered this year I have an abnormal EKG, heart muscle hypertrophy and circulation problem. I get out of breath very fast on cardiac treadmill test and blood pressure went way up. Cardizem interfered with my asthma so we stopped it. But, I still have my nitro prescription. I think my cardiologist thinks that the heaviness and constriction I felt in the center of my chest this year, concurrent with asthma, was angina. I have an amazing allergist who first suspected it and said she wanted me to get a work up. That was March. The workup didn't happen until July.

I also showed low immunoglobulin G on blood test so more tests will be needed. I believe my lifelong respiratory illnesses are linkable to this.

You must see an MD. A nurse cant do this level of diagnosis. If an allergist is not working out try a pulmonologist.

It is SO hard to get good asthma care that is comprehensive and creative. I hope you can find it and when you do that you can afford it.

Cutting out caffeine helps me.

I am also middle aged.

[digg in reply to IChoose]

Thank you for your reply, getting a check for heart disease is a very good by the fact that both my parents had it is a very good idea.

I get pretty anxious and i guess that will not help much.

Digg