Is this an attack brewing, and if so, what can I do prevent it?

[Limefime]

My PF is low/dropping this week (consistenly about 40-50 lower than my PB). I am out of breath from doing the half hour brisk walk that my husband and I have been doing for 2 months. At the gym I am feeling like I can't do what I normally do and had to drop weight/reps/resistance. At night I cough myself awake or have a very tickly throat. I have indigestion. Three times this week I fell asleep on the sofa after coming home from work.

I am taking my Fostair 2x a day, 12 hours apart. I am nearly done with the second week of going dairy free, under doctor's orders.

Last week I was feeling great. Night time coughing, tickly throat, acidy burps and eczema were all gone. I was full of energy. Our half hour daily walk was tough but enjoyable. My PB improved by 10 last week!

It is much colder this week, of course, which is a trigger for me. I have not had a 'coughing fit' triggered by cold air... just a return of the niggly cough throughout the day and night. I wear a mask when I am outside. Been called a bank robber, a religious extremist, a terrorist and Hannibal Lector by strangers in the street! But at least I am not coughing!

Are these warning signs that something is afoot? If so, what should/can I do to prevent an attack?

[Hidden]

Have you got a emergency pack steriods and anti biotics. Contact your gp.have you got an asthma plan... as for covering up I have been getting strange looks no one has yet said anything though.

I tend to get tired breathless and peak flow drops just before attack

[Limefime in reply to Hidden]

Emily, I do have an asthma plan but not an emergency stash of medicines. I still find it hard to judge at which point I am meant to up the ante in the treatment plan. I not experiencing an attack but it does feel a bit like it did before I had my first one end of Sept last year. How long does it take to develop from 'these are the signs' to 'this is an attack'?!

Thanks for your advice. I do think I'll up the inhaler as per amber phase and see if it makes a difference.

[Hidden in reply to Limefime]

Let us know how you get on

[Limefime in reply to Hidden]

Will do.

Just realised that when the asthma nurse updated my asthma plan last time, she just scribbled the new inhaler name on it and crossed out the PF values with my new PB but never adjusted the plan otherwise. I am winging it by doubling my Fostair to 4 puffs 2x a day, from this morning (as that was the plan for Clenil modulite I was on before).

[Hidden in reply to Limefime]

Good but please go back to your doctor

[emmasue]

I would go back to the GP. If your symptoms are worse, they could lead to worse symptoms and a chest infection. Take care of yourself. x

[Limefime in reply to emmasue]

Thank you, Emmasue. I'll try to make an appointment on Monday. It is not very easy to get one...

[emmasue in reply to Limefime]

I know it's a pain. I hate having to go back to the GP, but sometimes it is necessary. Good luck and let us know how you get on. x

[Birthday60]

Fostair is usually for mild asthma and is cheaper than more effective alternatives. I take Montelukast tabs and Symbicort 200/6 plus Spiriva. My asthma plan shows clearly when to jump to prednisalone. Try going back to your asthma nurse tho to be honest most are useless and give condradictory advice.

[Limefime in reply to Birthday60]

Birthday60, I am very fortunate that I only have cough variant asthma. As far as I can tell, it is not life threatening, just interferes with normal life. I have only had 1 attack so far and that was very frightening, so I have been a lot more dedicated to taking PF and medicines on time, and keeping a diary. I think that if I did that last year, I might have predicted and prevented the attack.

I agree that the nurses may not always agree on asthma. The last one I saw thought I was misdiagnosed because the cough doesn't always respond to the inhaler. Thanks to her referral and the subsequent tests and visits to the GP, it became clear that I have 2 types of cough: asthma and silent acid reflux coughing. I am still learning how to tell the 2 apart! I guess this time it worked to my advantage that the nurse didn't just go with the original diagnosis. But her advice on dealing with asthma was sketchy, to say the least!

[Birthday60 in reply to Limefime]

I also have a cough due to acid reflux - have gone through a few standard meds and now have Pantopraxole which is miraculous!

[Limefime in reply to Birthday60]

Sympathy, Birthday60. It is so tough to get these coughs under control... I was on Omeprazole in Dec but the side effects of long term use are hair raising! I decided to try and eliminate the possible cause(s) rather than medicate, unless I have to of course. My dad and his mum had issues with dairy, so that it my first thing to eliminate.

[Hidden in reply to Birthday60]

Actually Fostair now comes in two doses so can be used for any level of asthma that requires a steroid and long-acting reliever. It is cheaper but objectively just as effective as things like Seretide. It’s not for everyone though!

[Limefime]

We went for our daily walk this afternoon, DH and I. I managed to walk at a good speed again, and though I was tired and out of breath at the end, the walk itself did not feel like I was dragging leaden legs through cold treacle! So far so good re increasing the inhaler.

[Nutzs47]

I take fostair ,monteluckast and spirits and you can double the dose of fostair for a week but if no improvement you need preds .i have atopic asthma but work with my trigger although if I have a cold etc I tend to find it affects my asthma too as app that’s how viruses work they attack your week spot .

[Limefime in reply to Nutzs47]

Thanks, Nutzs47. I was wondering how long I could double the Fostair for, but hope to see the GP or nurse before the week is out. I also hope that by then the symptoms will have improved so that I can go back to my usual dose.

[Nutzs47 in reply to Limefime]

I usually find that rather than doubling morning and night taking an extra dose mid afternoon works better as fostair is a dual action inhaler and having it then helps extend the longer acting part of it and avoids the shakes from the steroid part x

[Limefime in reply to Nutzs47]

That's is good advice. I think I'll start that tomorrow. I already had a double dose this morning...

I do get the shakes every time I take it! Not fun.

[Nutzs47]

By the way I take spiriva auto correct obviously thinks I’m a drinker too lol x

[Limefime in reply to Nutzs47]

Haha. I thought it was meant be steroids.

[Nutzs47]

Hope it works for you x

[johnsmith]

You need to investigate yourself. The chest is connected to the legs. There is a relationship between tightness of leg muscles and tightness of chest when moving. This is not an easy relationship because how legs move when walking is very variable.

When breathing becomes difficult there is a tendency to want to breathe in rather than breathe out. Breathing out is more important. Atmospheric pressure will force air back in after breathing out. This you need to investigate. Words can mean anything to a lot of different people.

How are you doing your brisk walk. It is more important to walk with coordinated movements and use the leg swing produced by gravity than to force a quick pace. The forcing quick pace feels like you are doing good according to recommended exercise. However, you could be doing things that are not to be recommended. Better coordination should be the aim. Better coordination has all sorts of health benefits while forced bad coordination does not. This is for you to investigate.

Sleep is important for the fine tuning of muscle behaviour. So find times to get more sleep if you are failing to get enough sleep at night.

Hope I have been helpful.

[Limefime in reply to johnsmith]

Hi johnsmith. You shared some interesting ideas. I didn't know about the correlation between leg and chest muscles.

DH and I walk fast but it is because we both have long legs, not because speed is the target. At the end of the walk my heart rate is elevated but I haven't broken a sweat, normally. The breathlessness I experienced this week is unusual, which is why it concerned me.

The walk is just a top up exercise for me, to keep DH company. His work schedule does not allow gym time but I get my exercise at the gym. I am generally quite fit but when I struggle with the CVA, I also feel its effects at the gym.

[johnsmith in reply to Limefime]

Thanks for the reply.

[Limefime]

Update (a bit late, sorry)

I got an appointment with the asthma nurse on 11 Feb. There are none available earlier. I didn't insist on being seen earlier as I am not having an attack or can say for sure that it is building up to one.

I have been taking the Fostair 3 times a day for a while, and have been feeling much better. I stopped on Wednesday as my mouth developed a burning sensation, as if I scolded the inside of my mouth with hot tea. I do rinse my mouth every time I use the inhaler, so not sure why this developed. I am back on twice a day and the burning has gone.

My PF improved while I was on the 3x a day dose but today it is right down again. Sigh...

I'll treat symptomatically until I see the nurse or insist on an urgent appointment if it gets worse.

[WheezleSneezle in reply to Limefime]

I get burning mouth and yucky white stuff when I’m on steroids and antibiotics. Steroids can affect our natural balance of bacteria and cause Candida or thrush in the mouth. I don’t know if inhaled steroids do that as they don’t to me but maybe check to make sure that isn’t the cause.

[Limefime in reply to WheezleSneezle]

It can. Last year I developed thrush because I was lax and didn't rinse my mouth every time I used it. I have been careful this time but with the increased dose came the burning sensation... 🙁

[Limefime]

An update

I saw the asthma nurse yesterday. I was feeling good, asthma wise, but wanted to pick her brains and get some reassurance about my asthma plan.

She agreed that I have both asthma and acid reflux and that the coughs are difficult to distinguish. She said that the inhaler can also aggrevate the acid reflux.

As my asthma seems to be back under control again (PF is good and legs are no longer leaden) and because I monitor my PF so regularly, she suggested that I drop my inhaler down to 1 puff twice a day to see if it will help with the acid reflux cough (which she saw for herself as I coughed throughout our visit - a short, sharp cough every now and then).

If the cough still persists, she says I should go back to the GP for further investigation of the acid reflux.

She was very patient and answered all my questions. Unfortunately it did confirm to me that asthma is a shape-shifting beast, as I suspected. Just about all the advice she could give me is of trial-and-error nature. So, here I go again with a different experiment - lower dose less acid?!

I am on week 5 of dairy-free, with mixed results as far as acid concerned. I have seen improvement in some areas - bloating and distension of the tummy has gone but other symptoms wax and wane.