Hi all. Really this is more about my asthma I think. But we will see. I am 55yr s old male. About 6 years ago after a major cold I started to need a puff of ventolin here and there , given by the GP but no steroid. This was ok for a while but I gradually needed more and more. After a while I went back and was given some clenil too. Didn't really help much but hey.. I was a smoker too by the way, then at 53 I collapsed while riding a bike up a steep hill and was told I had a blocked heart valve and this was probably also why I was short of breath. Anyway had the heart surgery but it didn't help with the breathing. While I was in hospital having a ct scan they found emphysema. So then I'm having a panic etc. Went for Spirometry only a few months ago and it seems I have asthma too. As I get %18 reversibility and once I've had 4 puffs of ventolin my Spirometry just about creeps into the low end of normal fev1. Now here's my problem on a daily basis that I'm hoping someone will know something about. I have been trying combi inhalers. I have tried surdupla, and recently duo resp. Neither suited me. But fostair seems pretty good. The only issue I can't seem to get around is my breathing in the mornings. My peak flow and my breathing in general is poor in the AM. It gets better as the day goes on. Eg. My peak flow at its best is 450. (I'm a short arse, but I think it's lower than the listed flow should be) and at 450 I'm pretty comfortable and can exercise etc with out issue. But first thing it's 370 I find it irritating as hell. I am going to see the asthma nurse in a fortnight and I was going to tell her again that I'm still not comfortable in the mornings. ( she's not much good to be honest, any questions and she's lost) I was going to ask for spiriva respimat as an add on after talking to one of the asthma uk nurses. But want I was hoping for was anyone with similar personal experiences and/or knowledge of this and how if possible to make it better. I did a search and found lots of asthmatics who are uncomfortable in the mornings. Even when peak flow was actually OK. Any advice appreciated. Ps stopped the ciggies 10 months ago.
Asthma copd overlap. : Hi all. Really... - Asthma Community ...
Asthma copd overlap.
You say: "The only issue I can't seem to get around is my breathing in the mornings. My peak flow and my breathing in general is poor in the AM. It gets better as the day goes on. "
This sounds like a possible muscle control issue.
Have a look at this Post
healthunlocked.com/asthmauk...
Alexander Technique may help the issue.
See these web sites for further information
alexandertechnique.com/onyo...
Youtube has lots of talks on Alexander Technique
youtube.com/watch?v=nZQFdh4...
Hi johnsmith
Could I just ask (as a few of us are wondering) do you suffer from asthma yourself, or do you have a close family member with it?
If so, I’d suggest reading up about the physiology of asthma, and the autoimmune aspect of it. Circadian rhythms have a major effect on various aspects of asthma physiology, including inflammation and anti-inflammatory processes, smooth muscle tone (not under voluntary control), and mucus production. All this tends to result in night time symptoms and symptoms on waking, especially in asthmatics who are less well controlled and/or have more severe asthma. The night time effect is quite well known - more people present to A&E at night and often have worse attacks at night compared with daytime. I find my night/early morning symptoms are closely related to how my asthma is doing overall - worse control, worse nights, but it will respond at least short term to meds and improve after my morning medication. I very definitely have better and worse times of day for asthma.
People do have breathing dysfunctions and mechanical issues resulting from asthma, and this may be more obvious when they wake up if they have been having a bad night with asthma and/or also slept in an awkward position. However, there doesn't seem to be any clear relationship between breathing dysfunction and circadian rhythms, as there is with asthma; dysfunctional breathing doesn't usually get better over the day. I've put links at the bottom to some articles on nocturnal asthma, including Asthma UK's advice, which Gazza01 may find useful. Second article is more technical for those who enjoy that 
Js706 and EmmaF91 probably have useful insights on this as well (medical and osteopathic viewpoints)
asthma.org.uk/advice/living...
ncbi.nlm.nih.gov/m/pubmed/1...
I have occasional breathing issues. I have a strong response to certain chemicals. I was diagnosed as mildly asthmatic many many years ago. I follow physical regimes which prevent occasional breathing issues from escalating. Learnt these from various experts over the years. Still learn about physical issues from experts.
So I take an interest speaking to asthma consultants about breathing issues at conferences or seminars. Have taught someone having an asthma attack to breathe out rather than trying to breathe in. Some asthma consultants know this method some don't.
I have a physics understanding of things. I have been taught about feedback mechanisms. Something which is not in a medical students training. I know a little bit about engineering systems again something not in a medical students training. I know a little about the brains input into how muscle behaviour affects things.
I know a little reduction in stress can make a large improvement in the way an engineering system works.
Read both your website references. Both fail to tackle the issue of muscle tension issues this is an area complementary medicine excels in and is often ignored by mainstream medicine. You cannot measure muscle tension by chemical probes. Muscle tension issues are present in non asthmatic and in asthmatics when waking up in the morning. Muscle tension issues can take a stressed system past the stress breakdown point. This then results in failure of the system.
How one exercises is important. It is not just the doing of the exercise.
Hi thanks for the lengthy reply. The whole stress and muscle tension thing rings true with me. After my collapse in the street with blocked heart valve, I was held in hospital feeling actually fine but was told open heart surgery was needed and that if I left the hospital I would almost certainly die. Well I went through the surgery and after about 3 months started to have panic attacks. Apparently quite normal. The mind waits until the body is healed enough and then presents you with the trauma. That was 2 years ago yesterday I collapsed and I still struggle with anxiety on a daily basis. Also find out I had emphysema was a shock. And then giving up the ciggies was difficult as this would be my crutch in stressful times. I feel there is defined at least some part of my breathing that is affected by the stress. Also I do exercise every day. Apart from staying very active I walk briskly on an incline on a running machine for 30 mins and then do some light weights twice a week too. I do try to take time to do relaxation but it's hard trying to switch off a busy worried mind. And of course when your breathing feels poor that's not helping either. You mentioned " the type of exercise" is important and I wondered if you have any advice on that score. Thanks in advance.
You say: "I still struggle with anxiety on a daily basis".
You say: "I walk briskly on an incline on a running machine for 30 mins"
The exercise is the cause of your anxiety.
Emotions are felt in the body. The emotions are determined by the state of the fascia. You setting up a fascia state by your brisk work.
A helpful book on fascia is “Fascia what it is and why it matters” by David Lesondak ISBN 978-1-909141-55-1.
The leg muscles set up a tight chest front and back for a brisk walk. Under non exercise issues the body engages in a brisk walk when you have something following you which is not very nice. Anxiety enables a brisk walk when someone is following you (possible mugger).
You say: "I do try to take time to do relaxation but it's hard trying to switch off a busy worried mind." I know no one who can switch off a busy mind. The mind is designed to be busy. What we can do is quieten the mind by changing the fascia state. Switching off a mind is asking for serious mental health issues.
The fascia has contractile elements in it and it has thousands of nerve endings which feed into the brain. The contractile elements are slowish to respond. So a set of movements to reduce fascia tension may take a few minutes to respond.
The following youtube video is not exactly what I do when I engage in walking meditation. However, it does give instruction which is helpful. This should cover relaxation and begin to relax the chest and legs. When I engage in walking meditation I work on following gravity and allow my legs to swing according to gravity dictates.
youtube.com/watch?v=_IFvabl...
Observe the effects and feel free to modify according to your observations.
The trauma response you mention is less the mind than the mind's response to your fascia state. You will have scar tissue in the fascia from the surgery. This has a defuse effect across the body's fascia.
Hope I have been able to be useful.
Unfortunately as you say you’ve found, a lot of asthmatics feel worse in the mornings.
This is because the airways tend to be narrower overnight (just due to how hormones we make vary over the day) so people tend to find their symptoms are worst overnight or first thing in the morning! And I definitely find this too - sometimes they suggest taking your ventolin about 5/10 minutes before your preventer inhaler, as that can help open up the airways and help it get deeper into your lungs.
nhs.uk/conditions/asthma/sy...
But if you’re feeling significantly worse in the mornings compared to the evening, and there’s quite a big difference between your peak flows at either end of the day then it may just be that your asthma isn’t fully under control yet and you might need an extra preventer inhaler. Spireva is probably a good one to ask about as it’s used quite often in both asthma and COPD!
Hope the asthma nurse in a couple of weeks is helpful and congratulations on stopping smoking!
Hi, I've just read ur post and I can say that I've been in the same situation as yourself, I've tried many different inhalers over the years, some helped and some didn't, sometimes when I started a new preventer inhaler and for a while it worked but then I had more problems than I care to remember, I've also tried many combination inhalers which were totally useless, I tried the spiriva handihaler as I was constantly unable to breath due to coughing all the time, the spiriva handihaler really helped and after a few weeks the spiriva was stopped my spiriva handihaler and left me with my preventer and my blue inhaler, I eventually found the right steroid inhaler and I'm now settled on it but I saw my asthma nurse well over a year ago and I told him what was happening and he put me on the spiriva respimat inhaler and I must say that it's the best one I've had, I'm on surdupla two puffs twice a day, I have my brycanyl (blue for emergencies) and I'm on two puffs of the spiriva respimat inhaler one per day in the mornings and it's the best thing that I ever did, I would suggest that u go n see ur asthma nurse or doctor and get him/her to give u the spiriva respimat inhaler, I hope u get sorted, keep me posted.
Thanks a lot. That is exactly what I had planned to do. It seems some of the day my breathing is ok, mostly evenings after my second dose of fostair around 6PM. I'm hoping that having the respimat working from a different angle, as it were, that things might get better. Thanks again.
Ur welcome, I used to have alot of problems with my asthma until I got the respimat inhaler, now the only time I have problems with my asthma is when I have a head cold, chest infection or when I've got a sore throat.
Hi Gazza,
I’m 55f and have about the same peak flow as you do (450) although on the rare occasion I’ve almost made 500. Very rare. I’m pretty happy with that as I can do most things again. I’m on Fostair (2 puffs morning, 2 puffs night and Spiriva Respimat (2 puffs daily). I have to say I have some doubts about the Spiriva. I started it later than the Fostair and haven’t seen any change in my peak flow. They say it can take up to 6 weeks to kick in but I’m at 3 months now. The doctor said he still heard some wheezing in my lungs so to keep taking it. But another 3 months is about all I’m good for. I get really nasty leg cramps at night and I don’t know which med is causing it or if it’s a combo. I want to stop taking it and see what happens. One thing I have noticed is that my peak flow is lower in the morning if i’ve overindulged in wine the night before. Sadly that means not more than about one glass! I also bought a serious air purifier (€350, Philips) and that seems to make a difference. It’s amazing how much cooking -for example, specially if you use gas- can mess with the air quality.
Congratulations on quitting the ciggies. It’s tough but well worth it.
Hi Gazza As a soon to be 75 yr old ex-asthmatic (40+ years) I found probiotic capsules & proteolytic enzymes, and magnesium oil for leg cramps, plus a healthy diet the answer to the 7 types of medication I used to take. Do a bit of research and then decide if it is for you. Well done so far! N.B. Massage or reflexology help with tension & stress
Well done on quitting the cigarettes that's the first hurdle complete.
I think it is "normal" to have a low peak flow in the morning, especially if you have been snoring all night and moved some mucus around in your lungs as you sleep.
I found doing a bit of physio first thing, followed by a large drink of warm lemon water with the medication makes me feel better. In fact drinking warm water throughout the day has really improved my breathing. I think we must need more fluids than non asthmatics and I like to believe the warm water helps melt the phlegm a bit. 
Maybe these steps will help make you feel a bit better too. Here's the link to the physio exercises: physiotherapyforbpd.org.uk/...
Good luck!
Hi from Tasmania Australia 🤗
I have been in & out of hospital for the last year's. I decided to start helping myself with natural therapies after my last bout in hospital which was March 2019. I do take one puffer 1st thing in the morning, I now take only 2 puffs of Spiolto Respimat 1st thing in the morning, it is amazing how much better I feel, I also have 3 times daily 3 desertspòons neat of Apple Cider Vinegar with Mother. Since being on this regime, I can't tell you how much better I feel. I no longer take all the poisons e.g. steriods etc. etc I was taking, when I came put of hospital I started looking at what I was doing as I felt I was getting worse with all the Pharma drugs. I also spoke to my specialist whilst I was in hospital & told him that the Ventolin they kept on insisting I take was making me feel worse, he told me that he has mentioned to staff on numerous occasions that we shouldn't be taking as much as we are told by the nurses & Ambo staff. The Mother Apple Cider Vinegar is essential, it may taste horrible but it really works...make sure you get the one Organic one with the Mother in it...good luck to you all! my love to you all, Robyn Namaste💜🤗
By the way I have been diagnosed with Asthma & COPD
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New diagnosis of asthma
Asthma Appointment 
What's your asthma action plan?
