No cough, no wheeze asthma

[Klau80]

Is there anyone out there who is not coughing and wheezing with asthma? I never have, but breathing is difficult. Had my heart checked and bloods done, so it must be my asthma making me breathless....not getting anywhere with docs though as I "don't wheeze enough". Not sure what to do now as meds don't seem to be right and would probably need something stronger....

[Leigh2305]

I don’t particularly wheeze when my asthma flares up. I just feel mainly breathless and then after a few weeks I get a cough. I only really wheeze with a chest infection when it’s really bad or if I run or with certain chemicals.

If you do your peak flow regularly though when well and unwell you will be able to correlate this to your asthma worsening. I always thought my peak flow was 400 regardless of how I was feeling. After actually monitoring my peak flow properly this last year when I’m well my peak flow is 650+ my peak flow can drop to 300 and I still won’t be wheezey I just get tired and can’t do much as I’m so out of breath.

[Troilus]

Hi Klau. I don’t wheeze either. Going off the people on here I think that is a lot more common than we think. Like you, after a big attack I was admitted for heart tests. My ecg was a bit off, eventually this was put down to the severity of the asthma attack putting the heart under pressure, as all tests (scan, angiogram, 24 heart monitoring) came back normal.

I was eventually diagnosed with asthma after spirometry but I understand they are not doing this during the pandemic.

If you are already doing so, start taking your peak flow. This can be very informative, not just for your GP but also for you. Over time you will get to know what is normal for you. If you look back ( I do a separate graph where I record the highest and lowest readings for each month) you might see patterns emerging. My danger months seem to be February, August and October. Useful to know.

As for meds, I would get back in touch with your GP or asthma nurse. Sometimes, when I have a review and I talk about peak flows, I am reminded that it is symptoms that matter, which is very true.

[Klau80 in reply to Troilus]

Hi Troilus, thanks for your reply.

I do take my peak flow sometimes, but I seem to blow the same in any situation or time. My PF is 350-370L. Which I guess is not very high but ever since I use this device, which is about 1 year, it always gives me these readings.

I take 2 puffs of Fostair 100/6 morning and night, and I need to use my reliever every day even 2x at one time. And even then itsnot too much different.

Will they not do spirometry now? I really like to have it done.

Can I ask what meds you're on? What is your PF?

I thought about having this symptom due to anxiety, but can that really be that I'm breathless virtually all the time? I can walk and exercise ok, even if breathless....

[twinkly29 in reply to Klau80]

Anxiety definitely can cause severe symptoms - breathlessness, chest tightness and so on. It can be really debilitating. In addition people can have it alongside asthma symptoms and it can be really hard to unpick it.

This post is really good at trying to do so....

healthunlocked.com/asthmauk...

Peak flow wise though, your peak flow is only important relative to your own best score, not to anyone else's. So if your best 370 then anything else you manage, higher or lower or the same, is looked at in relation to your 370. It would be useful for doctors or asthma nurses for you to do it regularly for a couple of weeks and record the values so they can see a picture of what's going on now.

So twice a day every day, in the morning before you take your Fostair and then in the evening before your Fostair. Best of 3 blows each time.

Then additionally, it would be good to do it when symptomatic before you use your blue inhaler AND 15 mins after using your blue inhaler. Noting these values, the time and your symptoms will give a really good picture of any patterns in symptoms and whether the blue inhaler is helping.

[Klau80 in reply to twinkly29]

Thanks you so so much your message really helped me, I will record my values now for a few weeks and let the GP know! Xx

[Troilus in reply to Klau80]

I take Fostair 200/6 two puffs twice a day, Spivira Respimat, Montelukast and of course I have my blue inhaler.

Peak flows are relevant to your height and age. There are predicted levels, but they are just an average. Some people are naturally below the average and some are above the average, just the way it is in all walks of life I suppose. If you search predicted peak flows, you should be able to find yours, but don’t be concerned if you are below or complacent if you are above. The best thing to do is just go off the readings you are getting.

When I was sent home from A&E after my first attack, they took my peak flow. The nurse laughed. I was blowing as hard as I could, but could only reach 100! I was given another nebuliser and then sent on my way. I’d had so many nebulisers I had the shakes and walked like a drunkard.

Over the next month I averaged 200 to 250 after meds. That progressed to 270 to 290 and then I blew 330. I couldn’t believe it. However, things continue to improve over the following months. The next jump was to 390 and the 420.

However, I’m not good in October and this has dropped to 310, so I am currently on day three of a course of prednisone.

I would tend to take your peak flow everyday. If you do it first thing before your meds and then again half an hour to an hour later and the same at night, then this will give you an idea of how you respond to your meds. It might also be an idea to take it when you are experiencing breathlessness - to see if your peak flow has dropped at all.

It is also worth bearing in mind, that if two puffs of your blue isn’t sorting you out, you can take more. I tend to wait 20 mins and then try another two and maybe another two twenty minutes later. I make a note of what I have taken and its effect, or lack of ! so that I can better explain to my GP what is going on.

As you are still experiencing breathlessness I would definitely get back to your GP and explain what is going on. You could also ask if you can use extra doses of your Fostair 100/6 as this might help or maybe you too need a course of prednisone. Only your GP or asthma nurse can advise on this.

Generally speaking, spirometry is not being done at the moment because of the COVID 19 situation. There are concerns about people blowing into tubes and in some tests, inhaling air through tubes. I suppose it is about the practicalities of sterilisation.

Do get back to your GP. If can’t do any harm. Peak flows are useful, but they don’t always tell the whole story. When I started this course of prednisone my peak flow was 330, but I couldn’t speak in complete sentences. Now it is 310 and today I have unpacked the shopping, mopped the kitchen floor and have prepped for our meal tonight.

[Klau80 in reply to Troilus]

Thank you so much for your reply it's very clear and so helpful!

I'm just so at a loss with this as keep going back to the GP/asthma nurses and all I had was they changed my inhaler from symbicort to Fostair. Which I think is even less effective for me...And if I ask them for Montelukast or anything to help they say I'm not wheezing as much and my symptoms don't add up (being able to exercise and walk, but feeling breathless all day long). Good to know I can take more of the blue inhaler, I'm always so cautious not to take a lot, as I believe it is for emergencies and taking it every day surely not normal?

I do take my peak flow every now and then and only ever managed 370. But will do it regurarly now.

I get why they wouldn't do the spiro, makes sense, although it would help me so much having it done so I know it is asthma.

[Troilus in reply to Klau80]

Hi Klau. Yes your blue inhaler is for emergencies, but it is also a reliever, which means you can take it to alleviate any symptoms you have. It is wise to keep a record of how much you are using, as this in itself indicates how often you are experiencing symptoms.

The idea is that you gain control of your asthma and when that happens you you don’t need your blue inhaler much, or if at all.

As for Symbicort versus Fostair I have no experience of that. I started out on Fostair 100 and was then moved to Fostair 200. The 200 seems to suit me fine.

There are people on here who have not been able to get along with Fostair and have gone back to the GP to see about getting it changed. Different inhalers seem to suit different people. Some can only get along with the dry ones.

Just on a side note. I was given Montelukast because of night time wakening.

I hope they can get you sorted out. It is awful when you are left not knowing what is what.

If in doubt, you can always post here. There are a lot of knowledgeable and supportive people here.

[ninelives in reply to Troilus]

Great reply.

I don't wheeze during a bad attack but do once my airways start to open up again.

[Mogget]

Does your practice have an asthma nurse you can see? Keep pushing with your GP / submit a complaint if you don’t get anywhere as that’s a dangerous attitude for them to have. I have severe asthma and don’t wheeze or cough much. My main symptoms are a tight and heavy chest. You could try showing your GP information online at your next appointment regarding non-wheezing asthma. Fingers crossed you get somewhere.

[Superzob in reply to Mogget]

Me too. Fortunately, I had spirometry which proved an asthma component to my lung disease, but I understand that spirometry is not being carried out much at the moment because of coronavirus fears. However, I would expect an asthma nurse (or even the patient) to check peak flow before and 20 minutes after Ventolin, which should indicate whether the lung obstruction is reversible and therefore asthma.

[Mogget in reply to Superzob]

Spirometry showed me as having above average lung function ha... it’s just a snapshot in time so something worth bearing in mind if lungs are behaving that day. Mannitol challenge test has been the only objective thing proving my asthma so far.

[Klau80 in reply to Mogget]

I see so basically a spirometry is like an ecg only captures those 2 mins...I will look up the Mannitol, never heard of it! Xx

[Klau80 in reply to Superzob]

I just started checkimg my peakflow, before ventolin I could only manage 350, after ventolin 390. Is that substantial difference to conclude it is asthma?

[Superzob in reply to Klau80]

Similar to mine! But my asthma component is only 17% of the total lung obstruction - the rest is COPD. However, I do notice tight chestiness at the moment whilst taking NSAIDS, which I believe tend to exacerbate asthma rather than fixed lung obstruction. So even a relatively small decrease in lung function caused by asthma may make a significant difference to symptoms.

I suppose it’s possible that your medical professionals think that such a small decrease is unlikely to be significant, particularly if you don’t wheeze (though that’s a red herring) but, since everyone is different, it’s quite possible that it does, both in my case and yours.

I would be tempted (as others have said) to keep pursuing this, and see if a full spirometry and/or mannitol (a sugar substitute which irritates the lungs) challenge is possible

[Klau80 in reply to Superzob]

Thanks, will pursue the further checks, your messages have been really helpful thank you so much!

Xx

[twinkly29]

Wheezing is definitely not a requirement for asthma (although many doctors do seem to fixate on its need which is rather frustrating). I've never heard of someone who doesn't cough or wheeze with asthma - but that's obviously not to say it can't happen.

Do you track your peak flow regularly and/or when symptomatic? Such readings would potentially be useful . If you don't, or want to know more, EmmaF91's peak flow post is brilliant:

healthunlocked.com/asthmauk...

Also does your reliever inhaler help when you use it, with symptoms and/or improving your peak flow? There are other things that mimic asthma which could cause such breathlessness or feeling like you can't breathe as they give identical symptoms - but asthma relievers wouldn't typically help.

[Watforddogs]

Well - you and me both

When i was a kid it was wheeze / cough

For the last 40 yrs it has been the same as you and i have noticed a link with several things

- anxiety

- pollen

- weather changes

- colds

So - i would not worry that you don't have a wheezy chest!

[Klau80 in reply to Watforddogs]

Oh good to know and glad to hear I'm not alone 😊 x

[Wrighty2018]

Yes I do but put it down to viruses around

[mylungshateme]

I dont generally wheeze but do cough at times but mainly short of breathe like you. My lung function tests I had above average for my size height and sex!!

[Jolu29]

I saw gp yesterday, as I didn't wheeze and haven't got chest infection, she said it wasn't my asthma that was causing my breathless and peak flo going down just made me feel bad for seeing her, even though the asthma nurse said I had ti go in to be checked over. All they can do is keep giving me steroids didn't think another course would help, the asthma nurse did prescribe Fexofenadine anthimine to see if that help signed me off work to try shake it off. Always find the asthma nurse helpful could u phone gp ask to speak to asthma nurse for advise.

[Klau80 in reply to Jolu29]

I had the same, was prescribed Prednisone when doc saod I don't wheeze enough for asthma. Prednisone didn't do much at all. I'm on Fexofenadine 180mg for years now, it's for allergies, for me mainly for eczema. Don't think that would do much for asthma? But I'm not a doctor so don't really know...

The asthma nurses are nice, but I didn't get anywhere with them either ...hope you have better luck 😉

[Ari17]

Sorry you are going through this too. It seems to be a reoccurring thing for me as had the same flare up this time last year. Have just finished a course of steroids and can already feel symptoms returning. Had the same issue as you with doctors as I am convinced I have been more breathless ever since they changed my steroid inhaler. But doctors & asthma nurse reluctant to do anything because peak flow, wheeze etc. is fine. Have read from the comments that you also are on same medication as me and I was also switched from the symbicort to fostair. 100% agree it makes it 10× worse.

For me there seems to not be much of a pattern. I do find my asthma worsens generally with anxiety & weather changes but the breathlessness can come on very suddenly with no trigger. I honestly think the best way is to track as much as you can so that when you go back to the GP they have no excuse not to take you seriously. At the end of the day it's you who's taking the medication and if you're not happy with it they need to find something that works. I am hoping for the same outcome eventually 🙏 Hope this at least helps to let you know you're not alone and I hope you get it sorted soon!

[Klau80 in reply to Ari17]

Hi Ari17, I am so happy there are others like me! It is definitely worse since I've been changed to Fostair I think. I did suffer with breathlessness before, on symbicort, but I think it's worse now...

I've just been prescribed Montelukast. Hope that will make a difference but honestly I lost hope...

I am even doubting now that this is asthma..as even though when I breathe out long I do wheeze, otherwise I breathe ok, I only feel I do not get enough air in, if you know what I mean. I sometimes have very tight chest too, mainly in the afternoon/evening. I also thought of silent reflux, even worse, but I really hope it's just uncontrolled asthma and eventually I will find someone who will give me the right medication...

[twinkly29 in reply to Klau80]

Hi, if you think it might be silent reflux, or even just want to rule it out, it can be pretty easily done with the likes of Gaviscon. Taken regularly 4 times a day for a couple of weeks it should really improve symptoms (if reflux is involved) - and if it does, or if it shows some improvement but you feel it would be worth something more, then speaking to GP about longer lasting medication might be worth a go (sometimes a few weeks course of something like omeprazole is all that's needed). Think these days with prescribing rules they'd want people to try the Gaviscon route first but could be worth a go if you are wondering about reflux, or like I say even just to rule it out if the Gaviscon make no difference.

[Klau80 in reply to twinkly29]

Thanks twinkly29, I will try this for sure, jist to rule out!

Just a question, been now prescribed Montelukast, I heard some people have issues with it? Not sure to take it now....

[twinkly29 in reply to Klau80]

Sorry only just seen this - some people do have issues with it but many many people, me included, take it with no ill effects whatsoever. I'd say give it a go. If it's a problem you can always stop taking it.