Late asthma diagnosis + regular low peak flow

[Bmc83]

Hi all, hope you are well. I was diagnosed with asthma last year just after the pandemic kicked off, as such it's been quite an isolating experience getting support. It started off with me getting chest tightness, in particular at night, as well as wheezing. Was given blue inhaler over phone by GP not seen f2f due to Covid, who said might be allergy related and prescribed fexofenadin as well (it was pollen season & my eyes often stream!). Long story short tightness at night carried on, being woken every few hours by it called surgery again explained what was happening despite using blue inhaler (a lot!) Spoke to asthma nurse on phone, she said sounds like I need a steroid inhaler too (Clenil 200) Fast forward a year to now quite a few blips -- and on oral steroids last month for first time for weeks of chest tightness at night, then a few weeks back it started again. No sleep, blue inhaler not really taking tightness away and scary as on own with 2 very young kids (single parent).

Family history wise my mum had chronic asthma, and COPD which she died of at 55. I am ex smoker have not smoked for a decade. Worried it could be COPD, I can go for long walks quite fast though without sob. The only other thing I can think which might be causing this is postnasal drip, I can literally hearing my sinuses dripping most nights and have for 4+ years and heard this can then cause/contribute to asthma? My GP won't refer me to ENT though and just wants to escalate asthma meds rather than investigate any cause. He has prescribed montelukast which I'm reluctant to take as hate taking meds and now already on 2 inhalers 😬 the other thing is my peak flow is low for my profile (female, 5ft 9) it's only ever been about 350 even before asthma diagnosis. Have been keeping a diary this week -- worst 330 when having symptoms best 380 after blue inhaler. Have been using that far too much, to point it gives me shakes!

Is there anything I can do naturally to increase peak flow? Exercise? Blowing up balloons? 🎈 (Always struggled with that!)

I suppose to sum up, a year after diagnosis, I'm back where I started... Being woken in night by chest tightness & sometimes wheezing with it despite a year on standard clenil treatment. Should I just take the montelukast ? 🙈 Heard it's a marmite drug. Gp calling back in a month & got impression he wasn't very happy I was dithering over whether to take it or not 🙄

Any advice or support in general welcome!

Also wondering if anyone has had any improvement on elimination diet too?

Thanks in advance

[Lysistrata Administrator Community Ambassador]

Hi, sorry to hear you've been having a rubbish time!

It does sound like things aren't really under control and you need to adjust something. I get that it's not fun taking meds, but once you get the right combination you should find things do improve. It's better to be on the right meds than let the asthma be poorly controlled (which is bad for you) or need frequent oral steroid courses (inhaled steroids or montelukast is definitely preferable).

With that in mind, it's probably worth giving the montelukast a go. It may not work, or it might be great and just what you need! Some people do have side effects from it so keep an eye out, but many people take it with no problems. An alternative might be to try a different steroid inhaler and/or combine it with a long-acting reliever in one inhaler. This post explains more about some inhalers and other treatments you might be offered: healthunlocked.com/asthmauk...

Are you on a nasal spray to help with the allergy/post-nasal drip? If not you could ask GP about trying that as well as the fexofenadine.

Regarding peak flow: really the best way to get it higher is to have better controlled asthma! Your best number in itself doesn't necessarily mean that much, and trying to push it higher for the sake of it isn't really that helpful (I have severe asthma and my best is way above predicted, but it doesn't mean my control is better!) However, while some perfectly healthy people just don't reach their predicted (it is an average number for your age/sex/height only and not an absolute), not being able to reach your predicted may well reflect that you just aren't that well controlled at the moment. Ideally you should be at or near your personal best when well without much variation (the variation is often used to diagnose asthma). This post should be helpful for more on peak flow: healthunlocked.com/asthmauk...

Regarding the elimination diet: some people may find cutting out a food helps if they find that is a trigger for them. For example, there are asthmatics who find dairy (or soya) is a trigger and if that's the case then obviously reducing it or eliminating it will help, just like I don't eat mangos because even a tiny amount triggers me. However, just doing an elimination diet for the sake of it isn't really helpful for asthma, if you don't think you have a specific food trigger. There's no evidence that dairy, gluten or anything else is bad for asthma in general (unless it's a trigger). In particular, don't believe the 'dairy creates mucus, it's bad for all asthmatics' myth that absolutely will not die - it really is a myth, though dairy can make any mucus you do have more noticeable and feel icky in the mouth so some people like to avoid it for that reason if they have mucus.

These posts may help for general tips about asthma - I know you're not completely new to it but it may still help, especially given you were diagnosed at an odd time, and even in the best of times GPs can vary in how much information they give you: healthunlocked.com/asthmauk... and healthunlocked.com/asthmauk...

I'd also strongly recommend calling the AUK nurses: they are lovely, very knowledgeable and can talk through your options with more time than you often get with the GP. You can reach them on 0300 2225800 M-F 9-5 or same hours on WhatsApp - 07378 606728.

[Poobah]

Excellent advice from Lysistrata. We all have different asthma experiences and so finding the right combination of meds for you is important- a bit like finding the most comfortable shoes. Not every asthma med suits all asthmatics, hence the need to always go back to GP after a few weeks on a new med without any improvement to your symptoms. Trial and error may be the only way to find what suits you best.

You'll know if Montelukast is working for you in a month. You may, or may not, get side effects. I have vivid dreams now and again, but if I forget to take my nightly pill I will be wheezy the following day. So I'm happy to put up with the dreams.

For years I just had a steroid inhaler (like your Clenil) and Ventolin and everything was fine. However, things changed as I got older and now I'm on Fostair (having gone through a few other meds), Eklira Genuair inhaler, Montelukast and Ventolin. But it took a few goes at trying different things in order to arrive at my current combination of meds.

Never wait until your annual asthma review to raise concerns. And remember that you need to keep going back to your GP or asthma nurse until you're satisfied that your meds are a good fit.