When my asthma is poorly controlled, I get airway constriction within seconds from odors (fragrance, cooking etc) which goes away with a rescue inhaler (if the odor source is removed). I understand that the odorous chemical itself is not an "allergenic" substance. Is the pathway of the constriction in this case not the same as an allergen-triggered one? Are there drugs that block that pathway? I keep mentioning this issue to the GP and the consultants, but did not get any direct suggestions on how to deal with it (I deal with it by wearing a charcoal/P3 respirator with me at all times).
I also seem to have a similar reaction to stress -- e.g. reading an email from work, or talking to a colleague on the phone who is trying to help by checking on me. I often have to apologize and have to cut the conversation short, b.c. I cannot deal with it. Would an anti-anxiety med help with this? I do not feel like it's an "anxiety attack" though (I know how those feels like). At work, all it takes is one "hello" from a colleague for me to feel chest tight in 2-3 seconds.
Thank you all (and the nurses) in advance!
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I have the same with things like paint, smoke, and certain odours including cheaper perfumes. My understanding is that these triggers act as a direct irritant to the airways, so it isn't the same pathway as when an allergen triggers bronchoconstriction; the allergic pathway is a little less direct and mediated by IgE.
However, I do have certain substances which trigger me where I don't think the reaction there is IgE-mediated. They trigger my asthma but don't cause any of the typical allergy symptoms such as hives or swelling, and they respond to Ventolin, but not to antihistamines. However, they seem to act like allergens in some ways (for example my initial reaction was quite mild on initial exposure to rose, lavender, and mango, even with quite a lot of exposure. The second and third time I encountered them, I had a much stronger reaction to a tiny amount,and I'm still very sensitive to tiny amounts now. This seems to be similar to allergic sensitisation, where sometimes the first reaction can be mild and then further reactions can be more severe. ) Other strong odours, even floral ones, I will be fine with, including most of the more expensive and famous perfumes (I'm guessing that the cheaper/newer ones I react to use a base ingredient that the older, more expensive ones don't).
I'm not sure of the mechanism in all this for those specific scent triggers, as it's very much guesswork/observation and I don't really have any way to prove it. I also don't have the opportunity to discuss it with anyone with expertise, since my consultant is quite dismissive and I'm not really able to discuss my triggers with him sensibly, plus this isn't really his area as he seems much more focused on more standard asthma and allergy. As far as I'm aware, there are currently no drugs to target this pathway specifically.
Re the stress: that is definitely a well-known asthma trigger for many people, though it's definitely not a trigger for everyone!! I actually find stress helps my asthma, oddly, but for others it makes it worse (as with many asthma triggers, something that's neutral or even good for one asthmatic can be a trigger for another).
I don't have experience with anti-anxiety meds and asthma, and obviously people on a forum can't advise you what medication you should take. However, you could mention the stress as a trigger in your appointment. If it's like other asthma triggers, it may be less of a trigger if you are better controlled generally. I think there are also some anti-anxiety meds you would need to be careful with if you have asthma, like beta-blockers, but again this is something to ask in your appointment if you discuss that as an option.
Thank you, Lysistrata. A pubmed search shows that the phenomenon of stress, temperature, humidity, and other "non-specific" irritants triggering airway constriction is via vagal nerve stimulation, and the cholinergic pathway is the name for this. Here is a very old paper (europepmc.org/article/MED/2.... I believe Iptratropium (looks like atropin...) blocks cholinergic receptors -- does that work for your asthma and its non-specific triggers, like temperature and flower smells?
Regarding stress -- when I am in an actual heated argument, I also feel like asthma is not a problem. Maybe it's the adrenalin kicking in. Found this 1998 review in Thorax on the link between stress and asthma, pretty readable:
Thanks for the links. I, too, react to many scents. All perfumes are included in that. If I am driving my friends anywhere they know not to wear perfumes. My eyes water, my nose runs and then the asthma begins. My reaction to "cheap perfumes" is worse. They sometimes make me feel nauseous. I have to be really careful what I say as I almost said the words "Cheap perfumes are worse." to a friend. Also just because a scent is labelled "natural" eg essential oils - doesn't mean it won't affect me. I get a little frustrated telling people this as many don't really believe that a "natural" product could cause problems.
Regarding the other issue - sometimes when I am relaxing, I don't realize that my breathing is shallow. It is only when I take a deep breath to speak or get up to do something that I realize that I should have taken my reliever a little earlier.
Initially, when I was young, I was very reluctant to take the ventolin in public and would go away from people to take it. Now it doesn't bother me and, if I see a surprised or worried expression on someone new, I explain what it is. I find that if I am open about it, then others also see it as natural. I'm a primary school teacher and with a new class, I often show it to them and explain how it works. They are initially very interested and then they take it for granted.
The degree to which I react often depends on my health. When my immune system is stronger, I react less. I once had chronic fatigue and found that I reacted extremely strongly to a washing detergent that I had been using for a long time. As I got healthier, the strong reaction lessened and I could tolerate it again. However there are certain things - like perfumes, that I have never been able to tolerate.
Interestingly, when I was young (about 8) , my parents asked me if I wanted carpet or lino in my bedroom. As soon as they said "carpet" I felt smothered and immediately said "lino". It was only years later that I realized the reason why I felt smothered by the word "carpet". Subconsciously I had picked up that I didn't breathe as well with carpet.
Yes natural things are often actually worse - if someone is truly sensitive to something, the natural form is often its most potent so people saying "oh it's natural" just makes me 🙄!
atoms around us are all natural, too -- born and bread in stars and Supernova explosions
LysistrataAdministratorCommunity Ambassador• in reply toTugun
If it's the pure substance I react to, then the natural essential oil will be worse as it's more intense! High quality lavender oil or an actual rose/lavender plant are much worse for me than cheap fake versions. (If I do react to an artificial version of something, say 'lavender' air freshener, I suspect it's more of an issue with the general air freshener ingredients or propellant rather than the specific scent, since I'd still have a problem with say cheap citrus air freshener spray, but natural citrus is fine for me.)
I also have no time for people who say natural is automatically better and good for you. That's not how asthma works and it's not how science in general works. I would hope those people aren't tempted to go and have a snack of pure deadly nightshade, yew berries, or Amanita muscaria, all of which are very natural.
Ipratropium definitely does help my asthma, regardless of trigger, and it's a standard treatment for more severe asthma attacks, regardless of the underlying mechanism or trigger. On a day to day basis I take tiotropium (Spiriva), as a preventer, which is a longer-acting muscarinic antagonist than ipratropium.
It might not be accurate however to say that this class of drugs is necessarily targeted specifically for non-allergic bronchoconstriction, at least not in the same way that a drug like mepolizumab is targeted for eosinophilic asthma. The cholinergic pathway appears to be significantly involved in allergic- and eosinophilic-driven bronchoconstriction as well as non-allergic, meaning the antimuscarinic drugs are effective in bronchoconstriction that is caused by multiple different mediators.
This recent paper has details about the mode of action of anticholinergic drugs in asthma:
Hello. I can empathise with you. My speech and language therapist noticed that when I was speaking on the phone I was breathing only with the very top of my lungs and becoming tense in my neck, shoulders and throat. She advised to take short breathes into the abdomen (the less is more concept) and think about relaxing my jaw, tongue, throat, neck and shoulders then slow down when speaking. You can practice this by reading out loud and taking breaths at every full stop and comma and when there’s a word such as “and “. I think it helped me to remind myself that I am as important as the person on the other end of the phone and I am worth looking after! X
I don't get asthma from stress, and have mainly allergic asthma, but strong smells can trigger me without being allergic. Also if I am poorly controlled, laughing is a really bad trigger for me. My consultant added 200mg of Uniphyllin a day, at a (non therapeutic level Ie I don't have to keep getting blood tests as it is a low dose) to the other medicines I take. He said he had had a lot of success in reducing "Lung Twitchiness" which is what he calls these triggering episodes. I have to say it has made a difference, however not so much when the bad allergies kick in. When I get a steep drop in FEV1 & PEF I am not sure anything makes a difference apart from oral steroids etc.It may be helpful to ask about this depending on what else you take when you next see your consultant.
Many thanks, R! Uniphyllin sounds like theophylline, i.e. a cholinergic blocker? I will make sure to mention it, along with Ipratropium, to my Consultant in 2 weeks.
Last week, I've added on Qvar 100 2x and Singulair (Montelukast) to my Seretide 500 2x and 10 mg/prednisone, and after 5 days I felt an improvement. Today, after 3 weeks in my HEPA tend, I was able to come out for 5-10 min at a time w/o a respirator. Even managed to have a 4-hr student viva over zoom, from inside the tent. So far so good.
>>>laughing is a really bad trigger for me
I can relate to that, too! Do you think it's because of airway irritation from rapid breathing, or is there more to it?
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Found this 1998 review in Thorax on the link between stress and asthma, pretty readable:
Asthma and feeling low and poorly
Adult onset, poorly managed severe asthma.
Stress and Asthma
