Asthma decline

[AnnaEllen22]

Hi,

I was wondering if someone could advise me. I have been struggling with hoarseness and breathlessness for a while now.

My asthma had been relatively controlled most of my life and quite atypical in symptoms. I only ever really had a barking cough and tight chest, worse at night, and very very occasionally a wheeze. Most of my adult life I have really only required my preventer in hayfever season. In fact it wasn't until I had a proper asthma review 5 years ago I truly believed I still had it.

However; in April 2020 i got covid where my main respiratory symptoms were hoarseness and breathlessness- by October I seemed back to my baseline and just had odd flare ups of hoarseness/breathlessness I put down to exhaustion (I'm a nurse and the last year has been tough). However; this hayfever season things have been increasingly worse.

My main symptoms have been a croup like cough with minimal phlegm, hoarseness, tight throat, breathlessness and dull ache/tightness in my chest. This was intermittent at first, episodes maybe once or twice a day but not everyday and relieved by ventolin. But this and my clinic stopped working and the occurrences became more regular. Previously Fostair had helped with this so my GP prescribed me the lower dose Fostair 2 puffs BD. This didn't work and a week later I spoke with my GP. I was then put on montelukast 10mg, fexofenadine 120mg and a 5 day course of 30mg prednisolone. The cough went, the breathlessness improved but the hoarseness continued to be intermittent. I finished the pred on the 17th and continued with fostair, fexofenadine and montelukast. By the 20th I was struggling again more with breathlessness, hoarseness and tightness in chest and throat- but no cough. I have moved on to the highest dose inhaler of fostair 2 puffs BD and restarted a 5 day course of pred. I take all my inhalers via spacer and use my ventolin 2 puffs up to 6 times a day at the moment. I'm day 4 of the new course of pred but feel no better and the cough has returned. Have you got any other recommendations?

My GP has organised a FBC blood test for Wednesday to check my eosinophil count. And has said if this course doesn't work she will need to speak to the respiratory team. I was just wondering if you might have any other recommendations?

[twinkly29]

How long have you been on the Fostair? Steroid inhalers take about 8 weeks to become fully effective and things like Montelukast take several weeks to kick in properly too. So it may be that these meds aren't doing that yet for you. It could be that Fostair isn't the right inhaler for you - but if others are tried at any point they would also take 8 weeks or so to become effective/to know if it's working so lots of changes may just unsettle things more at the moment, or become pointless if the appropriate timescales aren't used. Has your peak flow improved while on the Fostair?

A lot of breathing symptoms with and after covid (tightness, breathlessness particularly) are mechanical and related to breathing patterns not asthma. Such issues don't respond to asthma meds however many are thrown at it but do respond well to breathing exercises. It might be worth asking your GP if they can refer you to a respiratory physio for assessment in light of this. Breathing exercises are good for asthma anyway (breathing pattern disorders can commonly develop alongside asthma anyway, regardless of covid, particularly after a period of struggling).

Also there are many other reasons why one might cough, that's not automatically asthma either, eg post nasal drip and reflux/silent reflux. Again, it might be worth floating the idea of "something else going on as well as your asthma" with your GP. It's quite possible that, while your asthma has been problematic, the new meds are helping but there's maybe something else happening as well that's muddying the waters - these things are usually easy to treat but need very different things to asthma meds, but dealing with any such issues would then leave it clearer as to what was asthma and what was not, if that makes sense.

If you've been on the asthma meds for more than 8 weeks and dealt with other possible issues and things still aren't right then I'd ask for a referral to a consultant as they can then look into other factors, other treatment options.

[AnnaEllen22 in reply to twinkly29]

I have been on it for four weeks so aware it all takes time... and know the fexofenadine in particular has a stepped approach to start working. So have been practicing breathing exercises for the past week to try help. Just gutted and frustrated as usually very active and this isn't like me. I usually exercise everyday from running, to weightlifting, boxing, hockey, climbing....

My peak flow keeps going between 100 and 250... my best is 400-450.

I have a nasal spray as well forgot to mention for post nasal drip, used that on and off for years. And have previously had reflux so am on 40mg omeprazole OD. But to be honest I have none of the symptoms I usually get with those, unless they have changed.

I have my last dose of steroids tomorrow. And don't know whether I wait out a couple of days to see if things continue to improve or as there has been no change yet to just call my GP... I did that last week and ended up back on them. I just get so worried that it is all in my head. Although not sure how I can fake hoarseness.. 🤣🤦‍♀️

[Tugun in reply to AnnaEllen22]

Hi,

It's definitely not in your head! There are many things it could be. You've mentioned many of them - lasting weakening affects of covid in your lungs / hayfever which exacerbates the asthma. There may be a completely different reason. Keep trying to work out what works and what doesn't. One alternative is an intravenous large dose of Vitamin C. By going straight into the blood stream it bypasses the gut so no diarrhoea. I noticed a definite improvement in my lung function when I had swine flu many years ago. It may or may not help but might worth a try. However like all things remember that to have too many of these Vitamin C intravenous injections can interfere with other parts of the body but then - so can ventolin (hypokalemia). Google New Zealand - Swine flu - Vitamin C - for an excellent 15 minutes news report on the subject.

PS It took me over two years to get my lung function back to my normal after the swine flu. I personally believe that the vitamin C saved me during the few months it took me to recover to a base level.

All the Best!

[twinkly29 in reply to AnnaEllen22]

Antihistamines (so the fexofenadine) take a couple of weeks for full ongoing effectiveness but do start working very quickly - but it's quite possible whatever is causing the flare isn't an allergy as such. It's so hard to know sometimes!

It might be worth asking to try omeprazole for a couple of weeks in case that's adding to the coughing - it may well not be at all but at least would rule that out.

But I think I'd phone the GP today and say how you feel and that your peak flow is still only about 55% of your best. Either you need the steroids extending or maybe they could reduce them gradually. They sometimes don't like to do this but clearly this isn't sorted. If you're needing ventolin say 4-6 times a day on top of oral steroids (which aren't like day 2 of steroids so still kicking in!) then something isn't right. Yes you are still midway through preventer meds kicking in, but you still need help now, it doesn't seem "just a bit unsettled while the meds kick in" to me. So I wouldn't wait it out, otherwise it'll get set back further and then you're kind of starting again.

[hilary39]

I'm so sorry to hear this, it sounds frustrating and very uncomfortable and scary. Have you had a CT scan of your chest?