I'm a man in my early 40s of normal weight and never smoked. I've just come out of hospital with what is assumed to be a severe asthma attack. I spent 10 days in respiratory ward. My o2 got down to 89% and my peak flow down below 200. It took me a long time to turn round but now back at home recovering. I'm at 97% o2 and averaging roughly 470 - 480 peak flow. My top peak flow is 510.
This is my first real asthma attack. It came on after three weeks of a bad chest infection with wheezing and coughing up mucus. 12 years ago, I did have a chronic cough and saw a pulmonologist briefly but it ended up being more linked to sinusitis, for which I had surgery. And until now, not had symptoms since aside from being susceptible to chest infections.
I just wonder what to expect now. I was on no inhalers at all. They've put me on fostair and montelukast . And I'm now tapering off prenidsolone over several weeks.
Is this going to be a regular occurrence? Work have been good about it. But imagine that would be less so if it kept happening!
Any thoughts welcome!
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Particle32
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I'd really recommend calling the Helpline - they are brilliant and so helpful especially when you are newly diagnosed. They can talk you through any concerns you have, and check you know how to manage your asthma and what you should do if it becomes poorly controlled again. They were a lifesaver for me in the early days of diagnosis (probably literally, since I wasn't getting much help from my surgery!)
Hi Particle. My first outing was much the same as yours. If my experience is anything to go by then you will be ok. I had a few ‘hiccups” along the road but nothing like my first. I have had nothing that wasn’t settled very quickly by the blue inhaler. I have mine on a spacer because in the event of sudden breathlessness I can squirt the blue inhaler into that and breath it in as you would a nebuliser-normal tidal breathing.
In the first year after my big event I had 4 small attacks, each one followed by a course of prednisone- that was back in 2019. Meds were adjusted and I am now fine - but I still carry a blue inhaler with me wherever I go - I don’t want to go back there again.
Thank you! I'm hoping this is a relatively one-off odd thing. But I suppose I need to wait until the lung function tests to see what is really going on. My peak flow appears to be below average, but not hugely so).
Mine remained below average for about 3 months. When I was in hospital in the March it was 100. By the time I went to Spain in the April it was 270. While I was there I hit 330 - I did it 4 consecutive times because I didn’t believe it! It dropped a bit when I got home but by the June I hit 400 which is above predicted for me. It went a bit wonky then when the nurse in my hospital clinic reduced my Fostair to 100/6. It took me until the October to get put back on it.
I don’t know how exactly how long it is since your attack, but they say it takes 6-8 weeks for the steroid inhaler to reach full effect. Also, my peak flow tends to continue to increase even when I have finished taking it.
Hi Particle32, welcome to the forum and sorry to hear you had such a major attack as your first introduction to asthma! I would definitely agree with calling the helpline: 0300 2225800 or WhatsApp 07378 606 728 Monday-Friday 0915-5pm
Asthma can be quite a learning curve, but you will get used to it as you go. And you were completely untreated and unprepared for this attack to happen, so if you keep taking the medication and adjust as needed, it's totally possible that you won't have an experience like this again.
As Troilus says, the steroid part of the inhaler does take 6-8 weeks to kick in, though you have the oral steroids meanwhile, and Fostair has a long-acting reliever part which should work pretty much right away. Montelukast is about 6 weeks for full effect, but you may start to see benefits earlier if it helps you. It can be trial and error with medications, but if it's not working for you after you've given it a chance then there are other options. At this point you're probably feeling a bit rubbish and tired because you've had a big attack and it does take some recovery, even if your lungs are doing better.
The goal of asthma treatment, which maybe >90% of people with asthma do achieve (this forum is not a good sample because people with no asthma issues don't generally need to come on here), is to have no to minimal symptoms and need reliever inhaler no more than 2-3x per week. It might be a plus for you that you're a man too, because female hormones don't seem to play nice with asthma.
In terms of lung function and peak flow, both can be quite up and down - the joys of asthma. You might have great spirometry the day you do it, or you might not! This post has more on peak flow: healthunlocked.com/asthmauk... (there's a lot of info on there which you probably will need to come back to).
The main things to remember are to check against your own best, and not to worry too much if your best seems low (or high). I've got a wonderful personal best peak flow that's far above my predicted and I have severe asthma. My male partner has asthma he barely notices (he wouldn't notice it at all if he remembered to take his preventer) and his best peak flow is much lower than mine.
In terms of work - I get the concern, and hopefully it won't be an issue. But ongoing asthma issues do count as a disability under the Equality at Work Act, and your work does have obligations to make reasonable accommodations for you if you need them. Others are more expert on this, but for example I used to be able to work from home when needed and my work made sure to minimise triggers. It would probably be worth having a chat with the relevant people eg occupational health, if you find that the work environment is a trigger for you in any way - for example, I used to be able to use a disabled toilet which was kept scent and air freshener free, because scents are a big trigger for me. (I do still work, I just went freelance in 2019).
I'm going to add some more links to posts written by other members or by ALUK professionals, which you might find useful. You don't need to read them all now as there's a lot there, but you can save them and go back if you think they're helpful. Some of them are maybe 3-4 years old but still apply minus the COVID stuff.
When to do what (take your blue inhaler, get medical help, discuss your preventer medications and if they're working, and more): healthunlocked.com/asthmauk...
Asthma action plan templates (if you don't already have one) - you can download these free and fill them out with a healthcare professional to be personalised to you: shop.asthmaandlung.org.uk/s...
Because you mentioned your oxygen sats - something they'll monitor in hospital but you shouldn't at home generally, as good sats don't mean asthma is fine: healthunlocked.com/asthmauk...
Inhalers/tablets your GP might prescribe (though as you started off with a bad attack you may be under the hospital's care for outpatients still?) healthunlocked.com/asthmauk...
I hope this is helpful - I realise it's very long and after 10 days in hospital you're probably feeling like you just want to rest as it's not very restful there even if you're not that ill! But the information is here for when you want/need it, and you can always ask more questions as and when things occur to you.
Thank you. Lots to think about and this is very helpful. At least there was quite a lot of warning before I ended up in an and e. I had been having trouble sleeping, wheezing a lot, and coughing a lot, so hopefully I could get it earlier next time. And I've been through a very stressful time at work for a long time.
I'm sure i'll be on some inhalers in the long term. And will be ready to jump on it if things go downhill.
Only a couple of things to add to the excellent responses above;
1) it can take time for asthma meds to have a maximum effect. So Fostair can take up to 8 weeks to reach it's full efficacy - like most preventer inhalers. Montelukast takes less time. But if you find no benefits or not enough of an improvement in symptoms, talk to your doctor. We are all different, and what works for me might not be the best for you. Never be hesitant about saying that something isn't working well enough. And if it takes multiple doctor appointments, so be it. The aim is to minimise the asthma symptoms.
2) If your employer doesn't have access to a qualified occupational health practitioner, then you can avail of the free government scheme, Access to Work. The practitioner will review your specific health requirements against your duties and workplace and then draw up bespoke recommendations for your employer to implement. Anything from discounting sick leave when you have asthma flare ups, hospital appointments, hospital admissions to working flexibly or working from home. Under the various laws governing equality, working rights and workplace health, safety and welfare, you can enjoy protection and adjustments to accommodate your specific needs, the goal being that you're in the best position to do your job. So first steps is to talk to HR and ask for an occupational health review by a qualified practitioner.
I spent 15 years or so, having very occasional heavy attacks, which they did not realise was asthma, they thought it was cardiac.
Once they realised it and got me on fostair for my long term care and salamol for the attacks, after a couple of months they doubled my peak flow. They keep tweaking the regime as I still have a lot of minor attacks. So ask for access to an asthma nurse, at gp practice or hospital, they will help you tweak the medicines, spacer, check your inhaler technique.
My asthma hates dustmutes, pollen, humidity, cold etc. So I had to clean the house a lot, get air purifiers etc.
Work wise, find out what irritates your asthma there, then try to adjust it. It helped telling work, as they made me be more cautious, and stop just going for it.
Asthma is very personal so you have to work out what is right for you, so read all the available material, talk to asthma UK, and keep trying different things.
Hi Particle 32, I had adult onset asthma and it turned out to be eosinophilic asthma (check your eosinophils on your bloodwork, do they go up when you are having the worst asthma? Anyway, have been on a monoclonal antibody " Nuclala" for about 2 years and am greatly improved. Good luck
hello sorry to hear of your asthma attack I had the same in my thirties was put on oxygen and nebulisers that was over thirty years ago and medicine has advanced since then. Everyone is different since you have not been on inhalers previously this may be why your condition was so severe. You will now have to keep taking your meds and inhalers as prescribed by your doctor. Have you not been given the blue inhaler to open your airways know as salamis or ventolin the fostair inhaler behaves like a steroid and Montelukast loosens up the phlegm trapped in your lungs. There could be several factors affecting you in this way high pollen pollution from cars and smoke from woodburners in the atmosphere , dust, pet dander, even some perfumes can bring on an attack these are allergies which you need to get a test done so you can avoid anything you are allergic to. Sometimes a bad cold /chest infection that has not been treated effectively can develop into something more serious and cause problems with your oxygen saturation. I have two inhales used with a spacer to ensure they get deep into my air passages I take montelukast 2 hours before food and carbocysteine when I really struggle to breathe. Then I gradually get relief and so far have managed without going to the accident and emergency. Also if you have caught covid this can also seriously affect your breathing. I hope you will improve with the meds you have been prescribed and wish you all the best for the future.
Thanks all. I'm being well followed up and have lung function tests on Monday followed by an appointment with the chest clinic on Tuesday. So I will learn more then. I feel like I've been steadily improving since the attack. I think my blood work in hospital said I wasn't allergic to mould, pollen, dust mites, etc. So, I think it may be more related to irritants and particularly the chest infection I had for several weeks beforehand.
In the middle of the attack, it was the thick, solid green mucus that was the worst which was very hard to shift. That has now decreased a lot. But I still have loose white sticky mucus in chest. Hopefully that will abate as inflammation goes down.
Another thing that's freaking me out is a lung nodule (ground glass opacity) they found on my CT scan. I'm wondering if this is related to my symptoms. Googling them gets lots of scary stuff about cancer, but they've said to do a repeat scan in three months, so I presume they're not that worried.
Anyway, at least I've been on the mend. I can now go for walks etc fine without getting out of breath.
There’s lots of practical advice above and I hope you feel better soon. I just wanted to say welcome to the forum. There will always be company & support for you here x
Just an update. Now been discharged from consultants care and sent back to GP. I've recovered well from the attack and not needed ventolin in last week. My peak flow is now treble what it was in hospital and pretty much on predicted. I've also almost tapered off the prednisone. Did lung function tests and on the inhalers my FEV1 was 85% so not too bad.
I'm left on just the fostair 200/6 x2 twice a day which may come down in six months if I am doing well. Hopefully, no more hospital trips again for a few decades...
GPs have been good and I've got follow up with asthma nurse to draw up asthma plan.
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