Asthma without infection

[Thomas45]

Brief history. Moved north to West Yorkshire in 1974 (aged 29). Started with beathing difficulties. Had allergy tests and a course of desensitisation injections, which worked, but whenever I caught a cold, it morphed into a sore throat and chest infection leading to gasping for breath. Major attack 1st October 1983, in hospital for 12 days. Treated with oxygen and prednisolone. Over the years a few bouts a year. Treatment has been courses of antibiotics and steroids. I use DuoResp Spiromax 320/9 dry powder inhaler (and Salamol inhaler, when needed, not often).

I also am in my 6th year of Permanent, though asymptomatic, Atrial Fibrillation after 22 years of Paroxysmal AF. My only medication for that is an anticoagulant, Warfarin being my choice. My diet is vegetarian with some fish.

Both my asthma and Atrial Fibrillation normally cause no problems. Coincidentally having had every appropriate jab going since the pandemic, I have not any colds, so no asthma problems of the old kind.

In November of 2016 I had an emergency operation to remove my appendix, during which operation my heart-rate went over 190 beats per minute. I was kept in hospital until it had dropped below 70, whch took 3 days, during which time a hospital doctor queried why I hadn't been prescribed beta blockers, and despite telling him I was asthmatic, he prescribed a low dose of Bisoprolol. 7 weeks later the first of the side effects appeared, painful urticaria. While being weaned off Bisoprolol, the second side effect, a constriction of my lungs with chest pains occurred suddenly. I was in a Pharmacy at the time, and an ambulance was called to take me to hospital. There was no infection. It was relatively short-lived and after numerous nebulisers, once I started on a course of steroids I was discharged on the 3rd day in hospital.

My peak flow is normally lowish, around 350, but I did notice on Saturday just gone that I could breathe deeply, but didnt check my peak flow. On Sunday and Monday I had awful headaches and my ability to breathe was reduced. By Monday night my plan was to sit in a chair all night. I did to 3am at which time my breathing had become worse and my chest hurt when I breathed. I called 111 and an ambulance was sent. I only spent 14 hours in hospital before the chest pains had subsided and I could breathe normally. I had phials of blood taken 3 times. The consultant said the blood showed signs of inflammation, but that I had no infection. I was referred to heart specialists who could find nothing wrong, apart from AF with my heart. I had taken my own INR on Monday morning when it was out of range, but on the high side at 3.7.

I don't expect anyone to come up with an answer to why my lungs constrict without infection. In the first case it was Bisoprolol. In the second case I have no idea, apart from some form of allergy? Because I also have Foot drop of my right foot, I order food deliveries from a supermarket as the foot drop causes balance problems. My diet hasn't changed. Any ideas?

[Homely2 Administrator]

My asthma very much is caused by some external stimuli. So going to the pharmacy on a cold windy day, and then having to stand in a queue, can easily trigger pain in my chest and a constriction in my lungs. Simply wearing a mask solves this one.

I was also on bisoporol, due to some heart beat issues, and I have not been admitted to hospital for asthma since I came off bisoporol. My asthma treatment has made my heart rate steady and lowered my blood pressure.

Have you had a blood test for the common allergies, like dust mites, if not, you need it done. I am allergic to a range of things, but at present it is mainly humidity that is triggering my lungs.

[Thomas45 in reply to Homely2]

Thank you for your reply.Yes I had a blood test for allergies, and subsequently had a course of specific allergies desensitisation injections which worked. I believe the NHS does not now offer desensitisation injections, but it did in 1977.I suppose it is possible that something which didn't exist in 1977, or was not prevalent, could have caused the most recent attack

[Poobah in reply to Thomas45]

I developed a sensitivity to aspirin in my early 20s, so it is possible for things to change unexpectedly. I say sensitivity, but it's an anaphylatic reaction, so it was quickly identified.

I also experienced a change in my asthma for no apparent reason around 25 years ago, with my usual treatment of a steroid only inhaler becoming ineffective. I thought maybe the manufacturer had changed something, but my pharmacist checked with them and nothing had changed. I was moved onto a combination inhaler and that helped for a while.

I used to experience terrible attacks when visiting Jersey as a child and hated going there. Always occurred within 24 hours of arrival and required hydrocortisone injection to provide relief. Now I have absolutely no reaction when visiting, thank goodness.

You say you haven't changed your diet, but it could be that the way something you eat is produced has changed. Or something you use has changed; shampoo, soap, toothpaste, laundry product, shower gel, deodorant, household cleaning products. We are surrounded by potential triggers.

I discovered that soya was one of my triggers when I swapped to soya milk from cow's milk. It took several weeks for my asthma to become exacerbated and so it wasn't immediately obvious why my asthma was being triggered. Over the years I listed a range of foods that made me wheezy and it was only recently that I discovered that the common denominator is omega 6.

Unfortunately, food production has increasingly become reliant on soya and palm oil and so it's harder to avoid omega 6. Animals raised for human consumption are now predominantly fed soya, including farmed meat, fish, dairy, eggs. As much as 80% of soya production goes to the feeding of livestock. Palm oil has replaced animal fats in food production (ready meals, pastry). Whether we realise it or not, our consumption of omega 6 has increased considerably over the decades.

Nitrates and sulphites can also be hidden triggers in food production. Both are triggers for some asthmatics. The way grains, fruit and vegetables are grown will have changed too, with industrial practices becoming more intense.

I don't mean to sound so bleak, but triggers can arise indirectly without us changing anything. It's just makes it difficult to work out what the unseen trigger is.

[Thomas45 in reply to Poobah]

Thanks, Poobah. Soya was one of my triggers for Atrial fibrillation. Another trigger was coffee, but not caffeine. I drink tea, and in the past have drunk cola with high content of caffeine with no effect to AF or asthma.I normally drink organic cows milk, eat organic eggs, and other organic food when I can. The only thing I ate which I eat probably 10 times a year was some cook in the bag kippers. I shall avoid those for the time being.

I haven't started on any new household cleaners recently. I tend to use lemon juice with salt or bicarbonate of soda for cleaning which has not affected my health in the past.

Hopefully I won't have another episode. I'm now 78 and both AF and asthma ,together with lower leg lymphoedema, and benign prostate hyperplasia, are well controlled. My foot drop can be painful but it's better than it was when first diagnosed in 2020.

[Homely2 Administrator in reply to Thomas45]

In 2022 my asthma was not sensitive to humidity, now it is very sensitive to humidity.

My asthma and what it reacts to is constantly evolving.

[Patk1 in reply to Thomas45]

It's worth trying otc antihistamine,see if it helps

[Thomas45 in reply to Patk1]

Thank you or that suggestion. I was prescribed antihistamines when Bisoprolol gave me urticaria. I continued to take the antihistamines, in their otc version, until about six months ago when I became totally clear of urticaria (unless I eat tomatoes or oranges) I shall restart taking them.

[Patk1 in reply to Thomas45]

Worth a try x

[Gareth57]

like Poobah, my asthma has changed hugely over the years, as a child I would get wheezy during exercise but only had 1 or 2 bad exacerbations a year, but was too young to have any idea why, then it went away for about 30 years coming back in a mild form and not recognising any triggers. Then on day I found I suddenly reacted to ibuprofen, 4 hours of not being able to breath properly (which was not good 40 miles from home working on a building site) and then more triggers started to become apparent, some strong perfumes, candles burning, vinegar and as a consequence my medication has been changed and increased. So it is quite possible that even though nothing has changed as far as you know, your asthma may have changed so you now have a new sensitivity that you have not yet picked up on.

Good luck getting sorted

[Troilus]

Hi Thomas. I didn’t have asthma until I was 63! Yes I had hayfever, but nothing drastic. I took my antihistamines and was fine. At the same time I developed asthma my local council stopped cutting the field next to my house- it’s 8 miles long and about 3/4 of a mile wide. Coincidence? I think not. Likewise my dad developed asthma at the age of 63. He had recently moved house and not far from him were big fields full of rapeseed.

If nothing has changed in your immediate environment perhaps it something nearby?

[AJP2]

Regarding the latest episode - Headaches, chest pain, breathing issues - did you get tested for COVID?

Hope you are better now

[Thomas45 in reply to AJP2]

No I wasn't tested. I didn't have a cough or any noticeable mucous. After spending 14 hours at hospital with very little treatment both wore off. I was told by medics that my lungs were clear, but I was panting for breath. This was only the 3rd time I'd been in hospital for asthma on 48 years.

[hoven]

Just as a by the way, I moved to West Oxford from lovely mild Dorset ten years ago (Chipping Norton) and immediately started with wheezing and breathlessness. Probably the cold and hilly nature of the place. inhalers didn't do much, PF 200 at best. have ended up on biologics, which cause muscle side effects. should have gone straight back to Dorset!!

[Thomas45 in reply to hoven]

I'm aiming to get back to my home county, Lincolnshire, hopefully next year, which will have been after 50 years in West Yorkshire. I grew up in Lincs, went to College in Leeds, jobs 1-3 working for Leicestrshire County Council, 4th job working for West Sussex County Council, then up to West Yorkshire working for Bradford City Council, took early retirement 26 years ago. Hindsight tells me I should have gone back to Lincolnshire then.

[peege in reply to Thomas45]

I would test Lincolnshire out thoroughly before you contemplate the exhaustion over a major move in your late 70s. A lot can change in an environment over 26 years - for the better as well as for worse.

In his 70s my father in law suddenly developed extremely itchy urticaria on his lower legs. His wife insisted to doc that household usage hadn't changed but of course manufacturers can change their ingredients whenever they wish. ......the doc explained that in older age our bodies change including our natural antihistamine resulting in 'new' allergies. If I were you - I'm definitely not a medic though - I'd try just half of an otc tablet to see if it makes a difference especially as you seem to be very sensitive.

Asthma can definitely take a downturn as we age throughout life.

Many have exacerbations without infections , personally my exacerbations are always from infection. The slightest sore throat or cold will become a lung infection so I've developed my own personal armoury to combat the bugs growing.

I'm sure this reply isn't helpful at all. Main point is we loose all sorts of natural protection as we age (ie Vitamins B12 & D3) so full blood tests are quite useful.

I moved back to Gloucestershire 8 years ago from green, leafy Wimbledon which improved my asthma although this year it's taken a downturn again (just when I'm preparing to move east to Cambridgeshire 🙄).

My asthmatic son has lived in the South of France, he only uses blue inhaler if he gets a cold/cough/ chest infection.

[Thomas45 in reply to peege]

Thanks for your reply. I spent 50 weeks in Lincolnshire two years ago, after I'd slipped going downstairs and fractured my right fibula. What was not obvious at the start was that I'd also damaged / compressed / destroyed my peroneal nerve in that leg, causing foot drop. My fracture healed without intervention, my nerve didn't. I have foot drop. The easiest way to describe the effects of foot drop are that when you walk you automatically take your foot off the ground and move one leg forward, and automatically do the same with the other leg. Be sure the nerve in one leg doesn't work, the muscle which should lift my foot off the ground doesn't get a message from the brain via the nerve and the foot remains firmly planted on the ground / floor, with the result that you fall over.

"Fortunately" my brother has the same condition, as a result of childhood polio in 1947, so was able to show me techniques in how to lessen the effect of the loss of nerve. I now have a carbon fibre orthotic which has a springiness helping me to lift my foot from the knee off the ground. I need a stick for balance.

Patk1 suggested trying otc antihistamines. I took them for six years until about six months ago, after an allergic reaction to a beta blocker. I noticed at the hospital that my skin reacted to the i.d. band that they put on my wrist.

I restarted them yesterday, and like my anticoagulant, ( I have permanent, though asymptomatic,atrial fibrillation as well as being asthmatic) I shall continue to take them for life.

Tom

[hoven]

'hindsight is a wonderful thing'!