my son had persistent dry cough as a child, no inhalers worked but he never saw a specialist. A course of oral steroids sorted him out for a good while. He is now 23 and a professional singer, classically trained but suffers with reflux, persistent cough, and gets every virus on his chest. Recently he couldn’t shake off a chesty cold and ended up in an and e with low oxygen and wheezing. The an and e dr diagnosed asthma but it took 3 rounds of nebulised salbutamol and steroids to bring his sats up to 95. They were going to keep him in and try magnesium but decided 95 was good enough. It’s been 2 weeks and he still coughs , can’t sing so is getting depressed about his future. We have got him an appointment with a respiratory specialist to see if it is asthma and what treatment might help but give the standard treatments seem inadequate I wonder if it is asthma. His peak flow was 400-500 but as a singer he can do 850+ but doctors don’t seem to understand that.
what questions should we be asking, what are the best tests and what else could it be?!
thanks for reading.
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Mag999
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Hi, hats off to your son for becoming a singer to keep his lungs healthy. My advice would be to give the helpline a ring, Mon to Fri 9 to 5 for guidance on what to ask/discuss with the specialist. Number above.
Until covid I gave digs to theatre people, I recall one singer used steam after an evening's performance, they all seem to have their different aids to look after their vocal cords.
Your son will need to also take care of his immune system too (GPs seem to forget that) especially if he's with others, he'll pick up whatever's going. .
From my own personal experience any virus will turn into a bacterial infection every single time (doesnt mean that for everyone of course, we're all different).
Singing was always going to be his job just incidental that it does help lung capacity but sadly not all the irritation and coughing. He does all the steaming etc but this is out of his control now, we are looking at nutritional support and exercise to boost immune system too he really is desperate to get back to his best
Will talk to helpline nurses as soon as possible, thanks.
Your first thing to do is to fully investigate the asthma UK website
The second thing is to ring the asthma UK helpline and talk to a nurse. The nurse can discuss your newly acquired knowledge with you and help you work out what you want from the specialist.
This will get you up to speed with the terminology and the different types of asthma and tests.
Asthma is more of an art than a science, most doctors have their favourite approaches, so you need to be informed.
My current consultant likes blood tests for eosinophil, feno tests and spirometry. This works well for picking up standard eosoniphilic asthma but not so well for my asthma type, you need to be careful though if you have high standard peakflow as if you have your spirometry tests on a good day they think you are fine. He uses. prednisone, a steroid, very heavily. I dislike this approach.
My previous doctor liked feno tests, peak flow diaries, asthma questionnaires and allergy testing. She was very interested in peak flow variability, but not so much about the actual level. This approach is broader based and picks up a wider range of asthma. She minimised use of prednisone to emergencies. I liked this approach as it suits my non standard asthma.
My asthma nurse diagnoses asthma simply by measuring the effect of the asthma drugs on peakflow, she is not so much interested in the absolute peakflow level. She manages it day to day by seeing what percentage of your peakflow you are operating at. Again this picks up a wide range of asthma and fits me.
Drug wise, my day to day drug to stop nasty attacks is Salamol. My drugs to stop attacks are aninhaled steroid, fostair, with supporting drugs
There is a huge range of drugs, a good doctor will experiment until the asthma is settled and controlled
In addition to seeing the respiratory consultant, your son may wish to ask to be referred to the specialists at the Royal National ENT Voice Centre. The asthma consultant should have no hesitation in referring him seeing as his career is so dependent on his voice. Hopefully, this link will explain the services provided and the specialisms covered.
First of all I am in the US so things may be handled a little differently here. I have both asthma and GERD (reflux) and unfortunately they work hand in hand. I have been on 2x a day Fluticasone Propionate and Salmeterol inhalation powder 250/50 2x a day for the last 18 years. I have been on numerous different types of acid reflux prescription meds for the last 15 years. Even tho I am on both when things get out of hand from a cold or very stressful period I have required a 5-7 day period of steroids. Usually 20mg of prednisone and that will do the trick. I have regular 3-6 month appointments with my ENT who scopes down thru the nose to the back of the throat to make sure reflux meds are still working. It is a hard thing when you are managing two problems that feed on each other. I usually have a peak flow of 400-450 however I am a 65 year old woman so I can see his concern. It takes a good doctor to work with your son to find a solution during the fall out times and bring him through it. I hope he has relief and feels better soon.
Thanks for your reply, I think his reflux does affect his breathing and singing as well, the asthma is a new symptom although I understand they can go together frequently. I didn’t realise how complex and varied asthma was, time to research!
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