Blood Tests

[LottieB36]

Hi, I have weird asthma, am on maximum therapy and wondered what effect high dose antihistamines and prednisolone have on your blood test results. Every time I ask my consultant I'm told it's irrelevant, also is our medication taken into account when we complete breathing tests? The technician who carries out the tests always says that my spirometry is good, and that is what he would expect given the amount of medication I take and that it shows the medication is working. However, my consultant says we need a definitive diagnosis of asthma, and because my FeNo is low, blood eosinophil is below 300 and spirometry is normal he is having difficulty showing this. I've pointed out that I'm on semi-permanent high dose prednisolone, plus high dose steroid inhaler, steroid nebs and nasal drops, but he just dismisses me! I was diagnosed with Severe Asthma back in 2015 after all other tests ruled out other possibilities, I've shown >20% variability with peak flow diaries, and my asthma is triggered by allergens and infections, and I can be absolutely fine one minute, then an attack will come out of nowhere. We've also tried reducing inhalers and other medication, but each time we do this I have an exacerbation and we have to revert back. Many thanks

[Homely2 Administrator]

I have an allergy based asthma, diagnosed by a specialist asthma hospital a year ago.

My new consultant at my general hospital insists that if you do spirometry and feno when just coming off prednisone, the prednisone has no effect on the results. So happily puts me on heavy steroids while ordering yet more tests.

Personally I am going to do my best to get a different consultant, I have a telephone appointment with my gp, who is a very experienced campaigner and can advise.

[Lysistrata Administrator Community Ambassador]

Can you change consultants? If it's an option, worth considering? I have sympathy as I also have weird asthma and a consultant who doesn't listen!

It's not really new evidence that oral steroids reduce eosinophil counts - he should know that! He should also know it's likely to reduce FeNO. And that eosinophils and FeNO are not decisive diagnostic tests for asthma, even if he's ignoring the blatantly obvious fact that you can't get a good test of either one on steroids if you're trying to prove asthma that way. I quite often have no eosinophils at all and it doesn't stop me having issues with asthma which are effectively treated by asthma medication. I'm not sure how the antihistamines affect things off the top of my head - I think they may reduce FeNO too?

He also seems to be struggling with something that for some reason even specialist asthma consultants seem to not always get - asthma is variable!! Like you say you can be ok then not ok. Spirometry isn't always going to show that if done while you're ok (I know you know this but just agreeing that spirometry when you're relatively ok and on meds won't be that helpful for diagnosis).

I could understand him wanting to get a raised eosinophil level to qualify for biologics, but he doesn't seem to grasp the basic fact that the pred is stopping that so it's hard to work with him really. Also I would say for at least one newer one (tezepelumab) you don't need evidence of raised eosinophils. Of course that doesn't help if he wants to rediagnose you but without understanding what diagnostic tests are actually useful for asthma.

Sorry, this doesn't help you approach your consultant who seems unwilling to listen, but hopefully shows you it isn't just you and you're not imagining that your consultant isn't going about things the best way!

[ReedB]

Hi, I'm similar to you. I have allergic asthma which is most severe with pollen but I also react to the cold and viruses. My test results always come back as 'normal' but thankfully my consultant understands that due to the nature of my asthma I can be absolutely fine until I come into contact with an allergen. In an effort to cut down on prednisolone biologics have been mentioned but I'm borderline. Next year my consultant wants to try and do breathing tests during May/June when I'm usually at my worst to see if tests results change, I'm sure they will! I always come back to the same logic that if your medication is working then it's likely asthma and maybe your doctors just need to appreciate that we are all different in how we display asthma.

[LisaLuv3000]

Hi, Yes, I'm having a similar issue with my consultant about not giving the right test results... 🤦🏻‍♀️

Referred to respiratory consultant back in March 2023, after 3rd time on pred since Sept 2022, and first saw them in July - breathing tests, blood tests, CT scan and sleep study, plus they started me on theophylline.

I got ill again with chest infection and flare up at the end of this September and put on pred again (4th time in 18 months) and was told to contact Respiratory Team and let them know. Spoke to them yesterday and I have to have more breathing tests, more blood tests, and be referred to some super specialist for asthma because my eosinophil count doesn't show up as high on tests. 🤷🏻‍♀️

I did my research, so I did raise that there are now biologics for allergies and for inflammation (blood tests show really high inflammation when things go bad), but it seems there are more hoops to jump through first. He did also refer me to ENT, as it all seems to start in my sinuses, and I asked to see the hospital asthma nurse. I am so glad I had written down all my notes and questions, plus had done research into different types of biologics beforehand, so I felt more confident to ask and push a bit.

I'd also spoken to an asthma nurse at Asthma and Lung UK, and I was advised to request an Alpha-tryptine deficiency blood test, as 2 of my siblings also have severe asthma, so got that at the GP on Thursday.

I know I need to be patient, but it sucks that I don't seem to have the "right type of asthma", or that's what it feels like 😅 By all means, if they find it is something else that can be treated, great, but it's hard not to feel like my diagnosis is in question sometimes. 😔

Hopefully the extra referrals will help, but I'm just recovering from this flare up - it would be nice to have a plan sooner rather than later.

Take care and fingers crossed for good outcomes for you.

[Pipsqueak77 in reply to LisaLuv3000]

Hi

I have E asthma and am on Dupilumab which is working well…🤞After many many years of going around in circles like yourself ( pre biologics).

But I wanted to say be very mindful that eosinophil count is massively affected by pred.

So when you have your repeat blood tests try as far as practicable to be off of pred and a few weeks clear so that it doesn’t affect your results.

I’m not advocating this but some cons even take patients off of their ICS for a short time in order to obtain an unbiased eos level.

Just a thought…. Good luck and keep persevering 🤞🤞

[redstar9]

Your asthma sounds similar to mine. I have been told that I may have neutrophilic asthma but currently having tests to confirm or rule this out. This type of severe asthma can present with low feno and eosinophil count and causes inflammation in the airways. It also doesn't respond as well to steroids as other types of asthma. But there are other treatments that may help.