Puzzled

[WindsweptRissa]

Hi all,

I’m slightly puzzled, although more in an amused (shrugs shoulders) kind of way than a worried way.

First Background: I’ve had asthma since a toddler, which improved a bit when I reached my early twenties but then started getting worse as I approached my 40s (now 47). After several years of a productive cough and then a number of bacterial chest infections I was sent to respiratory medicine to see if I had bronchiectasis. Sprirometry revealed some obstruction in my small airways and CT scan revealed some mucus plugging. I was told that I did not have bronchiectasis (or what they saw was not enough to diagnose bronchiectasis) but the findings were consistent with small airways disease and the way forward was better control of my asthma. I was discharged with spiriva respimat and carbocysteine to add to my existing treatment (relvar ellipta, ventolin, montelukast). Since then (last July) I’ve had 3 more bacterial lung infections (2 lots of strep Pneumoniae and 1 haemophilus) as well as a couple of non bacterial flare-ups.) all needing antibiotics and/or steriod tablets.

Anyway, I’ve had a recent unexplained flare-up (nothing major, just a prolonged period of being symptomatic) and because of this and the continuation of infection and flare-ups the GP referred me back to respiratory medicine. In the meantime I had an asthma review with the nurse. Now in a discussion about symptoms of breathlessness she asked if I knew if my breathlessness was due to my asthma or my COPD. Firstly, I’m really not sure how you tell what your breathlessness is due to. but mainly I was slightly puzzled by her referring to my COPD because as far as I knew I don't have COPD. No one has mentioned it before so I thought perhaps she’d just meant the small airways problem, so didn’t pay much attention. But then the GP asked me to send off a sputum Sample to check my recent problems aren’t due to an infection and when I put the sample with the form today I noticed on the reason box it said COPD. So now I am a bit puzzled. 🤷‍♀️

[Katinka46]

Hello WindsweptRissa

I think sometimes doctors and nurses in the GP surgeries use the term COPD too readily. I have often been labelled with COPD. The forms don’t have boxes to tick for the rarer things. My small airways disease looks like emphysema on spirometry results. And my first diagnosis was that. Just bear it in mind when you next speak to a doctor or nurse, and query it.

I may be wrong but I have vague ideas that you live on a Scottish island?

All the best

Kate xx

[WindsweptRissa in reply to Katinka46]

Yes I do live on a Scottish island, one of the Shetland islands.

It was a handwritten COPD rather than a tick box, but I expect you’re right, they’re probably just using it as a catch all term rather than a diagnosis. Luckily I wasn’t someone else who might have been alarmed by this new ‘diagnosis’. My mother has asthma-COPD overlap and I’m kind of expecting I’ll end up with that at some point but was a bit surprised by them using the term now.

[Hidden in reply to WindsweptRissa]

I'm sure that's right. Like you I have had asthma since childhood and then about 10 years ago it all worsened with frequent infections and coughing. When I was x-rayed it came back emphysema but my GP said that's nonsense and referred me to the resp. clinic. I was told it was just worsening asthma and had my inhalers changed and montelukast added. But nothing helped and I went on getting repeated infections.

Finally asked to be referred to the cough clinic in Leicester where after a whole day of investigations I was told I had bronchiectasis and needed a CT scan to confirm, which it did. No-one has mentioned emphysema again, and my asthma is well controlled now.

[WindsweptRissa in reply to Hidden]

Glad to hear that you have everything under control. At the very least, I hope that when I see respiratory medicine they’ll give me some clear instructions on how to manage flare ups because the usual hand out they give for asthma isn’t really much use to me and the doctors seem to rely on peak flow when deciding how to treat me, which doesn’t always match how I’m feeling.

[Patk1 in reply to WindsweptRissa]

I was told by a younger gp, if i was struggling to breathe,to slowly take additional puffs of blue inhaler.10puffs is equivelant to nebuliser dose.ru using a spacer with puffer