Breathless and Barking Cough

[Exflex]

Can anyone relate and / or explain why breathing and barking cough gets worse at night time / bed time. I was kept awake coughing for hours last night until I finally got to sleep in the wee hours.

[ Bio: I’m almost 2 months post Covid / pneumonia and a CT revealing pulmonary fibrosis. After 2 spells in hospital, first in August and most recently 2 weeks ago I was prescribed oxygen, 4L/min for mobilisation using a portable oxygen tank, and a concentrator set to 1L/min which is barely sufficient to walk around. I understand exercise is important for the body including the lungs, but I wasn’t informed what my target O2 should be when mobilised. All I know is that I get breathless really quickly on 1L.]

[Alberta56]

You need to speak to someone about the coughing; find out if anything can be done for it. You are still recovering from the pneumonia and other illnesses, so things should start to get better gradually. Best wishes.

[Exflex in reply to Alberta56]

Thank you for your reply 😊🙏. I really hope so with each day.

[Bingo88]

Good morning Exflex. Do you sleep on plenty of pillows. I have copd and was struggling in a morning with coughing and breathlessness. So I brought a wedge pillow to raise me up and found it helpful. Good luck. Brian

[Exflex in reply to Bingo88]

Thanks! I tried sleeping on 3 pillows last night and that helped. Just been looking at wedge pillows on line and I can see the benefit. I was given a nebuliser by the hospital with saline, but I’ve been a bit lazy. In hospital I was using it 4 times a day. I’ll give it a crack again today.

[cazza34 in reply to Exflex]

Hello me again I do standing/ chair exercise via you tube british lung Foundation even if ur having a tired day u can sit on the sofa. I and build 15 mins per day into my morning routine.

[cazza34]

HelloFirstly it can take several months for you to recover from covid/ pneumonia

. Coughing is worse in the evening because your muscles are all tired, as are you. Ask the doctor for some Oramorph syrup it helps with the coughing. I take it daily, sometimes twice. I'm on oxygen 24/7 and also have PF. Also if you are moving put the canister on, not the concentrator that is only for sitting static or maybe sleeping? If you are moving at all use the canister. If you feel you are more home bound at the moment ask for the concentrator level to be raised, oxygen assessment can help with that. And remember rest.

[Exflex in reply to cazza34]

The lengthy recovery period is difficult to come to terms given I was quite active prior to getting ill but I suppose I have no option. My wife does a lot of reading trying her very best to help my recovery and from what she’s read it says don’t sit and let the muscles of the lungs (and the rest of the body) deteriorate. The internet advice on action for pulmonary fibrosis variously says is to be as active as possible within your limits, to push yourself, which seems at odds with remembering to rest. But in the end your lungs and the rest of you tell you when to sit before causing damage to the heart etc.

I tried taking Oramorth but it caused me to become dizzy, hospital gave me lorazepam and I took 1/2 a tablet before making tea last night and it helped calm the ‘panic’ fast breathing my brain has a tendency to trigger when feeling breathless.

I’m now using the canister at 4L to move around but those bottles don’t last long. I’d struggle climbing the stairs otherwise, going to the kitchen etc. I’ve now realised the 1L concentrator is just for boosting and I watch the pulse oxomiter go up 96 or a bit more watching TV. I switch it off after 5 or 10 minutes as I’ve read it can be both good and bad, ie making the lungs dependent on it and something about CO2 retention. I have a respiratory nurse review at home on the 7th October so I’m listing my questions, as is my wife.

[cazza34 in reply to Exflex]

Hello again ah don't worry about oxygen dependency ur medical team wont let that happen. They are very strict on prescribing it only when needed. I have a home concentrator set to 3L I use this to move around downstairs room to room I use a canister to get upstairs on 4L and I also have oxygen tubing upstairs ( connected to the concentrator downstairs) so plug into that when I go upstairs. How much Oramorph were u taking I take 1 ml I also take a tablet called slow release Oramorph which just suppresses the cough during the day. I get tired come 3pm and need to rest.

[Exflex in reply to cazza34]

I think it was 1ml to be extracted and dispersed by syringe, but it made me a bit dizzy. I’m finding half a 1mg Lorazepam helps the panic but not sure about the cough. I’m not keen on being dizzy because I make nocturnal visits to the bathroom and would not like to stumble around.

[cazza34 in reply to Exflex]

Ah maybe the slow release Oramorph would work better for you I was prescribed it for suppressing my cough.

[Exflex in reply to cazza34]

I think I’ll ask the resp nurse when she visits on the 7th. If I ask the GP she more or less says ‘try it and see’ without too much resistance. I also became quite constipated on Oramorth but Lorazepam can do the same, so have to use a sachet now and again. Can’t be dealing with both lungs and back-end together. 🤪

[cazza34 in reply to Exflex]

⁷When you go to oxygen assessment appointments they do a test ,( from ur ear lobe) to determine if you have a high carbon reading mine is high or rather was, but this is because I shallow breathe thus was not breathing out the co2. This made me feel really tired all the time with occasional headache. I was referred to have a Bipap mask fitted, and I wear this for 4 hours daily my levels are now normal and I'm not constantly tired, which is great.

[Exflex in reply to cazza34]

Just a further thought / comment. Does supplementary oxygen help with the recovery, any idea. Having come down stairs with the tank and made myself something to eat I switched to the 1L concentrator but knocked if off after 5 minutes as my pulse oxomiter was showing 98. Now it’s off it’s between 93 and 95. I think there’s a bit of shallow breathing going on if I’m honest even though I took Lorazepam about 40 minutes ago. I’m also on a reducing dose of steroids, hospital started me on 40mg reducing by 5mg every week. Now on 30mg /day for 7 days.

I’m so grateful being able to discuss breathing issues with others here. Unless you suffer it’s difficult to understand.

[cazza34 in reply to Exflex]

In my experience it will be the steriods kicking in, they are a bit of a wonder drug I'm on 10mg daily but it dosent do much at that dose, recently I had a chest infection and was on 40mg...I felt great haha. As u taper down u may notice you cough slightly more if you can sit and maintain 93 that's good. I can maintain at 92 but the minute I move it drops. The numbers come up quickly tho. It's such a learning curve. Yes anytime you have questions feel free to msg me or the group it's a really helpful positive group.

[Exflex in reply to cazza34]

Thank you kindly!

[Izb1]

Have you tried a V pillow. I found it helpful when my sinus's were blocked x

[Biker88]

Coughing at night is caused when you lay down and fluid in the lungs sits on the side or back of the lung, normally the fluid sits at the bottom of the lung. When the fluid is sitting on the side/back the body tires to clear it hence to cough. I sleep in a semi sitting position propped up with adjustable back rest and extra pillows. My resting O2 target is 88-92 I have emphysema and Aspergillosis and I’m on ambulatory oxygen, I haven’t been given a level for when exercising and I have seen it drop to low 80s but it soon come back up again. If you are on ambulatory O2 I would have thought both settings would be the same, in hospital I was on 1 lpm at rest but upped to 2 when moving about.

[Lutontown]

I have COPD, Bi-basal Bronchiectasis and mild to moderate heart failure. I don't lay down to sleep. I have an adjustable bed now, and my trunk is probably at 45deg. but before I got that, I slept in an easy chair in the living room with my feet raised on a pouffe. I find that if I lay flat, I tend to fill up with muck. Also, I believe human's body temperature increases slightly throughout the day, and lowers through the night. So, would be at its highest at bed time. So, don't know if that would have any effect? If you have a cold or flu, I reckon you tend to feel worse towards bedtime, and a bit better in the morning.

Also, have you had your mucus tested for any bacteria? If you have a chest infection, you will need the CORRECT antibiotic to see the bug off.

And are you taking any medication to thin your mucus. Carbocysteine for example.

Is your home free of Black Mould? We got rid of Mould in our bathroom in Apr 2018, and had no chest infections since.

[Exflex in reply to Lutontown]

I took my last Doxycycline a few days ago, hospital prescribed. They said I had another or same chest infection that didn’t clear properly. Whilst in I provided quite a few sputum samples but never got any feedback, but I think they were checking blood looking for CRP and other things.

[Lutontown in reply to Exflex]

You can always ring your surgery and ask for the results of your sputum test. I used to have loads of chest infections; 18 in 2017 when I kept a diary. So, pretty well continuously on one antibiotic or another. In 2014, I had an infection with a bug, Staphyllococus Aureus, which took little notice of oral AB's and ran from end of March into November. I had a CT scan which showed I now had Bi-basal Bronchiectasis, and the bug was finally knocked out by an intravenous AB, administered by the District nurses and at the hospital. A week after that went, I had another infection cured by an oral AB. As I said, I believe the loads of chest infections was due to the black mould in our bathroom. This was probably in the home we bought in Aug 2013, and maybe it was in our previous home, as I had a lot of infections in 2012. And the lady of the family who had that house died of a fungal lung infection. I think the medical fraternity are, maybe waking up to the dangers of mould in peoples' homes, and it needs government to wake up to it as well.

[peege]

When I have an infection I always return to doc fir more antibiotics if it hasn't improved by two days before they run out so the courses are continuous. We lungies need a much longer course of abs than 'normal people's. At least Doxycycline is a decent antibiotic. Pneumonia takes absolutely ages to recover previous health and activity, slowly slowly DON’T OVERDO IT ! I learnt the hard way being previously very healthy and fit.

There's a link to Pulmonary Rehabilitation exercises somewhere on this forum, explains that the diaphragm is a muscle and needs to be exersised, I do it with deep diaphragm breathing - the video will show you...

[Exflex in reply to peege]

Hi there, link is taking me to vaccine eligibility for some strange reason.

[peege in reply to Exflex]

Whoops, sorry for wrong link. I'll try again in a bit ×

[O2Trees]

Generally the resting target for people on oxygen is 88-92%. This is always what paramedics tell you. Reason it should not go much higher is that this can trigger CO2 retention. Brian (Bingo88) above also mentions this target.

[Exflex]

update: carted into hospital during the night on Saturday 28/9 following a 2am call from a Dr saying I have a hole in my lung. Turns out I have two holes leaking air from my left lung: one is called a pneumo mediastinum and the other a pneumothorax. I’m on 4L of oxygen 24hr a day. Dr’s trying to see whether the holes will close up on their own if not surgery may be required.