A few questions from a newbie to asthma!

Morning all,

I went to the doc three weeks ago after failing to shift a cough/wheeze for 6 months despite antibiotics. A test revealed there was no bacterial infection. The cough gets worse when I lay down, when I gt up or when I start walking. The doc suspected heart failure (given that my ankles were also swollen) and sent me for a chest x-ray. That came back clear so she then suggested asthma after doing peak flow test - 350 instead of predicted 600. Better than heart failure but still a bolt from the blue.

I've since been doing ""reversibility"" PF tests - one test without the inhaler (blue - Salbutamol) in the morning, then a before-and-after test in the afternoon. Morning reading is usually about 340, the pre-inhaler afternoon reading about 370 but the post-inhaler one is only about 400 - my personal best is 420. Question - how much difference should an inhaler make to the reading? Is a mere 30-point average increase normal?

Second question if I may - when I said I did a morning reading, I do it when I've been up for an hour and got myself together. The last two mornings, however, I have woken up breathless - very disconcerting - and did the PF immediately I woke. It was about 220, massively below my ""normal"" morning reading. Should this give cause for concern?

Finally, I'm confused by the idea of a steroid inhaler to get rid of the severe coughing and wheezing. The Asthma UK leaflet says they are harmless. The nurse at my GP surgery said they are anything but harmless, and that they can lead to thinning of the skin amongst other things and should be considered a last resort, though the GP herself indicated she would prescribe one if she diagnosed asthma. I was supposed to make an appointment to go back last week but with the differing advice and my own uncertainties, below, I've not taken the plunge and gone back yet.

I'm still not sure whether my symptoms could be down to me just being unfit (overweight) and with a poor immunity system (long-term alcoholic) rather than asthma, in which case would steriods even be appropriate?

Any and all advice appreciated - thanks in advance!!

12 Replies

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  • Hello there,

    Rest assured that few people are lucky enough to reach their predicted peakflow, both those with asthma and without My partner doesn't haven asthma and even they don't manage to get their predcited 630 (best 450).

    Reversibility testing of bronchodilators (ventolin etc), is sometimes used to distinguish between asthma and COPD. For asthma, it is expected that there will be a 20% or more increase in peakflow following the use of a bronchodilator, whilst with COPD there is little change. Having said that, if your asthma isn't responding to treatment very well and is difficult to control, there may be little reversbility in peakflows. Just be positive that yours improved after the use of ventolin. It's a small step, but a positive one!

    As for morning readings, mine are very poor when I first awake and I feel it is misleading to check my peakflow when I first arise. I normally allow myself to full wake up abit first, so don't be too alarmed by poor peakflows first thing.

    Steriod inhalers are much safer to use than oral steroids, which where I think there is some confusion. Steroid inhalers deliever the drug directly to your lungs and thus, has little affect on the rest on your body. The side effects you mentioned normally relate to long term use of oral steroids eg. brittle bones/thining of the skin).

    No-body fully understands the causes of asthma. Being overweight and drinking alcohol may have an affect on your breathing or may have caused you to develop asthma symptoms. Try to to get to 'het' up with the causes, but focus on managing the symptoms. No doubt some lifestyle changes are needed also to help you regain control, but that is ultimately your decision. Whilst changing your lifestyle habits may prevent symptoms from occuring, steroids reduce inflammation and should help relieve your symptoms in the meantime.

    Try not to worry - but always go back to the Dr if you still feel unwell. Ignoring the symptoms won't help you in the long run and just isn't worth it.

    All the best

    Gareth

  • Hi Gareth,

    Many thanks for taking the trouble to send such a comprehensive and informative reply; it is much appreciated.

    It was particularly reassuring that the low PF levels first thing need not cause undue alarm, as was the information on steroid inhalers.

    I will be off to the doc on Monday – today the PF didn’t go over 300 until I took the inhaler, which still only brought it up to 340, and the coughing and wheezing is worse. I don’t know if I will get a final diagnosis just on the base of a few weeks’ PF readings but you’re right, ignoring it won’t help and I need to get to the bottom of what is wrong.

    Thanks again!

  • Hi, welcome to the site and I hope you find it useful. I agree with all that Gareth has said. It is a bit disconcerting that the nurse at your GP gave you rather scary information - it may be worth finding out if she has any specialised qualifications to treat asthma patients. I changed practices because my old GP had no idea about asthma, so I went to a different practice with an excellent asthma nurse. You may find it helpful to ring the AUK nurse helpline as they are a mine of information and advice. I hope you get sorted soon, it really is important to get to the bottom of your symptoms regardless of why or what has caused them. Cheers Sonja

  • Thanks Sonja.

    Well, I went back to the doc who did not actually diagnose asthma but gave me a brown steriod-based preventer anyway, to see if it helps, saying she thought it was ""likely"" to be asthma. Most of my symptoms are typical of asthma apparently while a few are not.

    Only been on it a couple of days and don't know how long it takes to kick in. It's made no difference to my PF so far.

    Patience is a virtue ....!

  • pward53,

    Hope you are feeling a bit better,

    keep going back the docs or AnE if get to bad.

    Your doc might send you for speromitary tests that usually helps diagnose Asthma and see a consultant.

    It look nearly a year for me to get diagnosed by a consultant

    and my doc was brill and gave me asthma meds as having breathing probs.

    Did have heart tests also.

    It will take a while to get the right combination of meds for you

    with add on meds if you need them.

    Good luck and hope feeling better soon .

    love Glynis xxx

  • pward53,

    Hope you are feeling a bit better,

    keep going back the docs or AnE if get to bad.

    Your doc might send you for speromitary tests that usually helps

    diagnose Asthma and see a consultant.

    It look nearly a year for me to get diagnosed by a consultant

    and my doc was brill and gave me asthma meds as having breathing probs.

    Did have heart tests also.

    It will take a while to get the right combination of meds for you

    with add on meds if you need them.

    Good luck and hope feeling better soon .

    love Glynis xxx

  • Hi Glynis,

    Thanks for the message. I have to say i would be much happier being looked at by a consultant. I don't like being in ""limbo"" and not knowing for sure what is wrong. I have a lot of time for my GP but would far rather be seen by a specialist. Might raise the possibility with the GP when I next return unless there is a drastic improvement.

    Hope it doesn't take a year like you though - you must have the patience of a saint .... !

  • PF readings are only any good if you use the meter right, not blaming or aving ago here , just alot of the time we quickly blow into it but not properly, me docs meter read 550 , mine read 400????? and of course different times of the day and so forth , they are a guide only not set in stone, you know how you feel, you make a better reading than a meter.Steroids are nasty drugs but? thats only if your on them for a long time , short term use should be ok , although dont expect to sleep much and eat like a pig:-)PS have you been tested for diabetes? Gaz

  • Cheers Gaz,

    Yes, I have been tested for diabetes - all clear there.

    What you're saying about being your own judge of how you are breathing makes sense to me - the more I read the more I see how much variability there is surrounding PF readings.

    As for the side effects you mention, I'm on another med with a sedative effect so hopefully that won't be a problem and if appetite increases, just better make sure I sttock up on apples rather than crisps eh?

    All the best!

  • Hello there,

    A little advice, you need to ask your GP to send you to a good Respiratory Outpatients for an assessment by a consultant. I too had late onset severe asthma develop out of the blue and was treated for over a year by my GP practise until I begged to be referred to a consultant. I became worse and wasn't responding to any treatment, I then did a bit of research into where the ""centre of excellence"" for respiratory medicine was situated and insisted the consultant refer me there. At this time I was barely able to walk and it the first time in my life that I had become really ill. Six years later I have my life back and am looked after so very well by an excellent team in the Respiratory Centre. There is no doubt I would not have lived had I not been referred on. With regards to steroid inhalers or tablets if you need to take them, take them, do you want to die of asthma with perfect bone density or would you like some quality of life, and if your treatment has to be steroid based then this is the question you need to ask yourself. I certainly would not be here today without steroids. Don't beat yourself up about things like alcoholism, concentrate on the present and future and not the past. another good tip, I have been taking a very strong probiotic capsule daily available from health shops and stored in the fridge, for six weeks and my asthma has improved dramatically this last fortnight, I really believe there is a relationship between bacteria in the gut and respiratory function. I hope you will improve and enjoy a good quality of life, be positive.

  • Can be quite amusing these pf readings, my wife non-asthma has a bad pf of 350, but never has breathing problems, me i have between 450-500 on a good day, but have real problems, and funny enough my co2 level were that of a fit young man, the wife was a corpse , so figures can be misleading , as are xrays and blood tests etc, even me doc says you cant totally rely on them.Gaz

  • Hi Selina and Gaz,

    Gaz – had to smile at your wife being a corpse!

    Selina, thanks for this. I will certainly, as soon as I’ve finished writing this, Google centres of excellence in this area, and won’t hesitate to ask for a referral if I am not happy with the GP treatment. At the moment, the coughing and wheezing are reducing considerably after nearly a week on the preventer. The PF is unchanged but considering what Gaz has said I’m not worrying about that too much.

    I’ll look into the probiotic too – not heard of that one.

    Really glad things have improved so dramatically for you, and thatnk you very much for sharing your experience.

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