hypothetical questions

hi everyone. I know for specifics that a doctor is in order, but I am asking general questions:

1. if someone who doesn't have asthma takes salbutomol, what effect would that have on their breathing/lung funtion/peak flow/general feeling?

2. if someone has sob related to anxiety, would that be affected by salbutomol? how much (peak flow/lung funtion figures etc) What is placebo relation?

3. Is asthma only recongisable if peak flow is less than 80%of best? what is normal variation? What if it is only 85% of best

4.Is a best peak flow measured after an inhaler or drug-free?

5 can asthma get diagnosed on reported symptoms only, or do you have to have measurable difficulties. What is the most reliable measure?

6. If you had to ask a doctor for a test/tests to diagnose asthma, what tests would you ask for

7. would ""borderline obstruction"" in spirometry be an indication to persue a diagnosis or to back off because it is only borderline?

8. can people without asthma have wheezing observable to others and is that nothing to speak to doctor about

9 (finally) if dr has a patient with the mildest of asthma, should they recall the patient for monitoring or should they just repeat prescriptions ad infinitum and it is up to the patient to make an appt if they want to change anything?

thanks for all info. I am only thinking mild end of spectrum here, not like most of you, but just have these same questions that keep reapperaing that I would like to hear your answers for.

thank you so much for your responses

Thanks.

3 Replies

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  • I'm not a doctor - merely an asthmati - of which my knowledge maybe inaccurate/sketchy at best, but as far as I know:

    1. if someone who doesn't have asthma takes salbutomol, what effect would that have on their breathing/lung funtion/peak flow/general feeling?

    As far as I am aware initially it may result in improved respiration but over all if they have no problems will not improve significantly. thorax.bmj.com/cgi/content/... This study is about the use in non-asthmatic athletes.

    2. if someone has sob related to anxiety, would that be affected by salbutomol? how much (peak flow/lung funtion figures etc) What is placebo relation?

    Not an expert on this one i am afraid - ajrccm.atsjournals.org/cgi/... this may be of use?

    3. Is asthma only recongisable if peak flow is less than 80%of best? what is normal variation? What if it is only 85% of best

    Significant improvements in peak flow after medication often signify that the illness is asthma - but this alone is not a cut and dried diagnosis... there are people whose peakflow hardly changes whether good or bad, and others dart all over the place...

    For example, I can be at 80% and feel not that great and other times be at this and feel on top of the world!

    Equally other symptoms and times of suffering are always considered as well... again I am not a medic and only giving hearsay feedback!

    4.Is a best peak flow measured after an inhaler or drug-free?

    Before medication - usually best of three - sometimes more attempts if you are capable...(I never have been!)

    5 can asthma get diagnosed on reported symptoms only, or do you have to have measurable difficulties. What is the most reliable measure?

    As I understand it some GPs like to have documented info, others go by symptons etc. Best would be mixture of both.

    6. If you had to ask a doctor for a test/tests to diagnose asthma, what tests would you ask for

    I probably wouldn't, my experience is that doctors who consider asthma as a possiblity will immediately put in place appropriate assessments for the disagnosis of the condition. Inlcuding the peak flow, possibly chest x-rays, spirometry. But the lattter in my experience would be if it was more serious and lacking control (usually having been defined as brittle/chronic though this is not exclusive nor a requireent).

    These tests maybe of use:http://www.asthma.org.uk/applications/control_test/ asthmacontrol.com/ for you to assess your symptoms.

    7. would ""borderline obstruction"" in spirometry be an indication to persue a diagnosis or to back off because it is only borderline?

    Borderline spirometry can be used as a ""Caution"" as unsure of the results, so will no doubt check again, can be significant enough to confirm or reject a diagnosis, be it of asthma, COPD etc. The testing is not only indicative of asthma illnesses.

    A restrictive pattern can be caused by extrapulmonary factors, such as obesity; by skeletal abnormalities, such as kyphosis or scoliosis; by compressing pleural effusion, and by neuromuscular disorders, such as multiple sclerosis or muscular dystrophy. A number of systemic diseases, such as rheumatoid arthritis, systemic lupus erythematosus and sarcoidosis, can cause interstitial lung disease, which leads to a restrictive pattern on spirometry. Other causes of interstitial disease include farmer's lung and other pneumoconioses, infiltrating malignancy, fibrosis due to side effects of some medications (e.g., some chemotherapeutic agents, amiodarone [Cordarone]) and idiopathic interstitial fibrosis, which constitutes the largest single category of interstitial lung disease.9

    8. can people without asthma have wheezing observable to others and is that nothing to speak to doctor about

    Wheezing is a sign of difficulty in breathing; trying to breathe through air passages that are narrowed or filled with mucus. Anyone can wheeze. Noone can say onhere whether the wheeze is serious or not, and if undiagnosed then the eprson themself cannot say this either! It can be a sign of a whole host of chest problems.

    Equally hearing a wheeze is not the only sign of asthma and many asthmatics may not have this present!

    9 (finally) if dr has a patient with the mildest of asthma, should they recall the patient for monitoring or should they just repeat prescriptions ad infinitum and it is up to the patient to make an appt if they want to change anything?

    There is in my experience a limit for the average mild sufferer until they need a review - I believe every 6 months for most practices - where they tend to have an asthma clinic. This varies though for other sufferers - mine generally is only reviewed by my consultant and my GP just adds in extyras if I need it due to worsening in between, but just gives me repeats and then renews the number of repeats allowed.

    My answers I hope are of some use - there will be far better members able to reply I am sure!

    Please go to your doc if you think you are suffering.

  • Thank you me, myself. That is very thorough and helpful. It helps in my plucking up courage to go to my GP, which I do not find very easy (or often very helpful I'm afraid). I will pluck up the nerve when I feel I have all the info I need under my belt.

    Once again, thank you.

  • Sorry to hear that you do not find your GP overly helpful, BUT I would go to see them if you have any symptoms at all - asthma is varying in degrees and symptoms, but these can also be indicative of other illnesses. For example, have you ever smoked? Notknowing your age - but the symptoms which may seem to you as asthma could be symptomatic of something else.

    Equally, by reading up on asthma you may end up convincing yourself you have symptoms etc that had you just spoken to your GP you may be in a better position to answer honestly. For example, someone may have dull ache in their back/shoulder, but after reading could be convinced it must be a sharp pain that is worse on inhalation! If you get my drift.

    Also, if you are suffering from asthma, without wishing to scare you, though you may believe you have mild symptoms now, without controlling it and fully understanding the illness in terms of how your body behaves you are putting yourself at greater risk of sudden far baigger asthma problems. I imagine you have read some of the horror stories of how even controlled asthmatics have quite big attacks out of the blue? Imagine if uncontroled...

    Please do go to your GP - if you can't then change for another! As a minimum see your practice Nurse!

    N O W ! ! !

    :-)

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