Extra air to exhale? (after new meds)

Hi,

I've noticed a few changes in my asthma/ breathing patterns and was wondering if anyone had similar experiences or advice which they could share.

I've just switched this week from Seretide 500 to symbicort 200 (2 doses/ twice daily at this stage). So far my peak flow has increased slightly (420 to around 450-460 in the eve/ same in the morning). However the main difference has been in how i have felt. I have noticed that when i breath out i get to a point and stop, and then feel as if i have to push more air out, using the muscles in my chest. It's difficult to describe but it feels as if there is a bit extra air to exhale. It seems to be worse during the day, although my peak flow is lower in the morning. Also during the day I've felt quite drowsy, slow and relaxed. This could just be me trying to relax a bit more but the effect is similar to when you take an antihistamine? For the most part I feel ok and it isn't affecting my daily life so no big concern but I just wondered if anyone had similar experiences, particularly with the exhaling? Inhaling is fine and haven't noticed anything different. In general my breathing feels slower, even during excercise.

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It could have always been a problem, but less noticeable because you weren't breathing as well generally?

Or it could e that your lungs deal with different asthma triggers in different ways and as the seasons change, so do the pattern of symptoms. I know I get different symptoms depending on triggers and seasons. Peak flow is only one of many pulmonary function measures, In asthma all the different measures don't always move in tandem so it is entirely possible that one aspect of your asthma could improve whilst others are more difficult.

What you are describing sounds like a change in whatever is causing obstruction in your lungs. What you are describing sounds like it could be air trapping, i.e. something is blocking exhaling and so you have to put extra effort in the process. As air flow speed through the lungs decreases, the airways tend to collapse a bit (kind of like the neck of a balloon when you stop blowing into a partially inflatedballoon or when you pinch above the neck in a fully inflated balloon so air in the balloon can't go out and fill up the neck. In some people some of the airways close before all of the air leaves the aveolae (air sacs), hence the need to do an extra push.

The drowsiness might be a sign of air trapping as well : too much CO2 in the blood can make a person drowsy (too much CO2 is why people get drowsy in hot stuffy rooms).

I'd discuss it with your doctor, just to make sure that everything is as he/she expects - of course, he/she may have other ideas of what is going on as well.

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Hi Beth,

Many thanks for your reply and ideas.

I think you may be right about both. I do in some ways feel that i am breathing better but this is uncovering another problem (obstruction). I've heard about COPD but I've always thought i am too young for this and I've never smoked.

I don't think it is related to triggers as it only started when i began taking the Symbicort this week. My peak flow has reduced since the autumn so i think the winter is worse for me in general but i don't think this has suddenly gotten worse.

I'll have a look into air trapping.

I think i will check with the doctor as you suggest. I may give it a few more days/ week to check that it isn't just me becoming accustomed to the new medication,

Thanks again for the reply.

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COPD: Asthma is clssed as an obstructive disorder, so it is not only COPD that involves obstructive processes. Asthma is variable or at least partially reversible obstruction which may or may not include tissue damage/remodelling. Astham can have good periods and bad periods in a person's life. COPD more or less starts with tissue damage and isn't reversible. The boundary line between the two does get fuzzy though when asthma involves tissue damage or someone with COPD improves with broncodialators.

Air trapping doesn't necessarily mean tissue damage either - it was once thought that it only happens when tissue is damaged and FEV1 is badly depressed but various studies including CT scans of people with ""mild"" (according to FEV1) asthma show that air trappring and breathing at a high functional residual capacity (the FRC number on your pulmonary function test) can also be a dynamic compensation for airway resistance and occur in people without any noticeable airway remodelling.

If ""look into air trapping"" means googling, then the other term you want is ""closing volume"" .

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When I switched from Seretide to Symbicort I had some problems and couldn't stay on it - but what I found really useful was my local pharmacist. I popped in and mentioned what was happening and was lucky to get one of the pharmacists who has worked with Asthma UK - a lot of them in Boots in particular seem to have.

They gave me a quick consultation (in a special room, not at the counter) and I took my symbicort and they were able to confirm that it was doing odd things to my heart rhythm (which it does in some people - others get this from other asthma drugs). They also - because they are especially lovely - rang through to the asthma nurse and sorted out replacing them with Seretide again straight away so I wasn't left without any LABA.

So - if you have any delay getting to the Dr, try the pharmacist first - you might strike it lucky! At the very least they should be able to give you some clues about how long it might take to settle.

As Beth says - there's a bit of COPD / Asthma overlap - I'm on spiriva which is a COPD drug used off-label for asthma but is likely to be used more frequently in asthma soon. For me, my asthma has a large mucus-plugging component, and the spiriva seems to help with that. That mucus can become so thick that pockets of my lungs get totally plugged up and so I get air-trapping behind the mucus - which I can only get rid of by violent coughing.

I hope that's vaguely helpful,

Cx