Newly Diagnosed - Help with cough - can this really be Asthma?

Hi,

I have had a cough for about 12 weeks, After 4 lots of antibiotics (Believed Sinusitis) the 5th Doc i have seen sent me for a chest xray (all clear) and did a peak flow test (Scored 310 - For my age should be 440 - 29yr F). I was referred to an Asthma nurse who believes I have Asthma. I was prescribed Symbicort.

I Have a terrible hacking cough first thing in the morning (I score 260) and then the coughing gets worse again in the evening (I score 310). My question is - is this cough really caused by Asthma? - I don't know anyone with Asthma to ask? (I am seeing the nurse again Tuesday so will ask then)

Also should i be seeing an improvement by now on Symbicort?

Any Advice is truly appreciated as starting to worry there is something else going on.

Thanks in advance

x

13 Replies

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  • Asthma is characterised by a 20% variability in peak flow which you have... Do you ever get any wheezing? There is a for, of asthma called cough variant asthma which manifests mainly as coughing.

    If you are still experiencing symptoms while taking symbicort it could be that symbicort isn't the medication for you... What dose are you on? The are 3 doses of symbicort so the nurse might increase your dose, or she might swap you into another combination inhaler...

    It took me well over a year to find the inhaler that worked best for me, but I would suggest that you tell the nurse everything...

  • Hi,

    I get wheezing when laying down and sometimes when out walking. I have been given Symbicort 200/6 to take in the morning / evenings and when needed. Currently taking about 4 times a day.

    I will have had the symbicort for 2 weeks when I go back on Tuesday. Will tell the nurse everything just nice to speak to others with a similar thing. The cough is driving me insane with everyone telling me ""stop smoking""! I never smoked in my life!!

  • My asthma hates dry powder inhalers like symbicort... I've tried 2 dry powder inhalers Seretide and Symbicort both of which made me worse... Maybe it could be the delivery device?

    There are a lot of other combination inhalers that you could try other than symbicort... Seretide, Fostair, Flutiform...

    Asthma is complex, meds that work for some people might not work for other people and vice versa. It's a case of trial and error really...

  • hi sparkle,

    im 27 F, cough variant brittle asthmatic (first diagnosed with asthma when I was 10).

    I have always coughed and almost NEVER wheeze. This can be ever so confusing for some GP's and paramedics and a&e staff, but it is a real form of asthma. The problem is that it can present in a completely different way to ""normal"" asthma, even on some of the asthma tests you can have a normal result. However peak flow variation and doing a test like histamine challenge are some of the ways that they can diagnose cough variant and be sure that is what is going on.

    My peakflow should be 450, at best I usualy get around 420. I haven't blown that since before Christmas though, at the moment im 360ish and go down to 320. When im in the middle of an asthma attack I drop to about 250 I think. For me an attack is where I start coughing and then just cannot stop, I end up exhausting myself, my inhalers don't help and I need to be nebulised medication with oxygen to break the cycle of coughing.

    I personally did not find that symbicort helped at all with my asthma. However everyone is different. You need to give it time to get in to your system, which would be several weeks. Then you can discuss with your asthma nurse how effective it has been (by looking at your peak flow readings). If it hasn't helped you can discuss different kinds of medications.

    personally I am using seretide and ciclesonide preventor inhalers, plus I have a blue salbutamol reliever and sometimes use a green ipratropium inhaler as a reliever too. I also take a tablet called montelukast every night.

    Do you ever get problems with acid reflux or heart burn? Cough variant asthma can sometimes be linked to acid reflux or something called silent reflux. Something my Gp's never mentioned and didn't seem aware of until my specialist brought it up. I am now taking several stomach acid surpressing medications to see if that is contributing to my asthma as it has been very poorly controlled over the last 12 months. You may not have any problems with stomach acid at all, but its worth being aware of it as a potential factor because I had had cough variant asthma for over 15 years before I knew about it!

    I hope you find a medication regime that works for you soon and that your asthma begins to settle down and you can learn to control it properly. It is scary dealing with a new condition and not really knowing if your medication is helping or not, but there is a huge selection of medication out there and a wealth of expertise, it might just take a little bit of time for them to find out what is triggering your asthma and how best to control it so you can go back to normal life as much as possible xx

  • Hi Germander

    Thanks for your reply, I am seeing the nurse this afternoon so will see what she says.

    S x

  • Hope it went ok with the nurse - what did they say?

    Just wanted to say I am also on Symbicort (quite a high dose) and it took about 3 weeks to work - was odd as it was nothing nothing then suddenly started to work (shame it's not stuck there...) -first time I tried it on the lower dose I didn't give it long enough (and maybe wasn't enough) and it did nothing. But I agree it doesn't suit everyone. I never got on with Clenil or Serevent, montelukast worked though. Now I am on a massive cocktail and have weird annoying asthma that sounds a bit like Germander_speedwell's - lots of coughing though my last attack was different and caught me by surprise as it was a lot quieter and a bit more classic.

    However, hopefully you will find what works for you and get on top of the symptoms - it's entirely possible for most asthmatics, but reading posts on here can be a bit scary for newly diagnosed people as there are a disproportionate number of people with stubborn, difficult asthma which lands them in hospital frequently. It doesn't reflect the reality for most people (definitely a minority) and the right meds should really be able to help you control things and get on with life without it bothering you too much. Crossing fingers for you and be persistent if you need - definitely ask more questions here if you need as well. :)

  • Hi,

    Thanks for your messages.

    Went to see the Asthma Nurse who was not happy that the Symbicort wasn't making a huge difference but said the same as you it can take a while to make a difference. She referred me back to my Doctor to arrange for further test. After speaking with my doctor I had some Blood tests done. ( I also am suffering from a sinusitis and blocked nose all the time, ) He seems to think I have an allergy to something which is causing the Asthma to flare up.

    So i have had the blood tests done - Results can take up to 2 weeks here. I have to continue with the symbicort (Just blown this morning and reached 280 which is good for me as in the normally in the morning don't get above 250. He has also prescribed me a nasal steroid spray and antihistamines and said to see how i go between now and when the results come back!

    Had a terrible coughing fit 2 nights ago when i was walking my dogs across the fields, The symbicort did help, I think when the coughing fits happen I get quite panicky about the fact I cant catch my breath and make it worse. A similar thing happened again last night but I felt much more in control about it.

    So at the moment its a wait and see game here - If I have developed an allergy of some sort, I am really hoping it is not related to my pets!!

    S x

  • hi sparkle, im glad you got to have a chat with the nurse and see your GP too :)

    Its really positive to hear that a) the nurse & gp are trying to work out what is going on and get you on the right meds and b) that you are showing some small signs on improvement. A step in the right direction if not the ""answer""!

    I wonder if you are allergic to something like grass pollen, if you had an attack whilst walking the dogs a field. the blood tests should show up if you are having a strong allergic response and hopefully the antihistamines and nasal steroids will help you, I am not at all an allergic asthmatic so I cant advise much on that front, my triggers are things like dust, exercise, laughing, hot/cold air and most significantly viral/bacterial infections -colds! they are what put me in hospital, but 95% of the time you probably wouldn't even know I am asthmatic. Hopefully you will get your asthma so well controlled that you too will be symptom free the majority of the time!

    Don't forget that you can always call for help from paramedics if you are struggling to breathe. Particularly if you are new to these attacks and asthma in general. With time you will know your asthma well enough to know when you do and don't need to get assistance but for the moment, if in doubt call them- they will be happy to help. My general rule is if you are really struggling to breathe and your inhaler is not sorting it out then its time to call for help. For years I was hesitant to call anyone out but with time I have learnt it Is much better to act swiftly and nip things in the bud that it is to struggle on your own and potentially let things get more serious.

    hope you get those blood results soon, and that your peak flow continues to improve! I'm off to see my local team on Tuesday (for my ""6 week discharge follow up"" after my admission in December! *rolls eyes*) and then the difficult asthma specialist & respiratory psychologist on the 12th of may, so I am hoping to make some major progress with medications and knowing what is going on in the next few weeks :) xx

  • Hi Sparkle25

    Agree with everyone's comments and just a couple of pointers from my own experience

    Firstly on when to get help - if you find you can't get enough breath to speak or sleep, you need to get to A&E. I was once awake all night because I couldn't breathe well enough to relax into sleep (shortly after first diagnosed). My GP was horrified and sent me straight to A&E.

    Secondly, I have used Symbicort, but had to stop because, believe it or not, one of the side effects is it causes coughing (not in everyone of course). I only use inhalers intermittently (because I only need them when I have a cold or worse) and found that for a couple of years Symbicort was fine… then it started making my cough worse. I also got leg cramps occasionally. Clearly, not everyone is the same and you might be fine with Symbicort, but it is a real pain to find that the medicine you've been prescribed makes your particular asthma variant worse! One to watch for if you find your cough is not improving.

    I hope you quickly find something that helps you manage. Check out the Cough Variant thread in the Medical section of the forum for other info:

    forum.asthma.org.uk/yaf_pos...

    Best wishes

  • Pooka - Symbicort caused coughing and paradoxical bronchospasm for me too! Although we have since found out that it was the dry powder that was irritating my airways not the actually medication. :)

  • Pinger_genguin - that's interesting… how did you find that out? I ask because my reliever is presently in the powder form (Salbutamol Easy-haler) so I'm wondering if that might be making things worse instead of better too!

  • I was on a ventolin accuhaler and that would make me cough when I was using it before excerise (I couldn't tell if the enrol in was making me cough during attacks etc) but I'm fine with the ventolin evohaler... Also I'm on the same meds in Symbicort (well the formoterol part) and that doesn't make me cough now that I take in an aerosol... I used to need ventolin after Symbicort because I was coughing so much and my peak flow would drop quite dramatically... I phoned my GP and he said that it was the dry powder causing the issues. I would definitely suggest talking to your doctor about it!

  • Thank, you, I will do that!

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