Constant breathlessness

Hello

I am 25 and have had asthma all of my life. The last 2 years my asthma has gotten a lot worse.

I am breathless everyday - The weirdest thing is this is the only symptom I get. When I am unwell I always get really bad asthma to the point were I am taking my inhaler around 10 times a day. I am unable to run outside now because of my asthma, I get excruciating pain and unable to breath, I was needing to take around 15 puffs of my ventolin to get some relief.

I am currently taking Budesonide 400 1 puff twice daily & Phyllocontin continus 250mg 1 tablet twice a day. I always have to take a puff of my Budesinde before I go to the gym - This is also something I have never had to do before.

I have had an X-ray which the Nurse said I have hyper expanded lungs. My CT scan was normal and I do not have inflammatory markers showing in my blood test results.

I am getting pretty desperate and I really don't know what to do next. I am very fit, I go the gym 3 times a week, walk everyday and eat a balanced diet and do not drink, yet everyday I am struggling with breathlessness. It feels like I really need to suck in the air to get a good breath, sometimes walking up the stairs feels like I have been winded. Same when I am in the gym sometimes I really struggle.

Any advice will be really good! If anyone can suggest any foods, exercise or tips that may be causing this - I am wondering i it is an allergy to something I eat or drink. The next step GP wise is to be referred to the hospital. I just feel a bit of a fool when all the results come back normal yet I am still struggling!! The GP & ruse have both said that I am on very high asthma treatment and they don't know why I am still struggling.

I really hope someone can help even if it is just a little.

Thank you

Claire.

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Hi Claire,

I'm not sure that I can be much help as I am in a similar situation (although I do get some other symptoms) but just a few ideas of things you can try.

Firstly, I would consider a hospital referral as they have many more tests they can perform, different treatment to try and generally more expertise in treating asthma. I know you can have an exercise test although it was 15 years ago when I had this. The other thing to consider is trying different preventative inhalers as some people respond better to different types of steriod etc.

You may also find it useful to keep a symptom diary (this has really helped me in the past). Basically record anything which you may feel is significant and then try to identify any patterns with triggers. Do you have a peak flow meter? If so you could take it before and after exercise (or during if you need your reliever). You could also note the type of exercise you are doing and the conditions (if the air con in my gym is working overtime this can make it very difficult for me to exercise) along with symptoms and number of puffs of reliever needed.

In terms of exercise, I have found very low impact sports to be beneficial in maintaining my core fitness as I can do these even when symptomatic. When I run, I always make sure I warm up very well and interval training is a big thing I avoid. If I feel able to run outside (which is very rare at the moment) I cover my nose and mouth with a scarf.

I hope this helps. You could always phone the helpline as the nurses there always have excellent ideas.

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hmmmm......

what is your personal opinion of your GP? Because from eading what you've written, im curious as to how good they are! lol! That might be me being an idiot, i'm not a doctor and have no access to your medical notes and maybe they have good reason for doing things, but its certainly a strange set of treatments you have!!you've kind of bypassed a few steps in the normal protocol!!

Firslty: is there any reason you use the brown inhaler before exercise?? Its not a typically reccomended thing to do. Steroid inhalers (the brown ones) take several weeks to build up in the lungs and so taking it before exercise or at any time you experience symptoms wouldnt have any effect at all. Whilst steroid inhalers are usually described as 'preventors' and blue ones as 'relievers' in terms of preventing something that is just about to happen its the blue we use. Normal advice for exercise is two puffs of salbutamol between 10 and 15mins before exercise and ensuring that you are warming up and cooling down slowly and carefully. If you've not been told to do this it is probably worth checking with your GP or asthma nurse that this advice is appropriate (as I say - I am not a doctor and given the strangeness of your treamtnet I am wondering if there is something I am unable to take into consideration!) however I am not sure I can imagine any situation in which using the brown before exercise would be of any benefit!

In terms of your meds, you're on a weird combo! lol! Phyllocontin is rarely started by GPs, its quite a nasty drug with a lot of potentially miserable side effects and a very narrow theraputic window (I assume they've done blood tests to ensure you're within this window as outside it you will either have little benefit, or be made ill by too much) and so isnt used particularily often anymore. Have you ever been on a combination inhaler? So an inhaler with both a steroid and a LABA (long acting bronchodilator) in it? This is the usual next step after a steroid inhaler alone isnt working. This is taken morning and night like the current one you have, however as well as having the steroids to prevent inflammation in your lungs it also has a LABA which acts like your salbutamol but takes a bit longer to start and then lasts for about 12hrs. Most people who arent controlled on steroid inhalers alone are controlled with a combination inhaler (common ones include seretide and symbicort) and i'd be surprised if a GP reffered someone to a hospital consultant before trying this as it is a really commonly used treatment and highly effective!! It's strange that they're surprised that you are not yet controlled. If a combination inhaler isnt working then another common drug to be added is montelukast, again, this is one a GP would usually start before considering refferal to a consultant. If you're on those three treaments that is when they'd start looking at other options. A few GPs are willing to add in ipatropium or phyllocontin type medications but that is starting to stretch the things a GP would normally be doing and so it is worth getting a consultants opinion as it is important to ensure that it is asthma and not something mimicking asthma that they might be missing.

Remember that if ten puffs of your reliever isnt helping (for one attack) then that usualy signals time to ring 999 - be careful!!

It might be worth asking the GP to do allergy testing (or to reffer you for allergy testing) so that you can quickly esteblish any allergic trigers and avoid them! has anything in particular changed in the last 2 years? As said above, it could well be valuable to keep a trigger/symptom diary to help estblish things that cause your asthma! As can peak flow monitoring!!

I'd definately go back to GP and discuss why you are on the particular combo of meds that you are on, it may be that they have a very valid reason for it, however it seems like it might be a strange oversight??

HTH - being breathless is miserable!!

Soph x

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Hi my name is Louise. I too have had asthma all my life. Now classed as serve brittle astmatic and under great hospital team with phone access to specialist nurse. Have you asked for a hospital appointment? My experience of chest clinics at 3 hospitals have been brilliant.

Try not to over do the blue inhealer. I you a space with most of my inhealer although have got seritide 500 in an accuhaler.

Take care

Loulou