Is this "normal"?

Hi,

Life long asthma sufferer

Male age 35

Fit and healthy - usual peak flow of around 600

Usual treatment is seretide 100 twice a day and salbutamol 100 twice a day

Been on the above treatment for best part of 20 years and have never really been compromised more than a few puffs of the salbutamol around sport and occasions if I'm suffering from cold or flu like symptoms.

4 weeks ago I was very breathless one evening, used salbutamol a few times which kind of helped, but by the next afternoon I was struggling and salbutamol wasn't relieving properly or lasting.

Saw my GP who started me on a course of pred - 40mg for 5 days.

After a few days I was better, but only slightly. Went back to the GP who gave me antibiotics for 5 days.

When I went back I had improved a bit but was still using salbutamol about 5 times a day.

I was sent to the asthma nurse who has upped my seretide to 250. Have been on this for 2 weeks now, felt I was getting gradually better and down to a couple of days of using salbutamol only 3 times. However yesterday was bad, almost back to how I felt with the original flare up.

I had been given some rescue pred to use and have started 30mg this morning which does seem to be helping some.

All through this my only symptoms have been wheezing and shortness of breath, no coughing, no fever, etc.

The lowest I have peak flowed was something like 540 despite me feeling incredibly breathless and my blood oxygen measured on those little finger clips has never been below 95. So I think that from the doctors point of view I probably haven't been that bad, but I know myself that my breathing has been terrible compared to my norm.

As I've never experienced this before I'm at a bit of a loss to understanding what's going on. Is it "normal" for a flare up to:

1 - present like this with no other symptoms

2 - go on for so long

3 - start for seemingly no reason

Any thoughts, similar experiences, etc. gratefully received.

11 Replies

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  • Just to reiterate we aren't doctors and all our experiences are different. Welcome to using seretide a good inhaler in my opinion as its works really well for me.

    You given out lots of information and you had a rough time too. Asthma sometimes surprise us for all the wrong reason. I was good for 10 years and then my went haywire. Back under good control of late.

    I going to tackle your triggers as I don't feel qualified to do the rest.

    4 weeks ago was there anything you can think set it off. Sounds like you face a trigger that you haven't had before. Pollen, dust, animals, pollution. Then you were given antibiotics so possible infection. Standard treatment is 5 days on rescue steroids. Then on higher seretide takes two weeks to kick in.

    This could be a new flare up as you were better. Asthma can mean wheezing, coughing and shortness of breath. We can have some of these symptoms but not necessary all.

    There is always a reason for a flare up so don't be surprised. Best advice is to ring the asthma care helpline. see asthma uk for number. mon to friday 9-5pm

    Glad to hear you have your rescue steroids. Keep taking them. Follow your asthma plan. Ring your doctors tomorrow and tell them what happen and that your taking the steroids.

    Didn't mean to write so much. I hope and pray you get better and get to the bottom of what's happening with your asthma.

  • My first thought was that it could be tree pollen. I had to take an anti-histamine yesterday. I developed an allergy to tree pollen a few years ago. I felt it was confirmed when I was in India last February (we try to get my lungs out of England then). I was sitting by a lovely pool, surrounded by flowering trees and I suddenly had trouble breathing. I turned round expecting to see a cigarette behind me and there was a gardener attacking a huge flowering bush.

    I am normally fine in South Goa - lovely warm air blowing off the Arabian Sea but this hotel had more trees.

  • How is your nose?

    You know your chest can be fine but Rhinitis of sorts can actually cause a wheeze and also make you feel breathless yet your lungs are relatively clear.

    I was in in meds for a long time for clear lungs but kept feeling week till I realised issues were in nose and ear area. Treated that with nasal steroids and saline and got stronger.

    It is a symptom that can be ignored (nasal congestion).

  • Hi,

    Check for a trigger. I once struggled for weeks thinking that I had a bad chest infection. I was extremely breathless. Eventually I found out it was severe asthma and there was no chest infection at all. Looking back I had mowed the lawn with a very old mower which had spewed out fumes while I mowed. Although I had not liked the fumes, they had not produced an immediate asthma attack. I had got gradually worse over a few weeks. I was lucky a doctor had recognised what it was. It took a little while before my lungs returned to normal.

    You will need to continue to investigate. When you said no coughing do you mean no phlegm as well? Have you had an x-ray? Has there been a change in the diet? Any changes in where you live or what you use? Keep thinking about what it could be. There is always a reason. But meanwhile keep doing what you are doing and keep checking in with the doctor.

  • Thanks for the replies so far.

    I've been racking my brains for what a trigger could have been. There has really been no change in lifestyle, diet, etc. I suppose if it's possible that it could come from anything airborne then it could be something entirely random that I may never come into contact with again.

    To confirm I have had no coughing or phlegm, which I guess one would expect with a typical chest infection. I haven't had a chest x ray yet, the doctor did previously mention it as a possible next step.

    I've taken my pred again this morning and that is definitely helping me.

    I'm actually on holiday at the moment, flying back to UK Saturday, so grateful I had the rescue pred with me. I'm going to call my doctor today to update them and see if I can see them soon after I'm back in the UK.

    Tugun, when you say it took a while for your lungs to return to normal, do you mind me asking if you were taking anything like pred to help get back to normal?

    One thing I'm thinking is after the original flare up, did I stop pred too soon. When I stopped I was undoubtedly better than I had been, but still nowhere near my norm, in fact the way I was feeling at that point would have still been enough to prompt me to visit the doctor if you see what I mean. As I have no experience with this I'm wondering whether really the pred should have been continued until I felt back to normal.

    Without much experience it would still make sense to me that an already inflamed lung is easier to inflame further. Does that ring true with those that have experienced this?

    Oh and a general thanks again to everyone on here. For someone who has not experienced issues like this before it is very helpful to have access to those who may have had similar experiences and are willing to donate their time to read and comment. Thank you.

  • It sounds a bit similar to how I have been recently. The last month or so my chest felt really tight and I was getting out of breath easily, reliever inhaler not helping. No other symptoms and my peak flow and blood oxygen were fine, felt like a fraud. Whenever I tried lifting weights at the gym my lips went blue and I got lightheaded. I am a lot better recently but still not perfect. I have put it down to pollen as antihistamines seem to have helped and i've ruled out lots of other potential triggers. Hope you get it sorted soon.

  • My asthma nurse once told me that inflamed lungs were like a fire that needed putting out. Once the fire is out you carry on damping down for a bit to make sure that it doesn't re-ignite. Just a thought.

  • The golden rule for rescue steroids is initial 5 days go back if you can't better ie. Still needing ventolin. I made that mistake in my ignorance first time I had an asthma attack so I ended up with stop start steroids which in the end 3wks but I got there. Next time it happen I was much bettered prepared. So I don't want this to happen to others.

    My advice is straight back to your doctors and then they will want to review your medication. Regular ventolin every 4 hours will help too.

  • I don't know about the whole peak flow thing - I did it as a kid a little it was done here and there but my doc did not emphasize it - he was super experience asthma and allergy doc.

    Last week I went in to doctor with recurrence after 7 years of basically free of chronic asthma. I blew 750 but I knew I was wheezing and in a bit of distress. He immediately lost interest in me but I said just give me the prescription I know I need.

    I am having fun playing with the peak flow meter he gave me this week but I know when I'm wheezing, or even just about to start. I think it's useful for new asthmatics or for people that don't realize they are in emergency. But for us types day to day (I've had this 45 years) not so much. Trust yourself - if you know it is bad demand to get it controlled. That's my opinion and experience.

    I agree with everything else said - search hard for your trigger (it may be new). Reducing exposure is the key to recovery for me. Whoever said it's like a smoldering fire - amen. You got to be completely clear for 7 days before gradually stepping down in my book. Thanks for the tips on pred - if I ever have to go back on (touch wood) I'll get well educated first.

    I will always thank the doc of my youth for teaching me to stay clear for a while and then gradually reduce whatever you were on. I think he's probably dead but thank you anyway!

  • Update

    Got back to the UK and saw my GP on Monday. She referred me for chest x ray, blood test and to a specialist. No change in treatment at this point - still using up to 10 blue inhalers a day.

    Tuesday evening I was struggling and had enough. I went to A&E where they put me on a nebuliser. First time for me and afterwards I felt fantastic, like my breathing was normal again.

    While I was there I had chest x ray and bloods done as well. X ray clear and bloods clear apparently.

    For 36 hours I felt back to normal but this morning I was wheezy again. By 10am felt I needed my blue inhaler constantly again.

    Saw a different doctor today and they have put me back on antibiotics.

    Right the way through the last 5 weeks whenever I've been peak flow checked and blood oxygen checked neither have been very bad. This doctor seems to think I have a lingering chest infection that probably isn't too serious but is causing my asthma symptoms. So effectively for 5 weeks a combination of salbutamol and pred have just been dampening the symptoms with no effect on the cause. I'm even wondering now whether pred has made it worse - given that it suppresses immune system I imagine it doesn't help one fight off infection.

    I'm back on antibiotics now and off pred. Also trying not to take as much blue inhaler as it was putting my heart rate up.

  • The other thing that has come out of this is that it appears my asthma has been terribly managed forever.

    Until this flare up I have never done any research, out of complacency and believing I was well controlled since asthma never disrupted my life as far as I was concerned.

    When I told the doctor today that I have been using a blue inhaler on average 15 times a week for my whole life (in addition to Seretide and Becotide in the old days) he was absolutely dismayed and told me that my asthma has been out of control and was surprised I hadn't had serious attacks before now.

    I feel massively let down. For sure I will take a much greater interest on acquiring all the knowledge I can now about my asthma. I always thought it was normal to use a blue inhaler that much and over many years have had countless conversations with GP's and asthma nurses where I've informed them how much I use it.

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