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Suspected asthma but no wheeze

I have been suffering with a cough for 2 months. It is worst at night, waking me from sleep and when I exercise. I saw a nurse about 5weeks ago and she suspected asthma. My peak flow was only 220, about half of what it should be. I was given a blue inhaler to relieve symptoms. I used this frequently for a week whilst my condition continued to deteriorate and ended up in the gp surgery on a nebuliser with peak flow of 90. I was given steroids for a week (40 mg per day). The steroids improved my breathing and eliminated the night cough but I continued to feel tightness in my chest. My peak flow max rose to 260. I finished the course of steroids 9 days ago and I am now using clenil modulite inhaler (100) 4 puffs a day and ventolin inhaler when needed.

The cough has returned and is getting worse. I woke 3 times over the last 2 nights and had to use ventolin and i'm also now coughing during the day. I'm finding that 5/6 puffs will stop the cough but it only lasts about 3 hours. My peak flow is dropping (now 160, increasing to 200 after ventolin). I saw my GP yesterday and have been refused any further medication or change to inhaler usage as my chest sounds clear, with no wheeze. I also had a chest X-ray yesterday that was clear. My reversibility test to confirm the asthma diagnosis is booked in early October as I have to wait for steroids to clear my system.

I have another appointment with my gp on Monday to review how I am. I'd be really grateful for any advice on what I should be asking for? I'm feeling pretty low at the moment from lack of sleep and the coughing.

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What time is your appointment on Monday? Wondering if you have time to call the Asthma UK nurses before as they are so helpful and will be able to talk things through. If not maybe have a look on the website so you go in prepared.

I hve to say your GP doesn't seem to be entirely familiar with asthma. Far too many doctors still go on wheeze and it just isn't needed. I hve severe asthma and I almost never wheeze! Chest X ray usually normal In asthma too.

From what you say about your peak flow and symptoms your asthma really isn't controlled at the moment and you should be asking for a step up in treatment. If you can it may be helpful to take some information along from Asthma UK showing how everything you.describe is part of poor asthma control ans a wheeze is not needed- though appreciate that can be hard to do tactfully! If they don't budge can always mention that you read it on the website and given all the signs you have of poor control could they explain the decision a bit more? I think if they still say no try a different GP, if it's been the same one you see every time, as you can't keep going like this. Was it the same GP who gave you the nebulizer and did they mention wheeze then?

Have to admit I am confused bout needing a month to get over a week of steroids for the test - not heard that before and seems odd. You clearly are already showing reversibility from your home monitoring and I don't think it would take a month for that course to suppress any twitchiness you might have! Not an expert t all though so maybe a question for the AUK nurses.

Sorry to.ramble on but hope this helps a bit.

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Thankyou for the reply. I agree that the gp I saw seems fairly clueless about asthma. I was put on a nebuliser by a different gp in a different part of the country as I was on holiday. When I was examined at that point, there was clearly noise on the left side of my chest but nothing now. The other thing that I forgot to mention is that my oxygen levels are still around 100% but they were high when I was put in nebuliser too. Apparently it is standard that you need to be off steroids for six weeks before the test can be done. I keep saying that this is classic uncontrolled asthma but just get told it is not definite it is asthma. The gp says it could also be COPD. My appointment is in the pm on Monday so I will call asthma uk.

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Ah that makes more sense re it being different GPs. Hopefully another one will be more clued up if you don't get anywhere this time! Maybe ask.AUK re the reversibility test too - not going to say I have the expertise to contradict that but not sure this GP is the best person to advise either! If you could have the test earlier it might stop them faffing about so much and do something!

Many GPs and even hospital drs are overly reliant on oxygen levels but you can definitely have high ones with asthma- your body can compensate and it's not the whole picture.

Hope you get on ok on Monday, sounds very frustrating!

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These are common symptoms of an under controlled asthma. Probably you need a long term bronchodilator plus some steroids. Consult your GP.

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You need a consultant. You might have to insist on this, but if you have no confidence in your GP you must find someone you do trust. Keep a diary of your symptoms - how long the coughing lasts, maybe record it if it gets very distressing, sleep and so on, how often you take the blue inhaler and why you feel you need it each time you use it. The more info the consultant has, the better s/he can help.

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Just a quick note, sometimes Clenil Modulite makes people worse and needs changing to a different inhaler.

Hope you get relief soon. X

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Have you tried taking anti histamines? As well. Just Xanax or whatever.

As this is so recent and you did not have asthma before you do not have the changes in your lungs which progress with asthma and corticosteroid inhalers.

Intal which does not have side effects, it stops mast cells from acting, might help. Take 4 times a day, persere with ventolin.

Then 2 times a day.

Could even use with some ccsteroid puffer as well, hoping to taper off quickly,

Getting into corticosteroid puffers does come with horrendous effects down the line,

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I think the antihistamines are a good idea, as Mas1 needs something available over the counter until an asthma diagnosis is confirmed (or otherwise). Also, drinks containing caffeine help dilate the airways (and counteract the sedative effect of antihistamines). Hope this brings some temporary relief until a more permanent solution is found following tests.

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Thanks both. I have been using Prevalin nasal spray with no effect so started an antihistamine tablet on Friday. So far there is no change in symptoms. I had another dreadful night, awake every 2 hours and using ventolin to stop the cough to allow me to go back to sleep. The ventolin is certainly not lasting the target 4 hours.

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I looked back at the message stream and noted that S4r4L0u153 had problems with Clenil, and so did I! In my case, I seemed to react to the propellant; might be worth trying a dry powder inhaler?

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What difficulties did you have when on clenil. The lack of clear diagnosis of asthma seems to be the main problem for me at the moment. If it was confirmed that I have asthma then i'm pretty sure the GP couldn't dismiss me with the symptoms i'm showing. Surely they'd have to try different inhaler etc? Everything I read says that if you are using blue inhaler more than 3 x a week there is a problem. I'm using it way more than 3x a day.

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My main symptom is mucous production; I found Clenil made it worse by causing it to congeal and therefore difficult to shift - I guess this could trigger your cough, but it would be difficult to confirm unless you changed preventers

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I am mostly well controlled with Qvar, mobtelukast andventolin as required . However, when having an exacerbation I rarely wheeze,my oxygen is usually fine at 98/99% but I cough and struggle with breathing. I have had asthma for 60 years and am often told that "you are fine as you are not wheezing " when clearly I am struggling and have a low peak flow. You may /may not be diagnosed as having asthma but it is absolutely possible to be so without wheeze.

You might be better with a different preventative inhaler as different ones seem to suit different people.

Keep chasing it up with a different GP ...also, is there an asthma nurse. At your GP practice? They might be more helpful.

Hope it is sorted out soon.

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Finally got a consultation with a GP who listened to me. I’ve been prescribed more steroids and a change to combined inhaler that incorporates the reliever medication. Thanks for the advice everyone. Fingers crossed this change in meds improves things.

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sounds like u need steriods for longer one day u can have a wheezethe next it could be clear ,they really don't like given steriods out but u need to come across like u know what ur talking about even if u don't.no sleep is the worse thing will run u down very quick and will play it chest up as well good luck

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Hi Mas1, you sound just like me but my peak flow is a lot higher than yours (but I understand that everyone's is different). I was diagnosed in August this year having suffered a cough since May. GP said it was a virus. After it didn't go away I went back. By now I was being sick from coughing. My oxygen levels are always fine and I only had a very slight wheeze. My chest xray was also fine. A different GP thought I had asthma and also gave me a peak flow monitor. He told me to get an appointment with an asthma nurse at my surgery (I saw him at a walk in centre as I was feeling so poorly). He also said I needed a chest xray. I then saw my asthma nurse. She's fabulous. My first line of treatment was ventolin and clenil inhalers. I've now been put on monteluckast and changed from clenil to seretide which has a long stay type of ventolin which keeps my airways open longer. I feel so much better. I've only been on this new treatment for a week and there were a few weird side effects (muscle aches and feeling shaky). However the side effects are easing and I feel so much better. I suggest speaking to your asthma nurse.

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