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Which inhaler ?

Hi everyone

I gave up smoking 4 years ago and I had no side effects from smoking, I'm currently 52yrs old. I then started training for a half marathon and struggled breathing. I was wheezing, coughing and felt as though I was going to collapse. I went to see my GP and after a few test, and because my mother had COPD, I was diagnoses with COPD. I disagreed with this diagnosis because I nursed my mother with this and I never get out of breath except when I'm running.

However, I continued taking my GP advice and she put me on clenil 200/2 daily straight away. This was my first inhaler and it did help but not completely. I was on this for at least a year and half before I was called in to see the asthma nurse, who I had never see before or been assessed. I told her that I did not have COPD, however, she documented this but thought I was in denial. She changed my inhalers to incruse because I think she realised that I should not have been put on clenil straight away. However, my lungs appeared to be used to have a daily inhaler now even if the diagnosis was wrong. I get mucus stuck in my throat and have to clear my throat a lot and cough a couple of times to clear it. The incruse along with reliever ventolin didn't help, I was running less miles (could run up to 8 miles, now only 2-3 before struggling) before I couldn't breath and had to take my reliever every time I went running. The inhaler was changed again to my current one which is fostair 100/6 along with a tablet called montelukast for hayfever/allergies. My asthma nurse has now told me that she thinks I have "asthma" with maybe a "little bit of COPD !!!! cause the steroid inhalers work best for me. I'm convinced that I only have exercise induced asthma but what do I know. I've been taking inhalers for that long now that my lungs are used to them now. Anyway, I'm still having to use my reliever 2 puffs before I go for a run and have to take it after 2 miles before I can go on and do more. I seem to be doing less miles and deteriorating instead of improving. The fostair 100/6 inhaler is not helping, I shouldn't still have to use my reliever every time I go for a run, should I ? So I've made an appointment for tomorrow to see the nurse again to ask for another inhaler but not sure which one. any ideas ?

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You could ring the Asthma nurses on Asthma UK website for advice.

asthma.org.uk/

Monday to Friday, 9am to 5pm on 0300 222 5800 (Option 1).

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I'm just waiting to see what the surgery nurse comes up with first but I will definitely phone when I've tried everything I can

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You should perform spirometry and reversability test. This will help your doctor to understand if it's asthma, COPD or asthma|copd overlap.

Initial spirometry -> inhalers trial -> Spirometry after a few weeks to see your lung function.

You shouldn't randomly switch between inhalers, some of them are licenced for COPD only and are not suitable for asthma.

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Thanks for your responses. I did initially have a spirometry test but I have only had the one. I've just ran 5 miles, up hill, and after 2 miles I felt dizzy almost as if I was going to pass out. My husband, who was running with me, said I was as white as a ghost. I thought I was going to collapse and die. I took my rescue inhaler ventolin and it did help but this should not be happening. I have been running for at least 3 years and I have ran up to 8 miles, I can't do this now. I will keep you informed tomorrow after I see the asthma nurse, king reagrds

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I, too, think a further spirometry is the way to go, but I guess your first one wasn't terribly conclusive, otherwise you would not have needed to post!

You will find a lot of posts on this forum from very active people who find it difficult to accept that they're ill, because people equate exercise with wellness. As you know, there are many athletes with asthma, though probably not with COPD. Personally, I think you need to be careful with your exercise regime. I have asked Asthma UK in the past whether those who have traditionally been very active should rein in their activity if they have breathing problems; I didn't get a straight answer, possibly because it might seem to contradict the general advice to exercise - you might have more luck with them, given your specific experience.

It is quite possible to get lung deterioration without symptoms. In my case, I started to get incessant winter colds and occasional chest tightness 8 years ago. After 6 years, I was given a peak flow test which showed my lung function to be only 50%; spirometry showed me to have late onset asthma and moderate/severe fixed small airways obstruction (I hadn't even noticed getting to the mild/moderate stage and I've never smoked!). With medication, I only have a mucous problem and I function perfectly OK otherwise, though I couldn't do your sort of running, but never could anyway!

In fact, during the time I had these mild symptoms, I went to the gym with my wife who wanted to lose weight. I couldn't understand why she could improve her time on the CV equipment whereas I couldn't, but I did increase my strength. Afterwards, I felt light-headed, and it occurs to me that this was the result of having poor lung function. I have always had poor stamina, so it is quite possible that my lungs started off poorly anyway, so the deterioration has been more marked. In your case, your lung deterioration would have reverted to normal when you stopped smoking, which is obviously a good thing, but even normal deterioration could tip the balance between having no symptoms at all and starting to get some.

So, in addition to the spirometry, I would suggest contacting Asthma UK and the British Lung Foundation for advice. Hope you find suitable treatment and get back to a level of activity you're comfortable with.

Best wishes

Trevor

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Thanks Trev, I will contact them but I want to have an allergy test first cause I'm sure that's related. I don't want to be taking inhalers long term if I don't need them. It could just be severe allergies, wait and see. Keep you posted. Thanks for your advice

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Good idea. My late-onset asthma was almost certainly due to having hayfever for 50 years. Your eosinophil count (from a blood test) will be raised if you have an active allergic response.

I didn't want to take my preventer inhaler either, and would have settled for Ventolin as and when, but my consultants have been adamant that regular use of a preventer reduces further lung deterioration and, certainly, there has been no decline in two years (though that might be too short a time to judge). I have insufficient medical expertise to argue with that analysis, so I'll keep going until told otherwise.

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Hi I agree with Bobcat. A spirometry test is the definite one to test for copd. Sometimes though you can be very borderline and one moment you will diagnosed with it then the next you will be told you don't have it. I had this when first diagnosed. However I do have it now but fortunately I am only mild.

Many sufferers packed in smoking years before their diagnosis so as an ex smoker it is likely you do have it. But don't panic coz even if you have it you must be very mild if you can run miles like this. Although copd is progressive it rarely progresses quickly so with a healthy lifestyle you can hold it stable for many years.

I only packed in the ciggies last year despite being diagnosed mild at 54 10 years ago and the doctor told me something else would get me first well before copd would ie old age.

I hope this is helpful. x

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Had my peak flow done at surgery and its 400-450. I can hold me breath for 30 seconds when taking my inhalers and I can run miles on treadmill without any problem. My breathing problems started when a started running. I'm convinced that my hay fever/allergies are the main cause. I NEVER get out of breath unless I'm running, poor nurse at the surgery is at the end of her tether. Can't help being a bit complex, ha

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well done for giving up the ciggies xx

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Oh you might also want to join the British Lung Foundation which is also on here as they are extremely helpful. x

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Keep in mind that COPD can be something of a generic term. I was diagnosed at my GPs with it a few years ago & referred to the resp. consultant, but she changed & refined the definition to something more specific after they ran all their tests.

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Practice nurse is considering referring me to resp, is this drastic or will it be beneficial to me ?

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No, I don't think it will do any harm at all. My diagnosis moved through various stages but I ended up with something very specific & therefore getting the right treatment. If I'd stayed with a more general COPD diagnosis, I think I'd have continued to be far more unwell than I am.

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My husband,son and I always use our reliever before exercise despite using daily preventers. It’s pretty normal to still need the reliever for exercise.

Hope you get things sorted. Xx

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My practice nurse said that you should use your reliever inhaler 15 minutes before exercise but you shouldn't need it during running. That's a sign that my asthma is poorly managed. Is she wrong ? xx

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When we have used them prior to exercise, we don’t need them during exercise, although sometimes afterwards, depending on how much we have done.

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I have to use it every time even if I run 4-5 miles or 8 miles. Hopefully the increase in the inhaler will work. If not, I'll see what the nurse says when she phones on Monday. Take care and happy running, stay safe xxx

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hi am a brittle asthmatic have been 40years. Not a Dr but seemed to me u need steriods the weather hasn't helped,maybe try sybicort 400 .2 puffs twice a day or oral steriods hope this helps.lastly u will find ppl that give up smoking for years can also get c o p d .

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Thanks for everyone's contribution. I have just come back from seeing the surgery nurse, she's at a loss when she sees me. She has suggested that I increase my fostair inhaler to 200 morning and evening and continue with the montelukast . I again, asked if I could be sent to have an allergy test as I am convinced that my hay fever/allergies have a huge impact on my breathing when I'm running. I never get out of breath, unless I'm running, but I have always had a runny nose. I can run for miles without any problems on treadmill but once I'm outside I have to stop after 2 mile struggling to breath. This is not a seasonal thing, it's happens all year round and I take a regular hay fever tablet all year round. I can't go anywhere without a tissue at hand as my nose drips. I'M sure it's allergies and exercise induced asthma. The nurse continues to be reluctant and stated that they do not do allergy tests, which I'm sure is not true. I have said that I will pay privately to have this test. She is going to speak to my GP and phone me on Monday to see if I need another xray. She then informed me that she would refer me to the respiratory team at the hospital, seems drastic but must find answers. She is also considering prescribing me an antihistamine nasal spray. I'm increasing my inhaler tonight and going for a run tomorrow so will let you know if it has helped. Kind regards

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Well increased my fostair inhaler last night and this morning and I have just ran 6 miles, trail running through the forest. I did have to stop after 5 miles but I refrained from taking my ventolin and didn't need it. Improved my time as well. I still have to keep clearing my throat and my nose is running while typing this but feel better. I'm going to try a decongestion tablet - Sudafed to see if this helps.

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Based on your history I suspect that your GP is right on COPD. I’m about your age and had asthma since I was kid. Since then I was on preventer. Like you I’m also physically active, playing tennis regularly. Almost 4-5 times per week and each session can last 1-2 hrs. I only use ventolin during flare-up and this is very rare. Maybe once or twice per year. One or two puffs are already sufficient. No need for additional puff during or after the session. You probably need a long term treatment. Good luck.

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If it is a mild form of COPD I can accept that cause I'm running around 15-20 miles a week and doing relatively ok. I just want the right treatment so I can continue to run and keep myself as healthy as I can. Kind regards

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Hi jogger1 I honestly think you need to get a true diagnosis before anymore meds a spirometry test will tell if asthma also ct scan take management and find out what your managing take care xxx

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I am on Flutiform 250 2 puffs twice a day which is managing my day to day asthma, but I still have trouble with exercise. I take two puffs before, always need it during at least once and usually after too. I've tried montelukast which is supposed to be good for exercise induced asthma, but it didn't help. The nurse and GP have no suggestions 🙄

I too used to be able to run 10ks with no problem., now can't manage a mile before my lungs complain, therefore no longer run as it's just no fun. So I feel your frustration!!

I'd be interested to know if you ever get it resolved.

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Deeply sorry to hear this and thanks for your reply. You must get back out there and start running again, just a mile at a time, don't give up. My breathing problems started when I started running and I have still completed 3 half marathons, namely being Hell up North which is tough.

Do you have a salbutamol/ventolin inhaler (rescue inhaler) to use before and during your running, it helps a little. You may be like me and have allergies. I put vasaline on my nostrils and use Beconase nasal spray as well. I do this routinely before ever run.

The nurse has just phoned and she isn't referring me or sending me for another xray. She doesn't think it's exercise induced asthma cause I'm alright indoors on treadmill. She, yet again, said there's no need to get me tested for allergies and the only change is to prescribe me a prescription antihistamine. Hope this works, if it doesn't I will pay for a blood/allergy test myself. I have to contact the surgery in another 6 weeks to see if any changes. I had a great run one day and couldn't run a mile the next day without stopping but once rested could run another 4 mile. Don't know what's wrong and it appears the surgery nurse doesn't know either. I'm not sure if montelukast is helping either, really frustrating. Nurse also said to go back to just 2 puffs of my fostair, use nasal spray, introducing another antihistamine and carry on with montelukast.

I won't get the antihistamine until tomorrow. I'm going for a run shortly but sticking to flat on the canal cause inclines kill me. I'm going to try and do at least 8 miles even if it kills me. I will let you know if I have any changes with new antihistamine if no changes then contacting asthma uk.

Please get back out and try running again. It's not about the time or distance, it's about your health and well-being

Keep well, get running and don't give up xx

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