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Is it really asthma ?

I'm new to this forum and I've decided to post my questions here because I've been struggling to breathe for 2 months and it's not getting any better. Before I start, I should probably mention that I used to have asthma when I was very little until age 5 and I suffer from allergies. But after that age everything became normal and I never had any asthma attack nor did I need any treatment. I only had trouble breathing after exercise like running but it used to quickly go back to normal without any inhaler. In recent years I noticed that my airways had become more sensitive, for example, smelling perfume or detergent would give me trouble breathing although it still didn't require me taking any medication. But everything changed this February when I got the flu. It just happened out of nowhere and once the infection had taken over my lungs, I would spend hours struggling to breathe, not being able to even leave my bedroom.

This whole time I only had salbutamol to help me through it and it didn't even work most of the time. The second time I saw the doctor he refused to consider that it could be asthma because he saw that my sats were good (99) and the respiratory tests (spirometry) were good and showed I had normal breathing capacity. CT scan and chest x-ray were also good. He then refused to give me any medicine. But I kept feeling worst and even went to the ER once because I couldn't take it anymore and the nebullized me which did work (though my sats were 99 before they nebullized me) and I was fine for a few hours before it all started again. The third time I went to the doctor he finally agreed to give me a medicine called innovair nexthaler and he said that the effects should appear after two weeks of using it. He thinks its anxiety which I know it's not.

My symptoms are tight chest and oppression, feeling like I'm suffocating and sometimes it becomes impossible to take a deep breath. When this happens breathing becomes extremely difficult and I have to struggle to keep breathing and it's exhausting. I normally don't wheeze (my doctor said if there is no wheezing it can't be asthma) except when it becomes too hard to breath I hear a wheezing sound when I exhale. This happens several times during the day in any situation , I often wake up with the tight chest in the morning as if my breathing was blocked. I'm scared and I now feel worried all the time. Even when I start feeling better (and it never lasts very long) I can't enjoy it because I start thinking about the next time it's going to happen to me.

So my questions are :

Is it possible to rule out asthma based on the good sat and spirometry results ?

Is it normal for the salbutamol not to be working ? (sometimes I feel like it works after 30 minutes but I can still feel tight chest and difficulty breathing) ?

If there is little to no wheezing and almost no coughing does it rule out asthma ?

Thank you!

22 Replies
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I can't answer your questions, but I can tell you that I'm in the same boat as you. It's been about 3 months for me and it all started after a bad cold. My symptoms are very much like yours. I find myself trying to yawn a lot as well but it just gets stuck. I hope we can find answers to whatever this is.

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Me too with the yawn thing. It’s maddening.

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I know what you mean about the diagnosis. My asthma is not too bad, however the spirometry test showed slight problems so I was prescribed Fostair. I suffered with a very bad chest infection every winter for about six years in a row but since being on Fostair I now haven't had a chest infection for two years. However, I do suffer from tight breathing sometimes, which isn't attributed to the asthma.

I would suggest that you see a physiotherapist for the breathing problem. My gp suggested it to me. I did a self referral, although that may be different depending on where you live, so if you can't self refer then ask the gp to refer you.

Once you have learnt the breathing techniques, it then becomes a lot easier to differentiate between a medical problem and a panic problem.

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As you’re not getting any clear answers, I suggest you go back to the GP and insist on being referred to a consultant. Even if you did have anxiety, what is happening to help you? Not much. Keep going till you find answers. Good luck!

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Firstly Hannah 125, there are many types of asthma and if you read through the posts you will see the frustration with GP and A&E who if your symptoms don't fit typical asthma then they dismiss as anxiety.

Secondly it is a myth children grow out of asthma, some seem to because children's lungs are not developed and as they grow and then stop growing the lungs learn to better cope with triggers.

That does not mean the asthma disappear.

My mum (77) and aunt (68) both suffered bronchitis when young both later told misdiagnosed it is asthma.

My aunt was ok for many years and after a bad bout of Pneumonia about 20years ago the Asthma stayed and got worse.

I did not have asthma as a child it developed at 15 and got diagnosed at 19.

Many asthmatics on this forum have no wheeze.

Asthma, Hayfever and eczema are linked conditions so if you have allergies this could be a trigger for your asthma.

For me my asthma is triggered by - cigarette smoke; exercise /activity; grass pollen; dust; and the biggy Respiratory infections.

If you put in search no heeze you'll find a lot of asthmatics.

Also oxygen 99% - oxygen levels have nothing to do with asthma - read some of the posts on here there are plenty of asthmatics with good Sat's. Mine sitting and standing is always between 97-99 it's only lying down my Sat's drop. (Note I have OSA which is where you stop breathing in sleep and wake up feeling like suffocating).

Spirometry tests show you on a given day.

Do you have a peak flow meter?

You blow into it 3 times and take best reading of 3. If you do your readings 3 times a day over a period of time it is a better indicator. Do it on a graph put a dot against the reading and join the dots. If you get up/down or peaks and troughs this is indicator of asthma. If it more level then breathing well controlled.

Note don't get hung up on the PF numbers there are expected readings but asthmatics norms can be better or worse it's about whether it stable or up and down.

Best option see a different GP in your surgery, explain had childhood asthma and your current problems and push to see a specialist

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Look up eilo and see if this fits your description, apparently commonly mistaken for asthma

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See the following post

No wheeze, Good Sats, 'Clear lungs' But severe attack for me last night

Bods4

4 days ago•5 Replies

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Thank you for all your answers!

I do have a peak flow meter but I think it is for children (I bought it from a pharmacy and they only had this one) so I ordered a new one from amazon.

Last time I saw my doctor I told him I had trouble breathing the night before and once he did the breathing tests and they were good he said it was almost impossible for it to be asthma. He said there was no way someone with asthma would have good results a few hours after an attack.

My next appointment with him is in two months and until then I am trying innovair. Has anyone here ever tried this medicine ? How long does it exactly take for it to work ?

Thank You!

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In your original post you say

My symptoms are tight chest and oppression, feeling like I'm suffocating and sometimes it becomes impossible to take a deep breath. When this happens breathing becomes extremely difficult and I have to struggle to keep breathing and it's exhausting.

In you bit above you say you told you GP had trouble breathing the night before.

If most of your symptoms are at night then I think OSA obstructive sleep apnoea is a high possibility and feeling like you are suffocating is typical.

It doesn't always affect when you are asleep you can be awake but lying down or even on the sofa lounging and the suffocating feeling starts.

I can't work out how to copy and paste link so this is what NHS says about it

Obstructive sleep apnoea (OSA) is a relatively common condition where the walls of the throat relax and narrow during sleep, interrupting normal breathing.

This may lead to regularly interrupted sleep, which can have a big impact on quality of life and increases the risk of developing certain conditions.

Apnoea and hypopnoea

There are two types of breathing interruption characteristic of OSA:

apnoea– where the muscles and soft tissues in the throat relax and collapse sufficiently to cause a total blockage of the airway; it's called an apnoea when the airflow is blocked for 10 seconds or more

hypopnoea– a partial blockage of the airway that results in an airflow reduction of greater than 50% for 10 seconds or more

People with OSA may experience repeated episodes of apnoea and hypopnoea throughout the night. These events may occur around once every one or two minutes in severe cases.

As many people with OSA experience episodes of both apnoea and hypopnoea, doctors sometimes refer to the condition as obstructive sleep apnoea-hypopnoea syndrome, or OSAHS.

The term "obstructive" distinguishes OSA from rarer forms of sleep apnoea, such as central sleep apnoea, which is caused by the brain not sending signals to the breathing muscles during sleep.

Symptoms of OSA

The symptoms of OSA are often first spotted by a partner, friend or family member who notices problems while you sleep.

Signs of OSA in someone sleeping can include:

loud snoring

noisy and laboured breathing

repeated short periods where breathing is interrupted by gasping or snorting

Some people with OSA may also experience night sweats and may wake up frequently during the night to urinate.

During an episode, the lack of oxygen triggers your brain to pull you out of deep sleep – either to a lighter sleep or to wakefulness – so your airway reopens and you can breathe normally.

These repeated sleep interruptions can make you feel very tired during the day. You'll usually have no memory of your interrupted breathing, so you may be unaware you have a problem.

When to seek medical advice

See your GP if you think you might have OSA.

They can check for other possible reasons for your symptoms and can arrange for an assessment of your sleep to be carried out through a local sleep centre.

As someone with OSA may not notice they have the condition, it often goes undiagnosed.

Read more about diagnosing OSA.

Causes of OSA

It's normal for the muscles and soft tissues in the throat to relax and collapse to some degree while sleeping. For most people this doesn't cause breathing problems.

In people with OSA the airway has narrowed as the result of a number of factors, including:

being overweight – excessive body fat increases the bulk of soft tissue in the neck, which can place a strain on the throat muscles; excess stomach fat can also lead to breathing difficulties, which can make OSA worse

being male – it's not known why OSA is more common in men than in women, but it may be related to different patterns of body fat distribution

being 40 years of age or more – although OSA can occur at any age, it's more common in people who are over 40

having a large neck – men with a collar size greater than around 43cm (17 inches) have an increased risk of developing OSA

taking medicines with a sedative effect – such as sleeping tablets or tranquillisers

having an unusual inner neck structure – such as a narrow airway, large tonsils, adenoids or tongue, or a small lower jaw

alcohol – drinking alcohol, particularly before going to sleep, can make snoring and sleep apnoea worse

smoking – you're more likely to develop sleep apnoea if you smoke

the menopause (in women) – the changes in hormone levels during the menopause may cause the throat muscles to relax more than usual

having a family history of OSA – there may be genes inherited from your parents that can make you more susceptible to OSA

nasal congestion – OSA occurs more often in people with nasal congestion, such as a deviated septum, where the tissue in the nose that divides the two nostrils is bent to one side, or nasal polyps, which may be a result of the airways being narrowed

Treating OSA

OSA is a treatable condition, and there are a variety of treatment options that can reduce the symptoms.

Treatment options for OSA include:

lifestyle changes – such as losing excess weight, cutting down on alcohol and sleeping on your side

using a continuous positive airway pressure (CPAP) device – these devices prevent your airway closing while you sleep by delivering a continuous supply of compressed air through a mask

wearing a mandibular advancement device (MAD) – this gum shield-like device fits around your teeth, holding your jaw and tongue forward to increase the space at the back of your throat while you sleep

Surgery may also be an option if OSA is thought to be the result of a physical problem that can be corrected surgically, such as an unusual inner neck structure.

However, for most people surgery isn't appropriate and may only be considered as a last resort if other treatments haven't helped.

Read more about treating OSA.

Complications of OSA

The treatments mentioned above can often help control the symptoms of OSA, although treatment will need to be lifelong in most cases.

If OSA is left untreated, it can have a significant impact on your quality of life, causing problems such as poor performance at work and school, and placing a strain on your relationships with others.

Poorly controlled OSA may also increase your risk of:

developing high blood pressure (hypertension)

having a stroke or heart attack

developing an irregular heartbeat – such as atrial fibrillation

developing type 2 diabetes – although it's unclear if this is the result of an underlying cause, such as obesity

Research has shown someone who has been deprived of sleep because of OSA may be up to 12 times more likely to be involved in a car accident.

If you're diagnosed with OSA, it may mean your ability to drive is affected. It's your legal obligation to inform the Driver and Vehicle Licensing Agency (DVLA) about a medical condition that could have an impact on your driving ability.

Once a diagnosis of OSA has been made, you may be advised to stop driving until your symptoms are well controlled.

The GOV.UK website has advice about how to tell the DVLA about a medical condition.

Preventing OSA

It's not always possible to prevent OSA, but making certain lifestyle changes may reduce your risk of developing the condition.

These include:

losing weight if you're overweight or obese

limiting how much alcohol you drink and avoiding alcohol in the evening

stopping smoking if you smoke

avoiding the use of sleeping tablets and tranquillisers

Page last reviewed: 14/07/2016

Next review due: 14/07/2019

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Diagnosis

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I have something similar to you, I am asthmatic but it doesnt normally cause me any problems. About a year ago I had a bad virus and had shortness of breath SoB I thought it was asthma but after realising my ventolin didnt work and my peak flow was normal my Dr thought it wasnt asthma.

I have had a few tests and im seeing a ent next week.

My best guess is its silent reflux (LPR) or vagus nerve issue.

Other possible conditions that mimic asthma are vocal chord dysfunction VCD, cardio vascular issue and possibly stress.

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You should have been given a reversibility test at the spirometry to check for asthma. if not, perhaps you need to go back. If the spirometry showed no reversibility, and the CT scan and X-ray were clear, then you may have an unusual condition which GPs will find difficult to treat. You may wish to see another consultant, which you would be entitled to do under the current NHS guidelines - like all people, consultants and doctors have different experiences and opinions but, if you search around, you may find someone who has experience of your particular symptoms/condition. I hope you get to the bottom of it soon.

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Last time I saw the doctor I believe he actually did the reversibility test. He measured my breathing before and after taking ventolin and apparently it didn't change anything according to what he said. Does that mean it can't be asthma ?

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I suspect this is what is foxing the doctors: you pass all the tests, but you clearly have a problem (I've had the same issue with prostatitis and IBS - there's obviously something wrong, but nobody knows what it is!). It's very frustrating, but I think you need to keep going back, either to the same consultant, or try a new one. Sometimes, it's just worth trying some medication in case it works, rather than have it refused because it doesn't fit your symptoms exactly. Doctors are very wedded to tests, but sometimes you find one who is able to "think out of the box" and prescribed something which may help.

I realise this is probably not what you want to hear, but there are medical conditions which are difficult to pin down and treat - but that doesn't mean you won't find someone who can treat it.

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See a different GP in the practice and ask for a Respiratory referral.

Check the PF readings

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I don't think this doctor knows much about asthma, but is making definitive statements which aren't true. 'No wheeze no asthma' as others have said is not at all true (severe asthmatic here, almost never wheeze). Also, if you were ok when you did the spirometry, even if you weren't the night before, you would probably have ok results - not at all true to say you have to still be bad on spirometry, asthma can be very variable even over hours, and many even severe asthmatics can have normal spirometry if they are not symptomatic. The sats are irrelevant (see the post about good sats that was mentioned above for an explanation of why these aren't that relevant in asthma. I can have a bad attack with normal sats). Chest X-ray and CT rule out some other lung diseases but not asthma - they're generally normal even in someone with severe asthma, though there might be some subtle changes during an attack.

I agree that you should see a different doctor if you can (are you in the US? You said ER not A&E...so not sure if you're outside the UK and have a different system), and push for a reversibility test - and don't let them stop it after the first part if it's 'normal'. Not everyone has the predicted best, especially if you do a lot of exercise, and the point of reversibility is to see if you can do 'even' better with Ventolin which suggests asthma even if the starting value was 'within normal range'.

I have to say that while I'm not a doctor and this is a forum, and you should also be open to other things, asthma does seem like a very strong possibility here and you should keep pushing and not let this doctor tell you it's impossible for reasons which aren't true. I say this partly because your story sounds quite a bit like mine - I had mild asthma diagnosed at 7, mostly went away until I got swine flu and ended up the way you feel now, and I also react to scents and exercise (plus weather, smoky things, and sometimes exercise). I also found that I had a period when anything I did made me breathless and exhausted - even just a short walk. During this period I had a similar experience to you and wasn't on any preventive meds. I tried several and they didn't seem to help which of course strengthened the view that it wasn't asthma - I can see why but it's not uncommon to need to try a few before one works. I ended up on Symbicort which *did* help. I also found that when I didn't have any preventer meds, my Ventolin didn't seem to help much and again this suggested no asthma to them, but I think was more likely that there was just so much going on that it had too much to deal with. I'm more severe now than I was at the start and on more meds, but my Ventolin generally helps me every time these days - if it doesn't, or wears off quickly, it means my asthma is flaring.

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The doctor I see is actually a pulmonologist but I too think he ruled out asthma too soon just by seeing my sats and spirometry were normal. I have been struggling with my breathing this past week so I decided to go see a new specialist this thursday. The worst thing about this is that I still have no way of stopping the chest oppression and limited breathing even when I take 2 puffs of ventolin every hour. Sometimes it will make me feel a little bit better for 15 to 20 minutes before the chest oppression starts again. Part of me thinks it is asthma but at the same time I wonder why it almost never stops and why ventolin doesn't work.

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Pulmonologists who aren't asthma specialists (and even some who say they are!) can be shockingly ignorant about asthma, even the basics - I've had more than one senior respiratory specialist tell me that asthma has to have a wheeze and it's just not true. You may turn out not to have asthma, but I have to say I'd be sceptical of anything the doctor you have already seen says about asthma given he's already been wrong about the wheeze, the spirometry and other things! I hope your new specialist is much better and listens properly rather than being dismissive based on false information.

I've been in your position so I know it is really hard to have the symptoms and also be second-guessing yourself along with the doctors doing it! I'm hoping they keep trying until you find out what the problem is. I realised after I posted that what I should have mentioned is me trying various different preventer inhalers and not getting anywhere till I tried montelukast, which was the first thing that really helped, and also helped my reliever to actually do something. Supposedly it doesn't help non-allergic asthma but my asthma isn't allergic and it definitely helped me! I'm still on it alongside various other things and it still helps a bit though not as much as it did. Montelukast may do nothing for you, but I wanted to share that to show that the approach of 'try on one preventer and if it doesn't help it's not asthma' definitely doesn't work for everyone.

Crossing fingers for your appointment, hope you let us know how it goes if you can.

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I see that it is rather common for asthmatics to have their symptoms triggered by viruses like the flu even if they didn't have any breathing problem before. If it turns out that it is asthma that was triggered by the virus, does it mean that it will just take a few months to settle down and then go back to normal or does it mean that I'm now stuck with it for the rest of my life ? I mean, once the condition reappears, can it go away again after some time?

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Hi Hannah ...I too had asthma when i was a child and it went away into late teens , and all my adult life ive ran competitively and rode and raced bikes and then i went through a trauma 3 yrs ago where my marriage ended and my running then started to suffer and I couldnt get enough breath to fill my lungs under hard exercise it was like they wouldnt open enough anyway the hospital say its Asthma...but anyway less of my issues ...I have no wheezing or coughing and they still say ive got asthma so that kinda answers one of your queries ....sorry i cant be more helpful x

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Hi everyone!

So, I had my appointment with a specialist in thursday and I thought I'd let you know how it went. He took me more seriously than the other doctors I had been to and he once again made me perform breathing tests which were once again normal (but this time I had used ventolin only 2 hours prior to the appointment since I had an attack and I couldn't do without it). Apparently he didn't worry about the fact that it could potentially change the results. I told him my problems started when I had the flu in february but I was surprised to hear him say that it was unlikely to be the cause of it since it happened 3 months ago.

He gave me seretide to take for 3 months. He also gave me nebulizer (atrovent + bricanyl) for a month. I admit it was me who asked him for the nebulizer since I can't seem to control my attacks and I'm having trouble breathing almost all the time even with ventolin. I'm a little worried about it because my heart already beats really fast due to all the ventolin I take (at least 10 puffs every day) and I'm afraid the nebulizer could make it worst.

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HI, glad this doctor was more helpful! Do you mean that he took the Ventolin into account when he looked at the breathing tests so didn't say you couldn't have asthma because the tests were normal? Good to know if so that he can take that into account.

I'm a bit surprised to hear he said it couldn't be the flu causing it - but perhaps he meant that it wasn't just a hangover from the flu/post-viral ie he thought it was asthma or something else. I would say that it's totally possible for the flu to have reactivated asthma (since you said you had it when you were little) and for that still to be going on - at least based on my experience! I'm not sure if they 100% understand how it all works yet, but there is a lot of work being done on how viruses affect asthma - mine hugely overreacts even now to a cold, and I *really* don't want to test it with flu (I get the jab religiously for whatever protection it can offer, and haven't had flu since the one that set things all off -really do NOT want to see how flu would mess with this now!

Re the heart rate: yes Ventolin does increase it, but what you often don't get told is that so will asthma. I can find that with a neb my heart rate will actually go *down* because I'm not having to work so hard to breathe. Back when I was in the early stages with all this I had pretty much given up on taking Ventolin for a bit as it never seemed to do anything, but my resting heart rate was 112 and went to 145 after a short slow walk so I got sent to a cardiologist, and was told it was likely due to the asthma. My heart rate is normal now unless asthma is flaring when it goes up, and will stay up for hours even after nebs, but come down as I get better. Hope that helps!

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Yes, I really think that the flu is responsible for the problem I have. But I've been wondering if the asthma flare up can last for months before getting better or if it always remains the same ? How long did it take you to recover from it ? Because it's been 3 months for me and sometimes I even feel like it's getting worst (my attacks last longer and I've had 2 this week with a lot of wheezing). Ventolin doesn't always seem to work and when it does it usually lasts one hour before I have to take another puff (I take at least 8 puffs a day which I've read is the limit). Even basic activities like walking around my house, taking a shower or just doing the dishes have become a nightmare and as soon as I start to move I feel my chest tighten and I have to stop everything I'm doing.

According to this new doctor I saw, my asthma doesn't impact my breathing capacity and my lungs seem to function normally. But I'm having trouble breathing and asthma symptoms almost the whole day long. So, could this be a sign of sever asthma ? Is it possible to have a severe asthma even with normal breathing test results ?

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