I’ve been diagnosed with adult onset asthma a four years ago. I’m 54. Diagnosed after a respiratory tract infection- no spiromtry or other tests I’ve read about on here. For the first couple of years I didn’t have symptoms most of the time- only when I had a cold. I could go without Clenil or Ventolin for months. I was only beconase for constant rhinitis. A year ago my mother had a stroke and for a few weeks I was running round like superwoman. When I stopped my health just collapsed. I had shortness of breath, chest pain, chest shaking (only relieved by placing a hot water bottle on my chest), stomach pains and weight loss (without trying). I was told it was asthma flare up put on a few short courses of prednisone, I was also given an endoscopy and diagnosed with gastritis. I was put on omeprazole. Now I seem to have general shortness of breath most of the time and frequent bouts of coughing up sticky phlegm - mostly every evening but sometimes also during the day. I was put on regular Clenil and rescue ventolin. Monteleukast made it worse. Fairly recently my Clenil 200 was swapped for Fostair 100/6. Not sure how much it’s helping. I frequently double up to 4 puffs or add in ventolin but I’m not really sure what lm doing. My peak flow never seems to go down that much (rarely below 400 - when well I remember doing around 500). But I still have symptoms. I’m still in a bit of disbelief that it is asthma. An asthma nurse questioned this recently but seemed satisfied it it was actually asthma when I mentioned the sticky phlegm. I’m very confused. I have been given a rescue pack of prednisone but I’m not sure when to use it. I have a a wheeze now which I’m putting down to catching my son’s cough/cold. Should I be using the rescue prednisone? I’m i in danger of a sudden deterioration?
Sorry for the long post- any advice welcome
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Calmcat
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Is it possible for you to ring your asthma nurse to explain your situation and get clear instructions about when to take your rescue prednisone?
If not I would book an appointment. My GP offers same day appointments if you ring at 8am.
You are certainly unwell at the moment and clearly need advice and possibly some other kind of treatment.
As for it being asthma or not next time you have a review maybe you could ask the nurse about spirometer your. Most GP surgeries now have machines which can perform a simple test to confirm the diagnoses, which might help to put your mind at rest.
As for Fostair, it worked like magic for me, but it is not for everyone . It might be useful to note that the steroid element of it does not have an immediate effect, it takes longer than oral steroids to reduce the inflammation. Again this is something that you can discuss with your asthma nurse or GP when you next go.
In the meantime don’t be afraid to use your blue inhaler but make a note of how many times you need it so you can share the information with your GP or nurse.
Thank you Troilus - so grateful you took the time to respond with such great advice.
I phoned the Asthma nurse at my surgery. She agreed I should start the oral prednisone (day two today). I’m still poorly but I guess it takes a while to work? I have to make an appointment to see her after the steroids finish. That might be a good time to talk about spirometry, a written asthma plan and maybe an alternative inhaler. Is is worth asking for a chest X-ray do you think?
I was told by the A&E doctor that prednisone starts to work immediately, which is probably the case, but it always takes a few days before I notice it. I read in one of your replies that you wondered if it was keeping you awake at night and the answer to that is, yes, it probably is, but it is worth a few sleepless nights to get rid of any inflammation in your airways.
Spirometry gives more information about breathing problems but there is no harm in asking about an x ray,
For most people it takes time for prednisolone to kick in (average is 2-3 days) but if you also have a cold the delay can be longer (because you’re also going to be feeling the cold, not just the asthma... and pred will only help the asthma).
I’d suggest printing off your own plan from the AUK website so that she can just help fill it in for you. It’s definitely worth asking for a spiro (Tho remember if you’re asymptomatic then you may get a ‘normal’ spiro).
I’d also suggest asking to do a sputum pot just to make sure you don’t have anything funky causing it. And if you are asthmatic sputum production is a sign it’s not controlled so swap (or play 😉) around with inhalers until that basically clears up and you don’t have any other symptoms (it’s irritating but with everyone responding differently to meds it really is a trial and error process).
Xray is u likely to show anything with asthma, but it can help rule out some of the other resp conditions.
Thanks so much for taking the time to reply - great idea about printing off my own asthma chart. Will definitely do that before I see the asthma nurse next week. A sputum pot sounds like a good plan too. I have really sticky sputum most evenings ( don’t know why evening is worse?). It’s always transparent or white tho - i always thought that meant no bugs in it but lm beginning to question everything at this stage. I also have chronic rhinitis tho so not sure how much is due to post nasal drip. I’ve been given flixonase nasules drops. Think it’s helping a bit but not sure- daren’t stop using them jic. Getting an accurate diagnosis does seem really important too so I will definitely ask about spiro too. Thanks again- all very helpful - I’ll have a long list of things to bring to my appointment. Thanks also for your advice on the prednisone thread. Have brought forward half my dose to this evening and feeling already!
Asthma and mucus production natural increases at night due to your circadian rhythm and then because you’re laying down you feel and react to it more due to gravity especially if you do have PND because that can pool then make you cough. White/clear is usually a sign of inflammation rather than infections but it’s always worth getting it checked. Hope this explains it a bit
Thanks yes very helpful. I might try to sleep/rest in a more upright position at night for the PND. I think Splitting the prednisone dose helped (I took half last night and second half this morning). I actually got some sleep 🥳🤣. Still got lots of muck in my lungs that I can’t shift tho and I’ve got fine shaking in my hands (I think from the ventolin/fostair?). Thinking about steaming. I know it’s recommended for chest infections but not sure it might make asthma worse
Glad the split help you to sleep. Fostair is notorious for giving tremor when you start it but it usually calms down over time. Same with ventolin.
If you’re ok with hot steamy showers/baths you should be ok to steam with your asthma. Steam is a trigger for some people tho so just be cautious and don’t ‘push through/ignore’ if you do think it’s triggering your lungs
Thanks. I haven’t really noticed baths setting me off (don’t have a shower) in the normal way (when I don’t have a flare up). It’s all a bit new to me tho so maybe I haven’t really paid attention! I don’t think I know any of my triggers yet - it’s all very frustrating - so your advice is very welcome. I might start with a hot bath this morning 😊
Thanks Troilus- I think the prednisone is working now- but like your experience it has taken a few days. It makes sense it’s the prednisone keeping me awake- but as you say worth it to get rid of the inflammation.
Just wondering...Someone on here said that the reason we are told to take prednisone in the morning is to reduce the sleepless nights thing. My asthma always seems worse in the evening- not sure why. I’m wondering if I could try taking the prednisone a bit later in the day? Given I’m not sleeping at night anyway perhaps it might not make much difference and perhaps it would be better to match it to when my symptoms are worst?
You say: "Now I seem to have general shortness of breath most of the time and frequent bouts of coughing up sticky phlegm". These can be symptoms of a common cold followed with a mild chest infection. They are common in a lot of people who have not got asthma.
One thing one needs to take note of is that medical professionals have no engineering training and have little or no understanding into how the body works as a number of engineering systems which interact with each other in unpredictable ways.
It is worth investigating the following therapists for help. An Alexander teacher, a McTimony chiropractor, a breathing physiotherapist, or a sports therapist.
All the above disciplines have a knowledge of how faulty muscular habits lead to poor breathing. Poor muscular habits are quite common following an illness. The medical profession is not good at recognising the issue of faulty muscle coordination that can be corrected.
The truth of the above can only be determined by investigation.
Hi John - I hadn’t considered muscle therapies before- although I’d heard of Alexander TechniqueI hadn’t really thought about it for breathing. I hadn’t heard of McTimony or breathing physiotherapists at all but it sounds interesting. Do you use them or are you a practitioner maybe?What are your experiences if you don’t mind me asking?
I have 40 years experience of Alexander Technique. I have been having McTimony chiropractor treatment on the NHS since 1994.
I have taught better breathing techniques. I am very much aware that tight ribs reduce the ability to breathe well. Have experience of bad cold alter effects creating problematic breathing . This was treated by the McTimony chiropractor.
Thanks John- I think McTimony sounds lovely (as far as I can tell after a quick Google search😁). It’s great you are able to get it on the NHS. Probably a bit of a post code lottery though. I’Il try and see if it’s available in my area.
It makes total sense that stress can tighten up the ribs and prolonged stress could cause asthma like symptoms. It would be so lovely if this could be reversed without drugs! Funds are a bit tight at the moment- if I were to check out private therapy I could only afford a little bit- would I best checking out Alexander McTimony or a breathing physio? (I’m not very sporty so I might be a bit out of place with a sports physio) Can I ask whether you have an asthma diagnosis as well as problematic breathing after colds?
You mention two irritants that are common in asthmatics; rhinitis and treatment for stomach acid (reflux).
Both nasal drip and reflux can reach the lungs so taking Beconase and an antacid can help avoid these known triggers.
Asthma comes in all sorts of guises so health care professionals will put together symptoms and other clues to reach a diagnosis of asthma. Responding well to asthma treatment can confirm the diagnosis.
Stress is a common trigger and when your mother was ill your health took a knock.
And asthma can change too, so at times it doesn't make sense to the patient. Going for years with well controlled asthma only to see a change for unknown reasons and having to try and find a resolution and get back to "normal". Living with asthma can be confusing at times.
I would say that I always ensure that I have a follow up appointment when taking a new medication. There should have been a review after swapping to Fostair.
Someone said on here that their consultant believed that Montelukast is only effective in 25% of asthmatics. Not every asthma med will suit your needs, hence the need to always review about 4 to 6 weeks after starting a new med.
Regarding the prednisolone emergency pack. Your asthma nurse should have given you a written asthma plan which shows you how to act when your peak flow reduces. That includes increasing your prevention inhaler (Fostair), Ventolin use for rescue situations and when to start the prednisolone. Of course you need a peak flow meter and to monitor your PF regularly.
I think you need to write a list of your questions and see your asthma nurse and get them to explain what they expect of you as a new asthmatic - be honest about your confusion. And get a written plan.
If you're currently struggling with shortness of breath and increased phlegm (a wheeze only on breathing out) then the prednisolone will tackle that. However, if your wheeze is evident when you breath in as well as breathing out I would make a GP appointment as it could be a chest infection. You should be able to get a same day appointment as long as you tell the receptionist you are asthmatic with a possible chest infection.
Hi Calmcat, I agree with the advice to contact your asthma nurse and get some guidance. You may also find it helpful to call the Asthma UK nurses who are very helpful and experienced and can talk you through things.
I think it would be useful to monitor your peak flow for a bit and see what it does and what your best is. Especially perhaps notice whether it responds to reliever medication. If it does respond well, that is suggestive of asthma, though ideally you would also have spirometry with reversibility done at some point to confirm.
However, not everyone with asthma finds peak flow the most useful way to monitor - for a start it doesn't capture what the small airways are doing. So if you do have asthma and get a plan for what to do when struggling, it doesn't have to be peak flow based - there have been studies that a good symptom-based plan can work too. It would be worth chatting with the AUK nurses and your asthma nurse about ways to make treatment decisions at the moment if your peak flow doesn't seem to be that helpful.
This is really useful information about peak flow- so if it’s asthma in the small airways then this might explain why my peak flow doesn’t go especially low even though I feel ill? I think I’ll take your advice and monitor my peak flow more systematically for a while . There might be subtle changes that I need to pay more attention to. I’m not sure what percent drop is usually considered significant. Also an excellent idea to call the AUK nurses for advice. Thanks so much for replying. I’m so grateful I found this forum!
Hi, off the top of my head an increase of 12-15% after reliever is usually considered significant (it does depend on which guidelines you read).
You can also monitor variability in peak flow over a few weeks (morning and evening), but this can be tricky to do around meds. I think the significant level for daily variation is 20%. This test isn't essential but it can maybe give a better idea of how you are over time and be something to show your nurse/GP. I do get variability despite my peak flow not always being the most useful of numbers just on its own.
It would be worth asking the AUK nurses about this too and seeing if they have any other suggestions for monitoring. Trying to notice any particular triggers may be helpful if you can.
If you're inclined towards apps there are some where you can track peak flow and symptoms and produce charts, though I find all of them have their limitations. At the moment I'm trying one just called Peak Flow (has a yellow icon) which is quite basic but allows you to set a personal best and to mark whether the reading is pre or post reliever, plus add notes. AsthmaMD often gets recommended but it drove me crazy and I found it unusable.
Thanks- that’s really useful. I hadn’t thought of apps. Can’t find ‘Peak Flow’ on iOS- there are several others - I might steer clear of AsthmaMD though 😅thanks for the tip 🙂
Ahh I have Android. I think there's a better selection on iOS though - I used to use one called something like AsthmaTracker on my iPad. I usually look for ability to set personal best PF, can track whether reading is pre or post meds, can add notes to readings, and can generate a readable graph.
Thanks Poobah. Your advice is very comforting. I think you’re right- it would be great to get a written plan because I easily get confused and panicy when I’m ill. It’s hard to get my head round the diagnosis- it’s like a cold isn’t just a cold anymore- I can’t just go to work and tough it out anymore in case I have a life threatening event. It’s all very scary. I’m also worried about losing my job if I have to take a lot of time off!
On the job front. You are covered by the Equality Act 2010 & as such are entitled to reasonable adjustments at work by virtue of your disability (asthma is accepted as a disability for these purposes). This can take the form of a more flexible sick leave plan, especially if the employer has a written limit to the number of sickness absence days an employee can take. Larger employers have a better idea of their legal obligations.
But you can Google Access to Work, a government initiative that will help you retain work. It's a very useful resource in our circumstances.
Thanks Poobah. I hadn’t heard of the Equality Act 2010. I will definitely check it out. I do work for a big company. I have to start finding the confidence to say ‘no’ to the pressure they put me under to do overtime and work when I‘m sick. It’s not fair because I bend over backwards to help with overtime most of the time - this all seems to be forgotten when I’m ill! (Sorry for the rant!)
You should ask to be referred for spirometry, as it's really the only way to confirm asthma. There is a tendency for doctors to throw medication at a range of different symptoms, without looking at the underlying cause which, in your case would seem to be stress; that will upset your system, and cause all sorts of seemingly unrelated problems.
There's no actual harm in treating the various symptoms if it helps improve your quality of life, because that helps you cope better and relieves some of the stress. However, since the original asthma wasn't confirmed, I think it would be wise to address that properly. In the meantime, you can find the recommended and maximum doses for medication on the BNF website (bnf.nice.org.uk), so you can be reassured that you are using the right amount.
Superzob Thanks so much for this reply. It sounds like great advice. If it’s not asthma it might explain a lot about why my inhalers don’t control my symptoms very well. Spirometry might be the best way to go.
Do they also do chest X-rays do you know? My grandfather (a lifelong smoker) died of lung cancer so I guess I’m worried about the big C (I did also smoke for a few years in my teens and 20s😞)
I certainly had a CT scan at an early stage, but let's take one thing at a time. If the spirometry shows almost all asthma (mainly reversible), then the respiratory consultant may consider a CT scan unnecessary. If there is obstruction in addition to any caused by asthma (ie, fixed obstruction), then you could suggest a scan, if it's not offered, in view of your family history.
Looking back at your initial post, depending on your height, the average peak flow for a woman of your age would be 390-430. You seem to be well within that range, though the "perfect" figure for you may be different. I'm no medical professional myself, but have suffered with stress for years, and it always gets your weakest point; as yours was probably asthma, I suspect the symptoms became more severe without any obvious physical changes.
You may find your body adjusts in time. You've had quite a shock and the adrenaline would have kept you going - you will have crashed out afterwards, which is only natural, and need time to recuperate. Hopefully, any further tests will show nothing serious, you can find a medication which controls your symptoms better, and that will reduce the worry and speed your recovery.
Thanks so much for your understanding. I think you’re right about the adrenaline crash. Your words are very reassuring. I hope I do find a medication that controls my symptoms better (and my worry).Ive heard Symbicort and Spiriva might be better when symptoms are not controlled by Fostair. I don’t like the prednisone- it seems to keep me awake at night- or perhaps I’m just too nervous to sleep. It seems worse when I lie down. I’ve been trying to sleep sitting up.
Ah - i see. That makes sense. Thanks DenBoy. I’ve been taking mine in the morning too (as instructed) but like you I’m still awake at night- very annoying - I’m quite ’Whizzy’ during the day too but I wouldn’t trust myself to do anything mentally demanding! Anythings worth it though if it means breathing a bit easier.
Just wondering if it’s ok to take prednisone at night instead of mornings- my symptoms are always worse at night for some reason and given I’m not sleeping anyway...?
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