Not every breathing symptom is asthma!

[twinkly29]

Tentatively posting this because it’s perhaps controversial on an asthma forum - but it is also really important.

It’s often assumed that any breathing symptom is asthma - those who have asthma assume it’s that because they have asthma therefore it must be that; those who don’t have asthma assume they’ve developed asthma.

Chest tightness, coughing, shortness of breath and wheezing can all be asthma symptoms - but not every tightness, cough, shortness of breath or wheeze are related to asthma. Very often they are not and, when this is the case, the symptoms will not be relieved or cured with asthma medications, however many are thrown at it. Instead they need different kinds of treatments. The conditions themselves and their respective treatments are no less real, no less difficult, no less frustrating or no less important than asthma - but it’s so important to find the right cause and in turn the right treatment so that things can improve. After all, you wouldn’t have your leg put in a cast to solve a gallbladder problem.

It can be difficult to unpick the different conditions because the symptoms can be very similar to those experienced in asthma (hence why they are often called “asthma mimics”). This is made more difficult by the fact that sometimes they occur instead of asthma but sometimes they occur alongside it. In people with confirmed asthma, type and severity of asthma are also irrelevant - there will always be other possible reasons for breathing symptoms.

A personal example is breathing pattern disorder (BPD) which is also known as Dysfunctional Breathing (DB). This is incredibly common in anyone with a known respiratory condition (although it can equally occur in those without one and be mistaken for asthma). It might occur after a virus (such as flu, pneumonia or covid) or a period of uncontrolled asthma - or it might simply develop because someone has had niggly (or quite frankly rubbish) asthma for some while. Basically the body forgets to breathe properly or develops unhelpful ways of breathing which are then unhelpful themselves and cause tightness, shortness of breath, etc. It’s a mechanical issue so asthma medication will not fix it. It's also a very real condition. Very often we are made to feel it's "in our heads", particularly if someone also has anxiety (the conditions can exist together but they don't always) but it just isn't (as any respiratory physio will tell you) and it's also not something one has any say over - it just kind of happens.

I saw a respiratory physio way back who taught me to teach my body better breathing patterns. The exercises were really good and I still use them from time to time. Earlier this year I had covid. I was most concerned that I wouldn’t know what was asthma and what was covid in terms of symptoms - but was surprised and pleased that, when the covid breathing symptoms appeared, they were very very different to my (severe and frequent) asthma symptoms. It sounds odd but I knew they were not asthma because the tightness and shortness of breath feels different and I knew the shortness of breath would not respond to reliever medication. They did, however, respond brilliantly to breathing exercises - done when symptomatic for just a few minutes, the symptoms went away. Of course perseverance was the key as I had to keep doing them when symptomatic but they definitely helped. It might not be as obvious a distinction in everyone (particularly I suspect if someone has more controlled asthma and so isn't used to the symptoms of it flaring), but having different things to try is useful (eg if reliever doesn't help, try breathing exercises).

This page from the British Lung Foundation (BLF) has some really good info on breathing techniques:

blf.org.uk/support-for-you/...

I found the breathing rectangle to be very good when symptomatic but I'm sure everyone will have their own preferences - one exercise a physio recommended just annoyed me so I don't do that one! 😅

Of course, as mentioned above, people experience BPD for many reasons but it’s important to deal with the issue or consider the issue because it could be being mistaken for asthma (in which case it’s not going to get better because no amount of asthma drugs will fix it) or it could be happening alongside asthma (in which case it’s also not going to get better if the asthma itself is controlled and it’s the BPD that needs treating). The country needs many more respiratory physios than it has!

It's worth mentioning here that some doctors/nurses are very clued up about these sorts of conditions - and others are not. This can be difficult as they can, in my experience and in friends' experiences, be either dismissive (not helpful when one needs the right sort of treatment for something!) or sort of lump anything into a "not asthma" heap, without trying pinpoint something specific in order to find a way forward.

Anxiety is another huge consideration - again, symptoms can be physical, very similar to those in asthma (particularly chest tightness and shortness of breath) and often debilitating. But again, the symptoms will not be relieved or removed by any amount of asthma medications so it’s important to deal with the cause of the symptoms. Furthermore, taking the likes of asthma medications might actually exacerbate symptoms if they're caused by anxiety - the meds have side effects that can easily cause further similar symptoms which can make anxiety worse. As with other conditions, anxiety can occur alongside known asthma as well as instead of it.

Asthma UK has a good page on asthma and anxiety

asthma.org.uk/advice/manage...

and EmmaF91 has previously looked into some of the differences of various conditions in this post:

healthunlocked.com/asthmauk...

There are all sorts of other issues that can cause symptoms similar to asthma but the principle is the same:

If you have asthma, it is important to speak to a GP or nurse if you are concerned or things are not as they normally are for you. If you are taking your asthma meds as prescribed but they are not helping/you have persistent symptoms and your peak flow remains good for you (especially if it’s always similar and doesn’t change if it’s done approximately 15 mins after using your reliever inhaler), it’s a sign that asthma may not be causing your current symptoms and they may have a different cause.

Having said all that, I absolutely wouldn’t want anyone with asthma to dismiss symptoms when it could be related to their asthma (and anyone who doesn’t have asthma should be contacting a GP about breathing symptoms). For this reason it’s important to:

• know your own asthma including what is normal for you

• take your meds as prescribed

• monitor peak flow regularly

• follow your action plan (if you haven’t got one, you should have!)

• know when to seek help ( healthunlocked.com/asthmauk... )

Finally, further information on other conditions can be found here

asthma.org.uk/advice/manage...

and the Asthma UK nurses are brilliant and available Monday to Friday, 9am to 5pm, on 0300 2225800.

[17Rose]

What a brilliant post twinkly 29 and thank you for taking the time to write and post it.

[twinkly29 in reply to 17Rose]

Thank you! But also thank you for reading the looooooong post 😅

[Poobah]

Excellent post Twinkly29. Thank you. 😊

[Quizzle]

This is really helpful, thank you. My main concern is the inability to speak suddenly mid sentence, it seems like I've run out of breath. This is so strange when I am not exercising, not feeling anxious, just sat talking to my clients. I will look into your post further.

[twinkly29 in reply to Quizzle]

Vocal cord dysfunction also presents in a similar way to asthma and can cause voice issues or breathing issues when talking. So that might also be something to look at.

[Quizzle]

Ok thanks, hopefully I can find out the cause and from there start to get better.

[twinkly29 in reply to Quizzle]

Yes it's annoying having to play the deciphering game - especially when you're largely having to do it yourself - but important to find out the "what" so you can sort it out as no amount of treatment for the wrong condition will help. Good luck though!

[Rubble86]

Great post, would you by any chance have any suggestions or websites that you could direct me to about asthma attacks and laryngeal obstruction caused by chemicals and fragrance?

[twinkly29 in reply to Rubble86]

Not off the top of my head but will have a look re the laryngeal obstruction/vocal cord dysfunction.

However the trigger or cause for an asthma attack or laryngeal attack wouldn't necessarily affect the strategies used as one should follow their asthma plan for asthma attacks and....do whatever one is supposed to do for vocal cord attacks (I'll have a look what this is although others who are affected may have had support in this area).

The breathing exercises in my original post will be good done regularly long-term for both conditions as it helps to remind our bodies how to breathe generally - but in an acute situation one would need to follow their usual plan for dealing with acute asthma.

[Rubble86 in reply to twinkly29]

Thank you very much for your reply. I did follow the link and found it very interesting.I have an inhaler but have found isn't the ideal treatment when the vocal chords swell. I do deep breathing breath holds etc, between attacks. Also voice exercises for alto and contralto and I try to sing. I find a spot of meditation is good though I usually end up falling asleep, I become so relaxed, even tried breathing through a straw which is said to be quite good for opening those vocal chords but i didn't find it much help during an attack. I do get a sore throat and hoarse voice from time to time for no apparent reason which goes away when I take honey, garlic and aspirin only to return again, so I'm wondering if I have a low grade infection lurking somewhere. Exposure to scents and chemicals pretty much brings on hoarseness and wheezing and that lovely swollen feeling down low in my throat and more recently, pain behind my lower ribs, upper back, and mucus unless I use my inhaler pretty sharpish. (BAH). Interestingly, I don't have any of the vocal problems that some of the other poor people have on this threat and if I stay away from pretty much the rest of humanity, so i really do think my problems are "chemically" induced ;have only had this problem since having an allergic reaction to having used a variant on my usual sun cream on my neck and chest area many years ago (that'll teach me to slap it on thick) , and that has come on slowly until I am where I find myself now; reacting to all sorts of things that I used to use without thinking, medication, washing up liquid, and powders, hair spray, you name it I react to it. . Air fresheners (not that i ever used one thankfully) and my ex favorite perfume are deadly, though I'm guessing that sort of thing goes pretty much aboard for asthma sufferers anyway. Air fresheners, should be banned as they don't actually do anything to freshen or clean the air. It's a sad world we live in today - where many people can't seem to exist unless they can be smelt coming a half a mile off. The UK seems to have gone soft. BAH again. I have also been told by an ENT after having a camera up my nose without being numbed that I have chronic rhinitis, I wasn't told if it was allergic or non allergic, ( do the two conditions look different on a camera??) puzzling because i don't have the classic symptoms and have been told i am "sensitive" to house dust mites and am histamine intolerant by a different consultant who tested me knowing i was taking antihistamine and then told me that the house dust mite sensitivity was of no clinical value, and declined to comment or advise me about histamine intolerance. Please excuse the vent but it feels surprisingly good to have gotten it all off my chest.

I was hoping that you might have heard of something that I could take to prevent the bad reactions, other than an inhaler afterwards and antihistamine which I take daily and find it barely touches it.

Looking forward to your post.

👍

[twinkly29 in reply to Rubble86]

Hi, sorry I forgot to get back to you!

I so agree with the arghhhh to everyone needing to scent things! People walk past, outside, and all you can smell afterwards is a fog of fragra6 - why do people use so much?! And air fresheners, yes! Just horrible and pointless!

Having had a Google, chemicals and fragrances and things like that can be a huge trigger for vocal cord dysfunction - other people may be triggered by other things (like in asthma where it varies too) but chemicals are definitely a common factor. Hoarseness/sore throat is a common symptom too so I guess those symptoms may be a more mild or underlying response in you (as opposed to a more obvious attack which presumably happens at other times).

Unfortunately, like with asthma, some triggers can be preempted and pretreated (such as taking antihistamines) or avoided altogether (eg a particular food one would just avoid it). But others just have to be avoided as much as possible. So for chemicals, at home you can use things you know you're ok with, but it's harder out and about. In those cases it would be more having ways to manage the symptoms when they occur because you can't preempt them always.

The pages I read said that speech therapy and the training they do is very good for longer-term support as it helps the cords not to react or not to react as strongly when they encounter the trigger. Also once you're used to doing them, the exercises should help in situ when you do get symptoms as they relax the cords which is what is needed - I guess mediation helps for similar reasons.

I'm not sure who you ask for support though - GP maybe to see if they can refer to speech therapy (a friend had speech therapy for a laryngeal issue and she's never had problems since, others I'm sure it's more ongoing use of techniques that is needed) or if not if they can refer to a respiratory specialist with an interest in VCD/ILO - I think these might be at more specialist centres (I may be wrong though) but when they've got an interest in such things they're usually pretty good.

The dust mite advice was helpful for you wasn't it?! I was given a fair bit of advice a few years back including damp cloth cleaning, decent vacuum cleaner with HEPA filter, allergy protectors on beds/bedding (the type that zip), using sinus rinse daily like Neilmed (annoyingly that does help hugely with rhinitis stuff - annoying as it's a bit faffy!) I always find it's disturbing dust that causes issues so try to avoid places if someone else is doing cleaning at home such as moving furniture and cleaning behind it, that sort of thing.

But I would try and Investigate speech therapy for ILO stuff if you can. I had it when being assessed for VCD (which the speech therapist decided it wasn't in the end) and the exercises were good anyway so worth a go.

[Penelope321 in reply to Rubble86]

I have the scent issue majorly as well. I work in a school, you can imagine my daily battle in avoiding hand sanitizer in these Covid times. Does anyone think what inhaling sanitizer 10 times a day will do to the health of children in the long run? I only do handwashing with my students. The rest of the building are happily sanitizing with their students all day long.

[Rubble86]

Hi Penelope321, agggh how awful, it must really get you down having to work with substances that we should really all be avoiding but can't. How do you cope with having to work around scents etc. Do you have to wear a respro mask all the time?

The harm that hand sanitisers and other sprays are doing to battle covid is becoming aparent by the number of medical papers and articles that are starting to emerge reporting the growing problems of skin and breathing problems through the use of these things. Our children don't have much of a chance of being allergy free these days.

No doubt there have been studies and think tanks about the long term harm of the use of masks, sanitisers etc especailly to children but I suppose they can't see any other way around the problem at present except spray spray spray to avoid more lockdowns. It must be such a hard desicion for parents, especially those with children with allergies, and other immune system problems, risk your child getting covid because you're forced to send your child to school/ nursery or deal with the allergies that are happening in response to the use of the very things that are supposed to be keeping us safe. Glad I'm not a parent.