Anyone know much about asthma attacks? Can I talk to you about DD?

[MartinLaunderette]

DD1 (aged 14) was diagnosed with asthma about 1 or 2 years ago and is on preventer and reliever inhalers, which she takes as required.

She was taken to A&E twice in the last couple of weeks, from school. The first of these attacks was brought on by very strenuous outdoor exercise. She had steroids prescribed, had her medication reviewed and after the second attack, she took several days off school. She was very well whilst at home, with no symptoms at all, and has also been seen by the GP who was happy with her, peak flow was at its best, her chest was clear. So we sent her back to school today and she had another asthma attack, resulting in a 3rd trip to A&E. She was doing very little at the time, just in a lesson, nothing strenuous. An ambulance was called and she was taken to A&E again. She recovered quickly, and by the time I reached the hospital, she was fine, same as the previous attacks.

Today, when we were discharged from A&E, the doctor said he did not think her attacks were asthma attacks and said he thought she was having panic attacks. He said if it was a severe asthma attack, she would not recover so quickly and she would still be quite symptomatic a couple of hours after last taking any meds, once the drugs she was given by paramedics had worn off. However the medical staff at her school thought it was the worst asthma attack they had ever seen. They thought she was going to suffer respiratory arrest. The paramedics were also clearly concerned because they put an IV line in to give her the drugs. Understandably, school don't want her to go back now until we have a lot more information about what is causing this.

So we have two very conflicting stories about what is going on. I am happy to get her treatment for anxiety, and am open to exploring this hypothesis - she can get quite anxious - but there hasn't been anything majorly stressful going on recently, a bit of normal girl drama with her friends, but I'm not sure if this is really at the heart of it. In the meantime she can't go to school, in case it happens again. I am also going to ask for a referral to a respiratory specialist tomorrow, to see if we can get to the bottom of it.

But what I wanted to know if anyone here has experience of asthma, does this sound like an asthma attack or not? Do you think panic can mimic or escalate an asthma attack like this?

Thanks in advance for any insights.
(Have name changed. DC know my usual username)

[giraffescantboogie]

Hi, there is a good parents of asthmatics thread you could try. Also Asthma Uk are good to phone and chat.

What are her symptoms during recent attacks?

Did hosp check her oxygen levels?

Hormones can affect asthma - worth thinking about given her age.

She could have both asthma AND panic attacks - which makes things even more confusing.

Sorry am asking more questions than am answering! What does dd think?

Am a brittle asthmatic myself.

[MartinLaunderette]

thanks giraffes

What are her symptoms during recent attacks?
Chest tightness and breathlessness I guess. I haven't actually witnessed any of the recent attacks but the nurse at school said it was terrifying and that she had a stridor (?) the whistling noise that people sometimes make when they can't breathe.

Did hosp check her oxygen levels?
By the time she got to hospital her oxygen levels have been high 90s, 98% I think.

What does dd think?
DD is a bit pissed off I think, and embarrassed to be told yesterday by a doctor that she is suffering from anxiety and not asthma attacks. Feels guilty that its all her fault. She doesn't feel like it is psychosomatic, but the evidence seems to suggest it is. I think she is willing to try out some psychological interventions, relaxation exercises etc.

[wfrances]

as far i m aware panic attacks dont cause wheezing, whistling sounds(i have had them my self) that sound is usually the airways closing.
dd makes that sound during an asthma attack ,and dp when he comes into contact with cats (very allergic)

chest tightness and breathless -definately in both.


what was her 02 levels in school the ambulance should have done it before treatment?

[Carrie5608]

I would second that panic attacks don't cause stridor. Stridor is quite serious. The current guidelines are that Asthma in children should only be diagnosed by a Paediatrician. She should be seen by a paediatric respiratory specialist ASAP.

In the meantime Boots pharmacists do an Asthma medicines use review where they check inhaler technique and use a device to show how hard to breathe in to get drug in correct part of lung.

It could be allergic type reaction. It might be worth asking GP if a ttial of an antihistamine is wirth considering.

Be careful about passing it of as panic attacks. You need a proper diagnosis.

[MartinLaunderette]

thanks folks.
Carrie I agree we need to see a respiratory specialist, her original diagnosis was by an asthma nurse and was purely based on variable peak flow measurement. I am not sure at 14, if she will see paediatric or adult. I am waiting for a call back from the GP for the next steps. I am not going to just assume it's panic, because her life is at stake. interesting about allergy. She has no formal allergy diagnosed, but she does get hayfever in the early summer. Maybe it's some sort of pollen or mould she is not be exposed to at home, because it's not happening at home.
wfrances, don't know the o2 level before treatment, I have just emailed the nurse at school to see if they have this info. If not I will phone the A&E department but they seem a bit chaotic, so I'm not sure if they will be able to tell me.

[RachaelAgnes]

I have asthma, from personal experience I have two types of attack, both come in v quickly, both quite severe, oxygen levels dip right down.

I go to hospital each time, and have been admitted each time!

Sometimes it can take me up to five days to get back on track, oxygen levels back up, and feeling well, others once I have had a nebuliser, with an hour or so I'm fighting fit!

I was officially diagnosed with asthma two years ago, prior to that my GP had diagnosed me with panic attacks (that were relieved by using an inhaler )

Think a formal diagnosis is necessary!

[MartinLaunderette]

Just found out her o2 saturation was 90% measured by paramedics. Respiratory rate = 14 (normal?) and pulse = 100.

[wfrances]

thats low
ive been back and forth hospital lately due to pneumonia and they get concerned when they drop below 95
95 -100 is normal
i think 14 resp rate is normal
which is usually higher in a panic attack - because you breathe too quickly

can your gp refer her today to the hospital for assessment?
we have an consultant led assessment medical unit for emergency gp referrals
whos job it is to get to the bottom of things like that.
your usually there all day - but they do most tests there and then and diagnose before you leave

[Carrie5608]

I am far from an expert but I don't think that pulse rate fits with panic attack. People with panic attack usually have a racing heart rate above 120 sometimes much higher.

[capercaillie]

I get exercise induced asthma - particularly bad if very strenuous or not a chance to warm up properly. Comes on quickly and goes quickly once I've had my inhaler. Same could be true with what ambulance would have administered which gets it to the lungs much more effectively. I tend to take my blue inhaler before a run or very strenuous session which does help.

Stress doesn't help asthma either in the situation you describe.

Exercise induced asthma doesn't get a lot of attention - for years I thought I was just unfit. Now I know that I'm fitter, then the asthma part is more noticeable unless it's controlled well.

[Carrie5608]

Hi OP just wondering how things are now for your Dd?

[MartinLaunderette]

Thanks for asking. She is fine. She has been at home with me.all week, and has had no symptoms whatsoever. She is quite annoyed still about being told it was panic. She says she is fine at school and that home is more stressful, and the attacks have only happened at school. We have an appointment with a paediatric respiratory specialist tomorrow. I am wondering if when she has these attacks she is hyperventilating, but this is only really after a consultation with Dr Google about hyperventilation syndrome. So I have an open mind. I am hoping they will test her for allergies.

[anotherdayanothersquabble]

It will be interesting to see what they can do to test for allergies as she could be reacting to something environmental or chemical at school. Regardless if whether it is panic related, allergy triggered or something else, Butekyo breathing might be worth looking into. It doesn't work for everyone (no idea why) but it does for my DS, his O2 levels go up immediately on getting him to follow the nose breathing exercise. His asthma is triggered by allergies which are mostly chemical.

[MartinLaunderette]

Consultant was fairly certain that anxiety is playing a big role and doesn't think her asthma is severe. She is being referred on for respiratory physio to look into her breathing. She is also going to have a lung function test involving a treadmill and she's also getting tested for allergies. So lots happening.

anotherday, Did you teach your DS the Butekyo breathing yourself? Or did he see someone about it? I would like her to try that. I am wondering if the physio will do something like that with her.

[anotherdayanothersquabble]

I bought a book, Close your mouth by Patrick McKeown and taught him myself. There are also lots of you tube videos. On a separate occasion he had physio which helped at the time but she didn't teach him how tany techniques to use himself.

[anotherdayanothersquabble]

We bought an O2 monitor from amazon which helps me to know we are getting things under control.

[BarbarianMum]

A 90% oxygen sat is not caused by a panic attack. During panic attacks people breath too quickly and get too much oxygen - hence all the breathing into brown paper bags.

[MartinLaunderette]

DD is still having the attacks at school. We are pretty sure now that she has vocal cord dysfunction. Does anyone have any experience of this? Apparently this is often mistaken for severe asthma.

She is definitely not hyperventilating, and her stridor is mostly on the in-breath rather than the out-breath, so it's not an asthma attack (although confusingly she does seem to have mild asthma as well). She has had one session of physio so far, to try to improve her breathing technique, and she is having counselling to address underlying anxiety.