To be unsure of this asthma diagnosis?

[MrsMigginsMate]

AIBU to think my doctor hasn't quite got this one right? DD 8 is now on inhalers for asthma but her symptoms don't seem consistent.

Her "attacks" usually happen in the evening as a sort of afterthought right at the end of our bedtime routine, she very calmly says she feels like she can't breathe whilst breathing perfectly normally.

Yesterday she biked for miles in cold wet weather and didn't have any symptoms until 5 hours later at bedtime she said her chest hurt and asked for Calpol thinking it was muscular. Instead I offered the blue inhaler which seemed to instantly fix it which perhaps suggests there is a tightness in her chest from it.

For context she is a bit of a hypochondriac child and does enjoy the attention she gets when ill, so part of me thinks she is fabricating it all. But obviously i don't want to take any risks by jumping to the wrong conclusion so I will continue with the inhalers, but it doesn't feel right.

Can anyone with experience of asthma tell me if this is normal?

Surely the doctor has performed the usual tests? They won’t have done a diagnosis purely on what the child has said.

To add to my first post. I am asthmatic, I don’t have attacks. But I think feelings is shortness or breath can come at any time and different people have different triggers, I came to think that pollution was my trigger as now I live in the countryside and no longer go into the city to work, I rarely even use an inhaler.

Careful here, you can develop a habit of thinking you have a tight chest until you take your inhaler- like a addiction if that makes sense?

Could be asthmatic, could be very mild panic attacks or anxiety. Has she ever been on a oxygen count machine and her oxygen levels low?

I don't know about asthma specifically but I do know of someone who had a few episodes of breathing issues as a child which was put down to asthma. Years later he had a huge fight on his hands to have it removed from his medical records as it was stopping him being able to join the forces.

Asthma isn't always consistent. A night time dip is common I think, she may be expressing her tight chest feeling as 'I can't breathe'. Exercise might not be a trigger for her but going from cold to warm might, hence why she said she needed inhaler after coming home, could she have been wheezing for a while and just not told you until she thought about it later so it made her chest hurt?

It must be hard if you think she likes the attention it gets her, but personally I'd rather give an inhaler than risk an escalation or an asthma attack. Does she take something morning and night or is it just a blue inhaler she's got?

She is supposed to have tests at the hospital but it's all paused due to covid so yes, unfortunately the doctor is basing this purely on what she's saying which worries me. Its a sort of trial at the moment for a couple of months and then the GP will ask us if it's helped.

She is a bit prone to panic due to some health issues she had earlier in life, in particular recurrent croup which genuinely did stop her from breathing and required her to be on a ventilator, she can be quite jumpy about breathing issues as a result of this trauma I think.

Could there be something environmental she is being exposed to in the evenings, which is setting it off? Asthma is often allergy based. I ask this because I have mild asthma and it is triggered by certain pollens, pollution and aerosols. I don’t exactly have asthma attacks as such, but my chest feels tight and I can get hay fever like symptoms. The inhaler does relieve the chest tightness.

@ZeldaPrincessOfHyrule

Asthma isn't always consistent. A night time dip is common I think, she may be expressing her tight chest feeling as 'I can't breathe'. Exercise might not be a trigger for her but going from cold to warm might, hence why she said she needed inhaler after coming home, could she have been wheezing for a while and just not told you until she thought about it later so it made her chest hurt?

It must be hard if you think she likes the attention it gets her, but personally I'd rather give an inhaler than risk an escalation or an asthma attack. Does she take something morning and night or is it just a blue inhaler she's got?

She takes a brown inhaler morning and night and the blue one for when she feels it's flaring up. She's managed not to use it most of the time and only has it two or three times a week.

Weirdly she doesn't ever sound wheezy, I've listened to her chest and I know the sound because my sister was severely asthmatic as a child but I can't hear any wheezing at all with DD.

@Captnip500

Could there be something environmental she is being exposed to in the evenings, which is setting it off? Asthma is often allergy based. I ask this because I have mild asthma and it is triggered by certain pollens, pollution and aerosols. I don’t exactly have asthma attacks as such, but my chest feels tight and I can get hay fever like symptoms. The inhaler does relieve the chest tightness.

Good thought but I'm wracking my brains and can't think of an external trigger. The main trigger seems to be positional, so lying down brings on the chest tightness.

I might try making her lie down on the sofa to watch telly in the day to double check if the position is doing it.

Do you have a peak flow meter? Readings at different times of day, including when she is feeling like she cannot breathe (before and after inhaler) would help to see what is going on.

House dust triggers my asthma.

@Rhubarbe

Do you have a peak flow meter? Readings at different times of day, including when she is feeling like she cannot breathe (before and after inhaler) would help to see what is going on.

Yes she has a peak flow meter to do morning and evening but I never thought to test it before giving her the blue inhaler, I will definitely try this thank you.

Keep a detailed record of when she asks for the inhaler, what happened before she asks for it, any activity earlier in the day and her mood. You should realise quite quickly if it’s emotional / anxiety / attention seeking, or perhaps more to do with exercise.
Some people find the feathers in their pillow set them off?

That's a good idea @Againanothername , I am inclined to think she asks for the inhaler only when tired or upset so there could well be an emotional aspect but I need to keep a diary to know for sure.

I agree with PP, pending diagnosis for asthma without diagnostic tests such as reversibility spirometer, a peak flow diary should definitely be kept. If you weren't given one from the GP surgery Asthma UK has them available.

These are really useful for spotting patterns and helping to identify triggers inhaler usage etc.

Asthma Uk has some great info and support forums.

Also depending on the type of inhaler used consider requesting a spacer device which makes the aerosol powered inhalers easier to use and more effective.

To second what Rhubarbe said get her a peak flow meter (prescription item so a request to a doctor) print off a peak flow diary available free from asthma uk and other sources and start charting peak flow: this is what will tell you if the experienced symptoms are asthma or something other. Understand the baseline reading which will be what she records when feeling absolutely fine (mine is 450 for example as an adult female) and then use this to track whether the asthma is causing a problem: if it’s asthma you literally can’t achieve a normal peak flow reading (I was told if it drops to 100 below my normal reading I should seek help for example) so it will be lower than normal if it’s asthma based. Keeping the diary over a number of weeks also allows you to track behaviours as well as peak flow readings: if concerned you can then take the diary to the asthma nurse for a consult.

You really can't tell just by listening to her chest. My dd has asthma and has had some very severe attacks. I had to get quite forceful with OOHs doctors who weren't familiar with her, a few times. She is a silent wheezer. Her oxygen levels can drop through the floor without an audible wheeze.

Asthma doesn’t always present with a wheeze, Ds is a severe asthmatic but doesn’t wheeze ever.

That said what you describe sounds like it could be panic attacks? Especially if the croup attack happened at bedtime (pure guess I know but based on normal timings for croup) have you tried getting her to do some deep breathing exercises before giving inhaler? (Obviously not if she is showing obvious signs she needs it) they form both part of DS respiratory physio program and what we do to help his anxiety.

Pillow, mattress and dust mites? Window mold?

Bedtime tight chest might be a reaction to scented bath or shower products, or to the bedding ( feather pillows, down filled duvet). Or has the cat been sleeping on her bed, etc.

Will look into deep breathing techniques @Sirzy , sounds like it could be useful.

No mould on her window @fallfallfall and relatively new bedding. Could be dust mites I suppose, perhaps I could try vacuuming the mattress.

@2bazookas that's an interesting thought, she really goes mad with the bubble bath. We've had to stop her putting it in herself as she used nearly a whole bottle a few nights ago, so I will stop using it.

Did she have a review and peak flow before and after inhaler?

I have asthma, only started to develop symptoms in my mid-20s. I did have a history of severe respiratory infections as a child, which doctors have told me probably affected my bronchial passages and lungs in some way, which is why I've developed asthma. I would say nothing you describe points to it not being asthma, though it's always possible it could be other things. If she was seriously ill though and on a ventilator, that sounds pretty serious to me! I would assume that could have triggered the asthma. I didn't have anything that serious as a child and I still ended up asthmatic as a result.

I should add, I've had probably 5 'asthma attacks' in my life and only ever wheezy with infections. For me, it's chest tightness and discomfort and being prone to infections, which lead to inflammation and more chest tightness, etc.