adult onset asthma

[Clarella]

Can this start / be triggered by a virus/ bacterial infection?

I've had abs and steroids now but there's still an odd wheeze. Not sure how long to let it rattle on. Became ill 2 months ago and GP said "small patch of pneumonia". A colleague was quite concerned as her asthma was adult onset and symptoms seemed similar.

Just an update and to say thanks for your thoughts and experiences.

I caught another bug and had some antibiotics which nailed it but still asthma type symptoms.

After a chat with a nurse friend (one of my best I love her to bits!) I got the courage to call asthma nurse. GP had been so vague I need answers and work had sent in an OC health referral (I'd been off a lot last year).

Over phone she said sounded likely and to see her this afternoon.

I'm crying with relief. Things have been so hard and I've tried to battle on. But in the past too. Possibly only when I have a cough / infection and I do think when I'm fitter I'm less prone (always thought that).

I know it might not be black and white and might be temporary but I feel taken seriously.

That is brilliant Clarella, asthma is very managable now and if that's what you've got then it would be ridiculous not to have it properly treated. This should make a big difference in your life. Really pleased for you

Well there's still a query I guess - nurse did the puff test and gave me salbutamol and then puff again - I got a little higher (but had had salbutamol earlier in the day, roughly 4 hours before so maybe not accurate). We discussed that my own peak flow could be low anyway. I didn't get much higher last week on the steroids though. Anyway, she said a 6 week steroid trial would help work out either way. I am noticing I can take deeper breaths with the salbutamol but I'm not sure if that would be the case for anyone?!

I am still quite confused about symptoms and the ins and outs but at least I have clarity about how to go forward.

Thanks again! I'll update you with final outcome. It could still be a bad reaction . (Oh my mum told me today my grand father had had quite bad asthma which I didn't know, so told nurse.)

Yes, mine became evident after walking pneumonia three years ago. Now v. well controlled with clenil and blue inhaler as needed. Was 32, had peak flow of about 250 (now 500 most days), kept two week diary (mine tended to improve over day), and had spirometry.

Fairly common way for asthma to occur in adult.

Salbutamol is a short-acting bronchodilator, so it makes sense that you can take deeper breaths with it! The duration of action is 2-6 hours. We call it reliever medication, to be used as-needed.

The reason for having steroid treatment (we'd call it inhaled corticosteroid, or ICS) is that ICS helps to combat the airway inflammation which is a key component of asthma. Hopefully you'll show improvement in the 6-week trial period, which will mean it's working for you.

Were you shown how to use the inhaler, a proper detailed demonstration? Incorrect inhaler use is a huge issue in the industry at the moment; the treatment itself can only do the job if it's delivered to the right place at the right dose level, so the importance of using the inhaler correctly can't be overstated. No sense in being moved up to more intensive treatment when the only problem is with inhaler technique!

Thanks godstopper. I think my doubt over if it is or not (and I guess theirs?) is the peak flow thing.

It seems to be around 350-370. The brown trial has been started as I hit 390 after the salbutamol with the nurse. I'm actually a bit hazy as to when I'd last had the blue really as didn't understand all this. The nurse said she'd hope I'd hit 400-420 after 6 weeks.

As I say, I suppose I've wondered if the upper 300s are normal for me and this is a very slight asthmatic response. Nothing like yours. Still I suppose significant?

The more careful thinking I've done I've wondered if I'm very used to feeling like this, and it's only slight, and been like this for some time. Coughs do linger, and just like this with me, the wheeze is new though I've had it a few times when poorly in the last few years.

No idea if its significant but I'm on thyroxine. And occasionally take beta blockers for stress though not much these days. I do think I noticed more chest tightness a couple of days ago a while after I took one (got in a state over OC health referral. But it could have happened anyway due to stress) Obv not going to take anymore.

I'm starting to hope it is mild asthma as my anxiety is all based around trying to cope with fatigue and the pressures and demands of other things on it eg work. If there's even a slight improvement in terms of this it would be wonderful! (Thus negating beta blockers!)

Thanks for reading, I'm feeling a bit over whelmed actually, not least as haven't been able to breathe properly since November!

How quickly might I notice any difference on the brown?

And thank you also again Lacountessa (I get the song ear worm every time I read that! Not a bad thing at all!!)

Sorry, yes I have a spacer now. I suspect nurse told the GP off regarding not bothering about the spacer (there was some tutting!)

Found answer to question re brown. I'm trying to work out if I should be sensible and take another week off (I'm exhausted and my back has had a very bad flare from all this - sitting upright all night, plus feeling emotionally fragile. I teach children with Sen/ asd but in different classes. Half of me wants to be there so I don't get out of the habit, the other half of me knows I'm not feeling very physically strong right now)

Clarella, does it help to pass on what I was told by a respiratory specialist? If you are not well enough to run for a bus (or other similar short burst of energy) you are not well enough to be at work! Hope that helps you decide. Sleeping sitting up always upsets my already dodgy back. Colds tend to make my asthma worse - for a short while, and I think that is common for asthmatics. I hope the inhaled steroid helps soon.

Thanks maggiso. That is helpful. I could run for a bus but working on bean theory I'd be wacked later on if that makes sense?

6 weeks sounds in right ballpark. It took me around 2 months to feel back to "normal" after 5th round of antibiotics and steroids cleared up the pneumonia. Gradual improvements then over a year or so. Made changes around the house (no harsh chemicals).

I don't know if high 300 is good. Also depends upon existing level of fitness and possibly height? I was at about 420 for a while, and it's improved since forcing self into gym.

Have you had a chest x ray? Was told that mine being clear also supported asthma diagnosis.

Thanks Godstopper. Yes I did actually, after the first lot of antibiotics but still had quite a bit of wheezing and coughing going on. I wondered if I needed another course. So she did X-ray to be sure. Which was clear. It absolutely never crossed my mind it could be asthmatic, she asked if I was - so carried on trying to cope (this was week before Xmas).

Do you mean 'back to normal' as a whole; stamina, strength, fatigue etc? Or just ability to breathe? (I'm thinking it might be wise to not be at work next week. I'm having to really take it easy today)

I've known that harsh chemicals and smoke 'catches in my throat' or makes me cough for a while/ aggravates chest when getting over a cough but just assumed normal, (which it probably is!) though I've always hated smoke much more than most people made a fuss

Interesting that exercise helps - I've felt for some time my coughs are less if I'm doing regular exercise but I'm guessing that's for everyone!

Well, my exp with the antibiotics was that some helped, but I was left with a low-level wheeze/feeling breathless until the next flareup. The last course only really worked in conjunction with Clenil (brown inhaler) and steroids.

Yes, after about two months was when I felt I got my breathing back. Took a bit longer to feel up to regular exercise.

I think I probably had it mildly before the pneumonia (I did a charity 10k run and had to keep stopping owing to burning in chest which never happened before) which then made it apparent.

4 weeks is a bit long without any real improvement, and you really should be having the spirometry and keeping a peak flow diary. GP should be on the ball with this - it's a fairly straightforward diagnosis if they are!

IME it is plausible. Just thought I'd share my experience as there are some similarities.

I had pneumonia following immunosuppression. A couple of years on I was struggling with heart rate / breathing when exercising and a persistent cough. Where this differs is that I definitely didn't think I had asthma as my peak flow was way above average (DP asthmatic, so we checked at home initially).

Eventually I went to the doc as I'd had (I know now) an asthma attack and DP gave me salbutamol to see if it would help (in the middle of nowhere). I explained scenario to GP and that it had helped and they got me to take a peak flow chart over a couple of weeks. Turned out my variation was huge, even though my 'low' would be another person's 'spot on'.

On that basis they referred me and even though the nurses were amazed by my peak flow when treated on steroids (550 at 5' & over 30 is normal now I'm on brown inhaler) and my lung capacity is huge for my height, I absolutely do have asthma. The consultant reassured me that my referral was absolutely legitimate and since treated I can now exercise properly with no attacks, don't wake up in the middle of the night with a tight chest and my constant non-productive cough has gone.

Docs agreed it could well be triggered by the pneumonia but at the end of the day main thing is it's being treated. A single sample of peak flow doesn't tell you much, I guess is what I'm saying and if you are symptomatic, best get checked.

I also find smokey environments tough, incidentally and always have.

Thanks buggersmuddle.

It's clearly not always straight forward to diagnose and everyone's symptoms are different (would that be right?!)

I always got the burn and cough when exercising as a child/ teen. And young adult. But I developed hypothyroidism aged 20 and pretty much spent a long time learning how to manage that. When well with that, I found I was 'better' (less prone to prolonged coughs) if I worked on my aerobic exercise. I literally have assumed that improving lung capacity helps. And therefore that I can cope with coughs better.

I understand peak flow can be improved through aerobic exercise? I haven't been able to do what I used to do for some time due to joint and thyroid issues, though that was improving and of started again. So it's quite possible it's just my peak flow affected by fitness. Nurse said the salbutamol improving peak flow slightly was evidence though. ()

I've had definite multiple 'episodes' where chest tightness and the very irritating cough has been helped by or avoided (if I use it when there's tightness) by using the inhaler.

Guess I'll just have to wait, and see though it confirms I do need to make sure I'm doing aerobic stuff either way as asthma or not it will help

!!!

Lacountessa would find your story interesting bugger :)

Buggersmuddle

It has just occurred to me that asthma might account for slightly out of range (high) red blood cell count? Due to not getting enough oxygen? Had a bit of that and quite badly a couple of years ago after a bad infection. Been looking at my ferritin levels which had dropped and have recently dropped again. (Was due to double check coeliac but I don't think I have it as no symptoms)

There is a cough variant asthma- asthma that causes coughing more than a wheeze. I don't know about RBC count - although mine is usually considered excellent (ie it is not the cause of my symptoms-I have both asthma and POTs). It is my understanding that asthmatics have good lung volume when well- I presume that is an adaptation - we need it.
I have been asthmatic since childhood ( and was considered 'chesty' before that), but my asthma became worse for a year or two ( from mild asthma to 'somewhat brittle') after a serious dose of pneumonia. I think the illness upset and inflamed my lungs and airways and it took lots of steroids and time to settle it all back down. It was a bit of a shock to me too - having never taken my asthma seriously before that. It must be a shock to you too. It has settled down, although I am on a lot more medication than before all that happened.
I had to monitor my PF and keep a chart. It then became obvious that asthma was the cause of my breathlessness - rather than 'just' recovering from the pneumonia. I still chart my PF from time to time ( ie for the weeks before a clinic appointment- I only check it intermittently otherwise). I also had spirometry ( hence knowing my lung volume is good) - both the big posh machine at the hospital and the little portable machine used to check patients with COPD - a couple of years later.

Thanks maggiso - yes it's a bit of a shock, but at the same time if it is a diagnosis then it's only going to be positive as I've felt there's been something else wrong for a while.

Brief looking up cough variant sounds very like what I've experienced though noticing some symptoms of tightness and wheeze too at times. I noticed a research article that showed if oral steroids helped then inhaled also did too so I'm on the right road!

No one has mentioned spiro thingy, and I'm not doing a peak flow diary, just looking for improvement in my peak flow reading after the 6 weeks.

My question regarding rbc was more about it being high as a result of mild asthma. If not getting enough oxygen the body adapting (like training up a mountain!)

Sorry to ask more questions.

I struggle to define what might be an asthmatic symptom and what might be just a cough. I seem to sometimes be quite phlegmy, esp early morning and morning. Deep slight wheezing and gurgling. Slowly clears. Cough sometimes dry but then sometimes shifts it. It's all starting to feel less inflamed though still feels swollen and I'm not getting quite the same level of totally uncontrollable cough. Probably over analysing but I don't know what's significant or not! Ordinarily I'd ignore and cough away.

Slightly musical wheeze this morning in and out but I felt it was stuff to be shifted and has now gone.

I never used to get any of this!

Hello again!

Well 10 days into brown inhaler and my gosh there's a clear upward movement on the peak flow readings. Hit just above predicted peak flow for first time today. I've only been tracking since last Wednesday. I also went up to 800 that day too.

I actually feel better than I had been feeling for a long time - a couple of years. And I went back to work today. Which is how I can tell. I've been finding work so so physically hard. I'd dropped to two days.

I almost hope I do stay on the brown inhaler and I do have asthma is I can feel this well (for some reason I'm still convinced I'm not asthmatic)