Asthma in adult newly diagnosed

[Sooverthemill]

Does anybody know about asthma? So I'm 61 and a history of chest infection from childhood. I also have eczema and hay fever ( I take antihistamine all year round). Since a chest infect last November I've had a persistent cough worse with exercise ( like going upstairs) and at night and with bad hay fever season. I had a chest X-ray after 2 months which was clear . Eventually after months of this I went back and GP initially just said it's one of those things but then I queried asthma ( DD has it) and she said 'oh yes it could be' gave me inhalers and told me to see nurse after 3 weeks. Now I've seen nurse and she's told me to cut out ventolin except when I 'need it'. But all week my chest has been awful and my throat is sore from coughing and my chest is kind of sore too. I've used ventolin a few times. And yesterday decided to go back to 2 puffs morning and night. I have spyrometry test booked in 6 weeks ( earliest possible). I don't think I wheeze ( my DD doesn't either) but I often feel like I simply can't breathe and I cough so much sometimes that I'm almost sick.

Should I go back to GP? I know nurse is asthma expert and not querying that but nobody seems to have advised me what to do. I have a little niggle at the back of my mind because 7 years ago I had 12 sessions of bleomycin which could cause lung damage. My follow up has been poor since we moved to a very rural area who follows me up simply by annual blood tests. Am I being a hypochondriac? It just all seems odd. And it hurts and I don't feel well!

Are you taking a preventer inhaler - it might be that the dose needs tweaking or that you need to try a different type. You shouldn't be needing to take regular ventolin.

I would want to be trying a steroid inhaler in your shoes. Make another appointment with the asthma nurse (obviously this will vary but I've always found them more knowledgeable than GPs).

nannyr yes I have a brown inhaler 2x a day which I know should in theory mean I don't need But I'm finding that do need it even after several weeks of brown.

mindy isn't ventolin a steroid? I'd assumed it was. My DD has a green inhaler which she needs to use sometimes . Is that a steroid?

I know the asthma nurse is an expert nurse and not doubting that but I feel unprepared for life with asthma! Should I be on different drugs? Having had chemo that definitely impacts on some people's lungs makes me worried they have overlooked something. My mum died of lung cancer and I've never ever worried about that but now I'm nervous

I would ask to do a serial peak flow between now and spirometry this will help with diagnoses also. Use the preventer as directed and the ventolin when required. If chest X-ray was recent that should help with differential diagnoses. You may need a course of steroids and antibiotics.

I would definitely go back to the asthma nurse - I would ask for a spacer device, using one with an inhaler means you breathe in much more of the active stuff, just using an inhaler on its own means a lot gets wasted, also a peak flow meter and get her to show you how to use it - keeping a diary of readings will be helpful to see if anything is triggering the asthma. If your chest has been bad for a while like this it may be that you need a short course of prednisolone (oral steroids) to get it properly cleared up.

I have a peak flow meter and had to use it 2x a day fir three weeks and it demonstrated that my peak flow at start was 250 and by end of 3 weeks of brown and blue inhaler 2x2x daily it was 280 at surgery and 340 at home. I have a spacer ( new protocol is everyone has to have one) and I use it always. I thought the chest infection triggered it originally and at present nurse thought it's the high pollen

itbemay what I don't understand is when is 'required '? I don't wheeze. I cough, pretty much all the time at the moment and I have very sore chest muscles and a sore throat from constantly coughing. Does that mean I should be doing 10 puffs ( I only know about that because of my DDs asthma plan)? It's just got so much worse since I was told to stop using ventolin twice daily and today I've already used it 4x 2 puffs and trying not to use it. I've looked on asthma uk and it doesn't advise

And I feel like an idiot

Seems like your preventer (brown steroid) isn't doing a good enough job, go back to the nurse it could be that you need a higher dose or that you need a different medication. At the beginning it's a bit of trial and error to see what works for you.

You're not an idiot at all, you need an appointment as a priority. Can you get to a pharmacy today? A pharmacist can decide where best to refer you to.

Asthma is not something to be messed with, and yours is not being well controlled. Speak to someone today.

Thank you! I will try to see someone ASAP.

You are certainly not an idiot. It does sound like asthma. I was diagnosed in my 50s after a similar cold/cough that lasted six months or more, though I had a long, long history of chest infections and nobody really joined the dots up because I rarely wheezed or had difficulty breathing. I'm 61 too.

Expected peak flows vary according to age, sex, height and weight, so I can only be approximate but your initial peak flow of 250 was quite bad for a woman of your age, and the levels you are reporting now aren't that great.

Don't be afraid of Ventolin/salbutamol. You can't overdose on it. Too much just makes you a little light headed. There's quite a lot in each canister, but the only real risk is that you run out. Personally, I have built up a little stockpile to make sure I don't. BTW, the NHS pays something like £1 for each Ventolin inhaler so it costs peanuts anyway. (Some of the other inhalers are pretty pricey but Ventolin is cheap as chips). It's not a long-term treatment, and as others have said you may in time be able to dispense with it, but that's in the future. As I said to DW this morning when she asked if I had some with me, if I am dressed there's a can of Ventolin in my pocket and if I'm undressed there's one no more than 10 feet away,

But if you are struggling to breathe for more than a few moments you need urgent medical attention. Asthma kills. The fact that you haven't yet had the formal diagnosis because there is a waiting list for spirometry doesn't change that.

If you are coughing non-stop you need medical attention now, from a doctor. Out-of-hours should be able to deal with it but if they can't go to A&E.

talbotAman thanks! I hate being out of control of my health and am so fed up as I've worked so hard to get healthy after cancer 7 years ago. At the moment gentle yoga makes me cough. I cannot easily get to out of hours ( 30 minutes drive away) as I care 24/7 for my very sick bed bound DD ( she has very very severe ME) and have no alternative care ( she cannot be left alone) but I'm conscious that if I die from an asthma attack that won't help her! So I'm going to use as much ventolin over the weekend as I need to stop the coughing and call asthma nurse on Monday to see if she can prescribe a different medication ie alternative to brown if that's not working on me . I guess not all the standard first choice medications do work for everyone. I'm prepared to be considered a pita by surgery ( my fear) but it simply doesn't feel right and if I was advising a friend in this situation that's what I'd tell her.

Don't worry about being a pita asthma needs to be controlled and it's not uncommon to need treatments tweaking. If you ever feel that you are not in control of it go and see someone.

Out of hours round here do home visits. They have fancy 4x4s with day-glo stickers saying 'doctor' and green flashing lights! Ring them and explain your situation, and they may be able to send someone out to see you.

@Sooverthemill Talbot's advice is good. You can also double up on your brown inhaler, eg 4 puffs twice a day, and use your ventolin as often as necessary, which is the advice I was always given, along with making an appointment with GP or asthma nurse ASAP. As a PP said, asthma can and does kill.

I hope you can get this sorted ASAP

It takes a good few weeks for the steroid (brown in this case) inhaler to build up in your system but you should be noticing a difference after 4-6 weeks. Did the nurse check your inhaler technique? It is a damned sight harder to use than people would have you believe, I second asking for a spacer device. What dose are you on?

Sorry just seen you do use a spacer, opened the thread meant to reply, got distracted by a stroppy two year old and the need to bake, and responded without refreshing first.

Today I can breathe! I've used ventolin and then the preventer ( and did last night) and overnight I was fine and this morning no coughing even going upstairs or during ( gentle) yoga. So I think my preventer isn't enough and I'm going to carry on using ventolin each day morning and night alongside it until I can see the nurse. Thank you for all the advice. I just feel like I'm fussing and should be able to manage this without medication but I know that's insane. Someone recommended buteyko exercises. Has anyone tried these? We attempted them with DD when she was quite young but as her teacher had a long haired cat it was hopeless and I can't find the very expensive pack we got...

You need to use the steroid inhaler (brown one) regularly to get your airway inflammation under control. It doesn't do any good if you use it intermittently. If you are taking it regularly and still find you need to use your salbutamol inhaler (Ventolin, the blue one), you need to have your medication reviewed to add a long-acting bronchodilator (e.g. salmeterol [Serevent]) or leukotriene receptor antagonist (e.g. zafirlukast [Accolate]), depending on which guideline your GP is following. You might end up needing your steroid dose increased.

You should not be taking salbutamol regularly morning and night. It has a short duration of action and should be used to relieve symptoms when you have an acute episode of wheezing or breathlessness. If you actually need to use it every day this indicates that the airway inflammation is not under control and your medication needs to be reviewed.

Does your GP practice have an asthma nurse?

sirtobybelch sorry I thought it was clear ( obviously not) that I'm using the brown preventer inhaler as directed by the asthma nurse 2 puffs twice daily ( I do it at 9.30 am and 9.30 pm). And I have been every single day since 19 June. Up until 22/7 when I had review by asthma nurse I was also using ventolin at same times as directed by GP . At review last Monday asthma nurse said I must stop using ventolin except when I 'needed it'. I assume I need it when I am coughing so much I think I'm gonna g to be sick or when I am breathless and struggling to catch my breath when I go upstairs? As on 4 consecutive days I have 'needed' to use my ventolin at a minimum of 8 x 2 puffs a day I've resumed morning and night time ventolin alongside my brown and yesterday was reasonably okay except when my DD caused me to have a fit of laughter then coughing and I couldn't stop until I used ventolin. I'm trying to see nurse today but I live in a very small rural area with only one nurse and I think she is now in holiday until 2/9 which is when my next review is due. I am incredibly pedantic about taking meds. I've had cancer. I had to take masses of meds for that i I used a spreadsheet and alarms for ensuring I took what I needed to each day ( over the cycle it changes). I have a similar system for my DD who has a chronic illness and is unable to care for herself. I am an excellent historian and used to noting items and dates and what was happening when x happened for example. I think I am the perfect NNS patient!

I asked my DH if he thought I was fussing/ being a hypochondriac and he said that actually on Saturday he thought he was going to have to call 999 for me. So I think I'm right to be concerned, what I do not understand is why it has come on so suddenly so bad at age 61

Got an appointment to see a nurse this afternoon who I am told is 'quite good' with asthma!

I hope you get some more help at your appointment.

You were clear. The ideal in treatment is that your preventer inhaler improves your condition to the point where you rarely, if ever, need to use Ventolin. You're clearly not there yet. Whether you need more time for your preventer to take full efffect, or whether you need a different preventer is something you will need to consider with your doctor or nurse.

Until you get your asthma under control, you will need Ventolin to relieve attacks.

In my case, according to spirometry, my asthma is mainly towards the bottom of my lungs. My asthma nurse suggested taking Ventolin shortly before the preventer (I'm on Fostair) in order to open up the airways so that the preventer could get all the way down.

But when people say that you shouldn't be taking Ventolin regularly, that is in the sense that you shouldn't need to. You should be taking a preventer and that should keep the asthma under control. Some people get psychologically dependent on Ventolin and over use it when they don't actually need it. At the moment, you clearly do need the Ventolin because the preventer is not keeping your asthma under control.

Why 61? Really difficult to say. I could similarly ask Why 55? The nurse who diagnosed me said that the oldest person she had diagnosed had been 72 (and recently widowed). Something happens which turns previous mild asthma into significant asthma. In my case we had had a lot of buidling work done over the two previous years and I am sensitive to the dust, but equally I work in a city centre and have a crawl commute so it may be the increased diesel fumes, which I think I am also sensitive to. Or both. Or something else.

Thank you both. Me too. It's scary