Getting to grips with asthma

[Dilbertian]

I'm newly diagnosed with asthma, after 30y of coughing. So my normal turns out to be abnormal, and my frame of reference is skewed.

I'm not clear on when I should use my reliever inhaler (Salamol). If I understood the Asthma Nurse correctly, right now I should be using it whenever I think I need it, in order to learn to recognise when I actually need it, and also to help us work out what the appropriate dose of preventer should be.

So far I have worked out that:
A sense of pressure on my chest, with chestiness, is eased by 1 dose of Salamol;
Pressure + chestiness+ coughing = needs 2 doses of Salamol;
Pressure alone is not affected by taking Salamol (so the sensation of pressure alone is probably related to menopause or GERD).

But I don't understand 'need'. When I get these symptoms I can generally continue what I'm doing. In the past they would eventually go away without treatment. Because these sensations are normal for me, I doesn't recognise any need to do anything about them.

So do I need to take the Salamol as soon as I feel them? Should I wait to see if they go away on their own? If so, how long should I wait? And if the sense of pressure and chestiness is eased by two puffs, but I'm still coughing a couple of times every minute, do I need to take more puffs?

The important thing is to get your preventer working for you - that's where you need to concentrate efforts. When asthma is properly controlled then there's no need for a reliever really

So take a couple of puffs of your preventer each morning and evening and see where that leaves you. And yes, tight chest or coughing or heavy sensation, take 5 reliever puffs and increase to 10 if required. But check what your GP had advised

My 13 year old has had asthma for years and 2 puffs of his dark purple preventer in the morning mean he rarely needs his reliever - maybe once every couple of months. So I know this is the correct preventing dose for him. If he doesn't have the preventer for 4 days or so, he needs his reliever. So we now know how much is in his system and we can manage accordingly

Asthma nurse here.
When were you diagnosed / when were you started on preventer inhaler and which one is it?

It can take up to 2 weeks to really get into your system so for now you should be using your reliever whenever you feel you need it - all the scenarios you described.
After a couple of days on your preventer you should hopefully start to need the reliever less and less - like PP said when asthma is well controlled you should rarely need your reliever rather than it being the norm that you do.

But for now, use it as you need it especially whilst your preventer gets into your system.

If you've had symptoms for 30 years, it will be hard to get your head round taking something that is "normal" for you and may eventually go away. But essentially, when you get any cough / wheeze / tight chest etc it is the airways constricting and narrowing / swelling. So treat straight away, long periods or frequent episodes of these symptoms can lead to longer term consequences so get on top of it as soon as you notice them.

The next thing to do is start to try and work out what your triggers are / when things are worse etc. so that you can avoid or change these things.

I was diagnosed earlier this week.

Mid-March I was started on 1 puff twice a day of Pulmicort 200. My PF improved significantly on this, and my coughing, too. I haven't been able to have the chest x-ray (Coronavirus lockdown!) but the Asthma Nurse is treating it as asthma.

Because I'm still getting episodes of pressure and coughing, I upped the Pulmicort to 3x daily after speaking to her a couple of days ago.

Triggers I have always known are air pollution, 'sprint' type exercise, and catching a cold. Trigger I discovered recently is stress.

The asthma U.K. website is useful. They also have a helpline staffed by nurses if you want some advice. www.asthma.org.uk/

If you haven’t got one already then get a spacer as it will help the medicine to get into your lungs more effectively. They’re about £12 online.

I can't find the answers to my question on the Asthma UK website.

I have a spacer.

I found/find this confusing still. I didn't suffer with it at all until recently but about a year ago I was diagnosed.

My asthma nurse told me I should be managing without a releiver wherever possible. Presumably this is because using the releiver is a sign of uncontrolled asmtha. I said I was having episodes of struggling to breathe but that if I sat calmly and breathed really carefully and waited it would eventually go away. She seemed not to think I should use a releiver in these circumstances and I still don't feel like I know if that's true. If I a have a big coughing fit, the releiver helps me not cough so much I'm sick. I can try really hard and stop coughing through major efforts but that's really hard because then I don't feel like I am getting enough air.

I was trying to explain to the nurse that there's a lot of "not breathing right" between fine and dead and that I don't know where on that line I'm supposed to use a releiver but she didn't seem to understand.

Not much help Op, I'm afraid, but it's not just you.

It really frustrated me, I have a bioscience degree and am really well informed about my other medical conditions but I haven't managed to get anyone at my practice to explain exactly when I am or am not supposed to use to me.

Why don’t you ring the helpline and talk it through?

Did they give you a peak flow monitor? Tracking that can be helpful.

@Nacreous if you are coughing you need to take your reliever.

Use the peak flow meter before and then a little while after.

You shouldn't be coughing, it's a sign your preventer isnt working. You might need an increased dose or a change in medication.

Bodies change, so do lungs. You may need a review.
Monitor your peak flow and record it. Then you'll have a record to give to your asthma specialist.

If your asthma is well controlled you shouldn't cough or need to take a reliever. Well controlled asthma is incredible, it's as if you are completely healthy living a normal life without restrictions. I've only experienced this once but it lasted for 15 years.

I’ve had asthma for 34 years, husband the same and 3 year old has it.

I was too young to recall the diagnostic process for myself but with my daughter the asthma nurse said that asthma is hard to diagnose - there’s no scan or blood test - but part of it is trying inhalers and if they work then it’s asthma.

Others have said the preventer is most important and this is definitely true.

With the reliever, take it whenever you feel discomfort so if you feel wheezy, short of breath, coughing or tight chest - then take it.

Once your preventer is established you should barely need the reliever, unless you come into contact with triggers. If you are using it a lot then it’s a sign the respiratory system is irritated and may be constantly inflamed, making the risk of asthma attack more likely.

Good luck.

planning Thanks - I have recently been changed to a combined steroid LABO inhaler which has helped, but I think from doing some further reading of the asmtha UK website that the advice from the asmtha nurse hasn't been ideal. It was the GP who moved me up as I insisted on an appointment with her. I had an asthma review after having had s cough for 3 months and the nurse just said it was tough luck and she had had a cough for ages too.

I said I didn't feel I understood when I should take my inhaler or effective management techniques and she told me I did understand them which wasn't helpful. I'm really normally quite assertive but I was really struggling to keep pushing.

I'm actually thinking I might need to change surgeries, rereading the above.