Asthma people - can you please give me some advice?

[CarlaBruni]

In September last year, I had an episode which, to me, felt like an "asthma attack". I was late 50s and had never been diagnosed as asthmatic before but have always had house dust mites/cat type allergies. Saw out of hours doctor who gave me a blue inhaler. Days later, my own GP checked and said I had a chest infection (I had no idea I was ill other than the struggling to breathe episode), and gave me antibiotics and steroids. I've now had a follow up spirometry test which I "passed". I've still not been officially diagnosed as asthmatic.

I've needed to use the blue inhaler occasionally since being given it - once or twice a fortnight. However, over the last few weeks, I've felt the need to use my blue inhaler a little more often - especially at bedtime. And some light activity (going up the stairs etc) can leave me feeling breathless. I will make an appointment with my GP as feel in limbo here as I don't know if I have asthma and, if I do, I would like more than a blue inhaler.

Anyway, my questions are, how often is safe to use a blue inhaler? I'm trying not to but, for the last week or so, I may have used it once a day but for four consecutive days. And, does the sensation of having a chesty cough I can't clear sound like asthma? I'm not ill in any other way.

It feels like a cough expectorant would help but I've read that they're not recommended for asthmatics.

Sorry, this is longer than planned. Thanks

I was diagnosed with asthma since around the age of 5. I personally don’t get along with salbutamol, so I take a different type of inhaler. I think you can take it up to 7x in 24 hours. It’s only a reliever, not a steroid which would give longer term relief from asthma symptoms. I’m not sure if that’s what you wanted to know.

With your age though I would probe the GP further as to your overall lung health.

As far as I know, you can use the blue inhaler as often as you need to. However, you shouldn't need to use it everyday or several times a day. You need to see a doctor or asthma nurse and explain that you keep needing the blue one.

I have asthma and only need to use my blue inhaler about once a year because my asthma is very well controlled. I'd be quickly making an appointment to see someone if I needed it all the time.

If you are having to use your blue inhaler on a fairly regular basis then you'll need to go and see either an asthma nurse or the doctor. I now use a brown inhaler twice a day that prevents an attack.

Thanks both. Re lung health, I did ask when I had the spirometry test whether it would show COPD. The nurse said it did and that there was no indication of that. But the results also don't lead to a "you definitely have asthma" diagnosis either. She did explain that at the start and that's the risk of a snapshot test.

I will get a follow up appointment as, for the GP, there's nothing to do next. But yes, my question was really "Am I ok using the blue inhaler as and when I need it for now?" and I think I am, so thanks.

You shouldn't be needing to use your blue inhaler that often (and current guidelines don't recommend blue inhalers for adults anyway)

Either you have asthma and it's poorly controlled or you don't have asthma and need a diagnosis.

However given your history of allergies, and that symptoms are worse at night it does all point to asthma.

Asthma varies in each person all the time so just because you had normal spirometry once, doesn't mean you don't have asthma. Especially if you did your spirometry on a good day or close to your course of steroids.

Frustratingly, the out of hours doctor tried to get one for me but they were out of stock. My own GP seems more cautious and wouldn't give me one until asthma is confirmed - fair enough, really, but I feel I do need something to prevent this chesty and then occasional breathless feeling.

Salbutamol is known as a reliever inhaler. It used to be standard to have one and carry it with you for emergencies for many asthmatics. Like a lot of people who are asthmatic, I have a regular inhaler (non aerosol) that I use before bedtime all the time. Modern prescribing says that this inhaler can now also be used as a reliever if there is any breathlessness. I am rarely in this situation but have not found the regular inhaler helps at all for emergencies and most especially with my very strong allergy to cats. So I still have salbutamol blue inhaler in my handbag.

Regarding you personally, I'd say that after a chest infection or major problem of that kind there is often a longish recovery period on some levels. I would seek another gp appt and get checked out but not get too worried. My own asthma is based on reduced lung capacity as I was very ill as a child. Despite that my asthma diagnosis came in my 20s. I might be a less usual kind of asthmatic in this regard by my allergy reactions and hayfever pattern are quite conventional.

Chesty cough that doesn’t clear is not how I’d describe asthma.

I use my blue inhaler regularly to prevent exercise induced asthma, on my GP’s recommendation. So using it regularly is not an issue per se, but if you do have asthma you may need something else to help you control it better. Definitely go and see your GP.

I'd call chesty cough potentially part of a long recovery. In 2017 I had repeated colds/viruses and could still yield something in a cough for a year +

OP get yourself checked out

The chesty sensation has only been in the last week or two. Just remembered, I did actually have a light cold the weekend before Christmas so could be a hangover from that. And just being indoors more.

Asthma feels more like you can't get enough air in, rather than a cough that won't clear.

If you do have asthma they'll probably want to get you on a regular preventative inhaler, so definitely get checked out.

Thanks. It's a bit of both, atm. I'm only using the inhaler when I feel I can't get enough air so before bed. I'm also wondering if drinking more wine over the holidays hasn't helped 😔

Ask your surgery if they have the machine that measures lung inflammation. It's not the spirometry test but might be the same machine 🤔 not sure.

My dd has an animal allergy that triggers asthmatic symptoms, but mainly coughing not wheezing. It was frustrating for a long time as couldn't access a brown inhaler without presenting in a more typical way. But it was eventually prescribed when seen during an acute phase (coughing continues for a few weeks as lungs get so inflamed).

I've just ordered a peak flow monitor thing. Should have done that after the spirometry so I had results in hand. I'd assumed my results would have got to my GP already and they'd have booked a follow up but nothing on the NHS app and Christmas has got in the way of things.

Not necessarily. This belief is why I was not diagnosed with asthma until my 50s, despite having a (non)smoker's cough.

When I went to the GP a few years ago, she gave me a blue reliever and peak flow meter. Told me to keep a diary of my peak flow for two weeks and then see the asthma nurse. The asthma nurse gave me a preventer to take twice a day, and told me to continue logging my peak flow and to come back to her in a month. By the next appointment my peak flow had improved from 270-370 to 390-430. Asthma nurse said this trial of treatment meant I very likely had asthma and referred me for spirometry. She also tried me on a different preventer, and my peak flow improved even more.

I no longer get a chronic, productive cough. I rarely gat as ill as I used to with colds, and only cough for a couple of weeks after a cold, instead of for a couple of months.

I have found it very difficult to learn to recognise the difference between chest tightness due to anxiety or stress, and due to asthma. A puff of blue has no effect on the firsf , but eases the second.

IIRC you're supposed to contact the dr or asthma nurse if you need more than 6 puffs of blue more than once a week. But this is not because that amount of salbutamol is harmful. It's because this would mean your asthma is uncontrolled and you are at risk of an attack.

Unfortunately, we did get a cat a few years ago. I've had no typical allergy symptoms so had hoped I might have grown out of it but, can't help thinking that having the cat has made it worse 😟

Thanks. Yes, it was the frequency of use I was thinking about meaning it's not controlled. But I was also worried it might be harmful as well so good to know that, in itself, isn't too much of an issue.

Asthma can feel like different things to different people - I didn't get diagnosed until I was in my 30s despite with hindsight clearly having had it since childhood.

It can be a cough, a chest pain, a tightness, shortness of breath - and it definitely doesn't need to be a wheeze.

When I finally got treated it took me a long time to figure out what my normal was, as I basically wasn't used to being able to breath properly.

It’ll make your heart race but using lots isn’t going to do much damage. As a PP has said it’s the risk of having an asthma attack which is why you need to see a doctor or asthma nurse if you need to use it more than 3 times a week.
And if you get to that stage they will give you loads of salbutamol alongside other stuff.

I was diagnosed with asthma aged 58. I think it had been going on for years but low level until I had a severe chest infection last winter. Menopause is the likely culprit. Now have brown inhaler daily and occasional blue one. I also passed spirometry test but had high allergy levels. All this has been complete new to me of course and am having to learn quickly.

The blue inhaler can make your heart race and give you the shakes. Unpleasant, but not harmful AFAIK. Make sure you rinse your mouth after using it. Gargle as well as swoosh the water around. The steroid can cause oral thrush. I get a benign but uncomfortable condition with a gloriously scary name if I don’t rinse well: angina bullosa haemorrhagica - blood blisters on my palate.

Have you been given a spacer? Makes taking the inhaler much easier, and recorded the amount that gets deposited in your mouth.

Reduces, not recorded.

Sounds similar to me. The out of hours GP suggested I'd probably always had it based on allergy triggers but it's been mild enough to manage.

I've not been given a spacer so have adapted a toilet roll tube for now 😄. Chest is feeling looser today so hopefully it'll pass soon.

Plastic bottle would probably be better than a spacer. You can get a spacer relatively cheaply from your local pharmacy.