[jfw]

Since November last year I have been plagued by chest infections. This started with a chest infetion in November, flu thing just before Christmas, then another chest infection beginning of Feb (very very ill).

I missed the 3 races i'd entered december-march

I built up gradually and managed the three peaks race in april(then got a bit over eager and did coniston the following wk end).

Then I got another cold, then another - I went to the docs to ask why I was ill all the time and he said it was just unlucky. He also said I could prob train as my chest was clear and I didn't have a temp.

Anyway at some point I realized I kept having a night time cough. And in May I had a dry cough all the time - which turned in to a chesty cough.

I was quite relieved as I thought ah its gone productive that should clear it out. But it didn't change - and I had a kind of death rattle at the end of a long exhalation or Huff.

So back to the docs - a different one in same surgery listens to my death rattle and says try this blue inhaler.

My peak flow was and is normal (and doesn't change morning to night, or before to after blue inhaler)

Anyway night time cough still there really annoying/tiring - so back to docs (another one in the same surgery) who says try a brown inhaler

Again seems to be a bit of an improvement but can't quite get rid of cough - back again and get purple inhaler.

Now - i don't genrally wheeze in the high pitched sense (unless eyeballs out in a race when i think i would have done anyway), my peak flow doesn't change (and is in the normal range), there are times most days that if I huff (i.e. do long exhale) i can rattle and cough up sticky white phlegm (some times with small bits of green).

Even when i can feel this gunk there - its not audible in my normal breath (even a fairlydeep breath with stethoscope) unless i do a huff. finally got a chest xray and it was clear. tried steroid tablets (prednisolene sp?) they seemed to clear things up but could only take a few days of crazy mad insomnia 

Is this asthma??? doc seemed to take effectiveness of steroid tabs as confirmation. would it be worth trying antibiotics in case there was some underlying/exacerbating infection?

Sorry this thread is so long - thanks if you got this far 

[dave k]

I have been moved from a blue (occasional use, when get wheezey) to a brown inhaler (regular preventer). I found the brown was not doing the trick and was advised to simply increase the dose. I reckon a while back when I had bad symptoms I was on 2 puffs 6 x a day, which worked a treat. After a few months I cut down and even stopped all summer.

I have started to get symptoms again this week and have started on the brown inhaler again.

I have not had an all out asthma attack for years. But do get wheezing - particularly when initally lieing down at night.

 

[fatdoc]

to answer your thread title, no.

to answer your health probs would be rather tricky over the tinterweb..

however may i suggest the following.

- asthma is well hard to diagnose correctly, i dunno how to but i do know that your peak flows indicate you dont have either  a significant obstructive deficit or a reversibilty from beta 2 agonists.

- or course i presume you smoke nothing, have a well ventilated dust free house with no carpet in the bedroom, no teddy bears or pets of any kind and dont train in some chalk clagged damp cellar from hell..?

- steriods (prednislone) make me go midly mad... but with insight. feels shite - symptoms fade after a few days..

you need to get advice from a GP I'm afraid.

[jfw]

cheers for the responses

Because I am kind of responding to steroids, its easier for the GP(s) to call it asthma even though as you say I don't seem to exhibit the reversibility aspect.

From reading up on the subject, the gold standard test for asthma is methacoline inhalation challenge but this is not very likely to happen in nhs gp's

I keep going to the GP and coming out after about 5 seconds clutching a prescrition for a new inhaler and wondering what happened to the questions i was going to ask.

I do have a dog, but the condition pre-dates dog ownership, my house was a bit damp, but is a lot better following roof repairs, i could do a lot to  make my house less dusty.

there are pin prick allergy tests you can do where you first do a generic "am I allergic to something test", if you are you can then do a specific tests (i think cats, dust mites, hay fever etc) might give the general one a go.

[jfw]

PS will running while my lungs are a bit rattly damage my lungs?

[GCW]

Don't forget it can take months for shortness of breathe to settle after a pneumonia.
It may not be asthma, especially with the 2 negative tests (diurnal PEFRs and trial of salbutamol).

I would agree you need to see your GP again.

No, you won't damage your lungs by running, you'll just be pretty limited with exercise tolerance.

[GCW]

From reading up on the subject, the gold standard test for asthma is methacoline inhalation challenge but this is not very likely to happen in nhs gp's

Or in the NHS in general.  BTS (short) guidance.

[fatdoc]

PS will running while my lungs are a bit rattly damage my lungs?

no. it took me 12 weeks to be able to have a peak flow over 300, ride a bike up a hill, or walk up to stanage after pneumonia /  H1N1 this summer.

I now have no inhalers and apart from a large girth am in good shape... it takes time... but you wont damage your lungs.

[Bubba]

apart from a large girth

The real reason you have four kids

[Houdini]

Ignore this witchcraft


What you need is a bong 

[rodma]

Since November last year I have been plagued by chest infections. This started with a chest infetion in November, flu thing just before Christmas, then another chest infection beginning of Feb (very very ill).

I had a pretty similar thing happen back in the winter of 2007.

Doctor also diagnosed asthma and I went through exactly the same steps inhaler wise. I now have the lilac inhaler and the blue one.

Worst thing about it is, you're meant to declare your diagnosis on health insurance (ie for bouldering trips etc.), even if your gp turns out to be incorrect, you have to declare that you've been diagnosed in the past (that's if you want to be covered for any respiritory illness at all. some swine flu deaths have been asthmatics.) It added £70 on to my insurance for going abroad over Christmas 

[slackline]

Insurance companies are thieving wankers who don't understand the true implications of medical diagnoses and risk 

[jfw]

Cheers for all the replies (especially the bong)

It added £70 on to my insurance for going abroad over Christmas 

Bummer - who was this with? I tend to have BMC annual insurance.

[rodma]

It added £70 on to my insurance for going abroad over Christmas 

Bummer - who was this with? I tend to have BMC annual insurance.

Not sure, mrs rodma sorted it out. I looked at the clauses and asthma had to be declared within a certain timescale of buying the policy. I'd imagine BMC would be similar, but I'd be happy to be wrong.

Insurance companies are thieving wankers who don't understand the true implications of medical diagnoses and risk 

 

[LJ]

As has already been stated asthma is a complex condition that is often mis-diagnosed and is hard to diagnose correctly. I'm not a doctor and therefore recommend as the others have that you should go back to your GP. My job is to assess lung function in patients so just thought i could give a bit of insight.

Peak flow monitoring is a difficult and poor way of assessing lung function as it tells you very little and is technique dependent. It can be effective in the diagnosis of asthma by looking at trends over a period of time and between morning and night, and can be useful for established asthmatics to monitor their own symptom severity. Other than that i completely ignore it as a measure. Unfortunately, because your PEF didn't improve post salbutamol, doesn't mean that you haven't had a positive response to the drug. A positive response (presuming technique is correct which often it isn't) is a fair indicator that the salbutamol is having an effect, however PEF isn't specific enough in the outcome of a negative test. The best way of doing this properly is to do a spirometry test (which your GP practice should have) which is similar to PEF, but instead of just measuring a maximal flow rate, it measures flow and volume from total lung capacity right down to when your lungs are perceived empty (residual volume). Doing this test pre and post inhaler is a much more suitable way to assess the effectiveness of the blue inhaler. Sorry if that is written badly! Having a normal PEF does not necessarily mean you have normal lung function, in fact it means practically nothing on its own.

In terms of a methacholine challenge, you are right in that it is the gold standard test for asthma, but you are also right in that you are very unlikely to get one (and definitely not at a GP's). I perform them on a very select group of patients as a last resort. These patients tend to be the patients that the consultants are convinced have asthma but the other tests have failed to be convincing. There are far easier/quicker/cheaper/less painful tests that can confirm asthma before you get to this stage (unless you want to be a fireman and have asthma on your record!)

So in short, go back to your GP!

[GCW]

Whilst you're right in that all suspected asthma patients should get spirometry (according to BTS July 2009), I doubt this happens in reality.  The old BTS guidance (2004) still stands for a lot of respiratory physicians and GPs (ie no spirometry, PEFR only).
In time, the new guidance will filter through but at present I think a lot of people will stick to the '04 BTS and old SIGN/NICE guidance.

PS Go see your GP 

[fatdoc]

My lord, once more this forum shows true colours.

- by now you will no doubt go see the GP.

More importantly, as a fully informed educated individual.

There are those on here far more worthy then I for Karma.

Ukb result, I hope you get better soon dude.

[jfw]

My lord, once more this forum shows true colours.

It's good isn't it. You're right I'm going back to my GP tomorrow when I'm working from home.

I had read a previous version of the BTS clinical guidance (and some NICE guidelines - if this is asthma wheres my written asthma plan eh?)

I can see what my GP(s) are trying is a (step wise) diagnoses by drug trial. When I initially went to the docs I had a really bad wheeze and concurrent productive cough (with lots of uncoloured phlegm). I tried the blue inhaler and it did seem to have a positive effect (but very hard to judge - I was also half suspecting something asthma like, and half hoping this was what was wrong if it meant it could be controlled).

Anyway couldn't quite stop the night time cough so stepped up through inhalers to combined long acting beta antagonist and corticosteroid (aka the purple one).

I still can't quite shake this cough (especially night time).

Running seems to have a dual role in
a) to an extent drying out the lungs and exacerbating irritation
b) conversely helping clear out the lungs

Because my symptoms are chronic cough, its actually very hard for  me to differntiate between a passing viral infection or worsening/step back in condition.

I have tried gaviscon to try rule out acid reflux as a cause or contributory factor.
(I don't know if you would actually have to try something more hard core to rule this out)

Other than asthma and/or reflux the other classic cause of chronic cough is post nasal drip - so i tried lemsips to little effect.

So if asthma is just reversible restriction I don't seem to exhibit it on PEF (but might do on spirometry). But if asthma is an overeaction of the immune system in producing phlegm and/or failure to clear mucous properly then that is the kind of thing (ie akin to eosonophilic bronchitis). I guess my GP won't really care which it is because the treatment will be steroids.

what my GP is likely to say when I go tomorrow and say I'm still coughing at night is to try more inhaler (i have already stepped to 2 x 3 puffs a day, instead of the recommended 2 x 2 puffs on her recommendation), i don't really want to keep taking more and more steroids.

ah well i will see what she says (this is me mainly thinking "outloud", well on a screen)

cheers guys 

[slackline]

My chest has got quite bad recently

<------ 

[fatkid2000]

I had a patient like this - around this time last year.

The thing that sorted his wheezing chest out was a PPI (lansoprazole) - there seems to be a subset of people who suffer from a wheezing chest +/- chronic cough and get silent reflux. You mentioned you've already tried gaviscon - i'd give a PPI a go.

If that fails a short course of steroids may be the way forward - to cover an allergic cause. 

[jfw]

i'll try asking for PPI - do you have to be a bit more careful with them? can they stop you digesting your food (are they also useful if you have to exceed the recommended dose of ibuprofen?)

i asked for gaviscon before - now i have a litre bottle of the stuff - in disgusting aniseed flavour (was cheaper on prescription than buying)

[rodma]

one other thing that's been an annoyance, is that the steroid inhaler has robbed my mouth of the years of filth i had built up. This means that i now find anything spicier than chicken korma inedible. Even drinking fizzy water is uncomfortable 

[jfw]

rodma do you rinse your mouth after use? (i nearly put do you rinse your mouth after puffs but thought better of it)

do you use a diffuser? (makes it look like a bong/crack pipe)

[rodma]

rodma do you rinse your mouth after use? (i nearly put do you rinse your mouth after puffs but thought better of it)

do you use a diffuser? (makes it look like a bong/crack pipe)

No, I don't have a diffuser and I've never tried rinsing my mouth out afterwards.

Do you think rinsing helps?

[GCW]

You should always rinse your mouth after a steroid inhaler, otherwise you'll be prone to thrush and mouth soreness.

[fatdoc]

and always use a spacer type device, to improve dose getting into the lungs.

BTW, FWIW

I slogged out a higher gear than usual 16km quick road ride this morning.. getting some base lines for the training programme for the Spring sportive season...

I was fine on the bike ( for me... 5 sprockets higher in equivalance to previous autumns) and really enjoyed the hills..

but I wheezed to a point of fumbling for an inhaler in near desperation on getting home..... viral pneumonia sucks...most say it's 12 months to get back, and from an anaesthetic point of view your airways can be a bit * reactive*... if you have a GA

[GCW]

Or it could be exercise induced asthma...... 

[jfw]

when did you have pneumonia fatdoc?

my february chest infection was the worst and cleared with erythromycin, but as soon as i finished the course (literally the day after) i got ill again (albeit with a cold).

i went for a short jog this eve, and damp cool air had a me more of a wheeze on than normal - think i might have a bit of an infection at the mo. (probably viral, though tending a bit green on the phlegm side). need to be more disciplined in taking my resting heart rate as an indicator - but i think i am a bit tired/stressed this week.

[Falling Down]

I woke up this morning wheezing and coughed up chunks. This thread is both worrying and educational.

[nik at work]

Or it could be exercise induced asthma...... 

Don't get me started, I can feel one of my rants coming on...

[GCW]

Rant induced asthma?
It's been shown that asthma is much more common in people of lesser stature, especially hirsute ones.

Asthma is a label that is hard to get rid of once it is pinned upon you, hence I'm always a little cautious about using it.

[fatdoc]

yeah... well i no doubt had for years as a kid and no one sorted it.. what I was trying to say is if you are suffering but previously well... be patient. It takes a long time to get better.

[rodma]

You should always rinse your mouth after a steroid inhaler, otherwise you'll be prone to thrush and mouth soreness.

Hmmm, why didn't my GP tell me this 

Thanks for that, I'll start rinsing as of today, my GP only said to rinse if I dound the taste overly unpleasant.

[jfw]

rodma - you can buy a spacer device from any chemist too.

the powder comes out of inhalers so fast that unless you have amazing technique (and even then to a degree) it coats the back of your throat more than being inhaled.

a tube or more open device lets a  kind of "cloud" of your medicine form which you can inhale more of.

cos they are not super compact i don't use a spacer for my blue in haler - but its no hassle for an inhaler you are generally just doing twice a day. i try to do my inhaler just before i brush my teeth as it sorts the rinsing thing out. if you uses a sacer this will also be kiinder on your mouth.

[rodma]

Good knowledge, i'll buy one from the chemists and be eating spicy food again before i know it

[jfw]

got months trial of PPI from docs this morning

[The Sausage]

I'm no doctor, so don't really know much about this sort of thing...
...but, could there be something rumbling along in the background like an atypical pneumonia that wouldn't show up on a normal sputum sample?
I worked (as a physio) a while back on specilized medicine at the Hallamshire, and I remember doing some 'induced sputum samples' whereby the patient runs a super tiny particle nebuliser with a (i think) hypertonic solution (is that the right word for something that's salter than us?) going through it. It basically enables the patient to cough up phlegm from much deeper in the lungs and is used for diagnosing Tb and other atypical nasties.
Hoefully somene with a far greater medical knowledge than me can add something to this..?

[saltbeef]

chest radiograph etc?

[GCW]

...but, could there be something rumbling along in the background like an atypical

Unlikely without other symptoms, but worth considering if nothing settles with time.

[jfw]

despite having coughed up loads of sputum samples into tissues round my house - i've never given one to a doctor

i did have a clear chest x-ray though

i'm wondering if next time i get a bacterial chest infection i can ask for a slightly longer than usual course of antibiotics(as the last course i did i seemed to relapse as soon as i finished it)

after PPI yest (but also no running) i had no coughing in the night and was about to pronounce myeslf cured til i started coughing up this morning. but someone mentioned patience