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asthma parents
June 29, 2010 1:10 PM   Subscribe

My mum has been diagnosed with asthma recently, at 63. Last week she had to go into hospital. How serious is this, and how worried should I be?

She was diagnosed a few weeks ago after a few months of feeling a bit short of breath and her voice disappearing when she gets to the end of the sentence (although that happens to me occcasionally so I didn't worry when she mentioned these). Nothing has changed circumstantially- she has pets, but has had them as long as I've been alive, she lives in the same house a bit away from the road, and although my dad was a heavy smoker (they were married days short of forty years) he died almost four years ago (though things kept in my childhood bedroom, where he didn't stay, still absolutely reek of it.)

Last week she got up and got short of breath, and then felt she couldn't breathe, and had to bang on the window for the neighbour - she says she doesn't know what would have happened if she hadn't been home. She had to get steroids at hospital and was kept in for a bit. Previously, she's walked a short distance to the doctors and had to be given oxygen when she got there. I suppose what I want to know is whether this is something that calms down or whether I should be really worried - I live a few hundred miles away so I can't check up on her, only phone, so it;'s hard ot judge.

She takes her inhaler four times a day - is this also a lot for someone newly diagnosed?
posted by mippy to Health & Fitness (24 answers total)
 
Sorry, I mixed up the tags and the title!
posted by mippy at 1:11 PM on June 29, 2010


it sounds like they're still trying to flesh out how to best manage her asthma. this can take a while. how are her allergies generally? does she suffer from seasonal allergies? for me my asthma is much, much worse when i'm not controlling my allergies.

if 4 years later your room still reeks of smoke, buy her an air purifier - maybe buy all new linens for her bedroom.

the most important thing for me with my allergy attacks is remaining calm. it's terribly hard to do, but also utterly important. so the best thing you ca n do from far away is to help her stay calm. make sure she has a cell phone with a 1 button or voice dial to 911.
posted by nadawi at 1:20 PM on June 29, 2010


I've been in the hospital for asthma and my gramma just got out. Thankfully mine isn't so bad anymore but nadawi is correct that it is key to learn to stay calm and not feel ashamed or embarrassed about calling 911. That nearly did my gramma in as she didn't want to be a bother. Nurses have told me that the ER is key for asthma patients. Not sure if that is something your mom would worry about but I just put it out there.

Using an inhaler 4 times a day isn't a lot when you have bad asthma IMO.
posted by kanata at 1:30 PM on June 29, 2010


It takes a wee bit for anything like this to get settled with what medication works. Things like steroids take some time to start working as well, so yes, it can be bad when it starts. One of the things I find difficult is remembering to take the preventer inhaler regularly, all the time - if she's having trouble adjusting to the new meds and so is forgetting to take some it will also mean they're not working as well as they should.

What concerns me is that 63 is rather old to be diagnosed with asthma for the first time - she has been given a proper looking over for other respiratory things, hasn't she? It's most definitely possible that she does have asthma, just that being diagnosed at that age with no previous history (I'm assuming no previous history from what you've said) is slightly unusual. Being treated for the right thing is always helpful!
posted by Coobeastie at 1:34 PM on June 29, 2010


Maybe not, it's just going from nothing to 4 times a day seems a lot. But then I don't know a lot about asthma and Google wasn't so useful about adult-onset stuff.

Oh - she lives alone, but my sister lives next door. I think last week she was taken straight to A+E (that's British ER). I'm just worried because I've already lost one parent relatively recently and I want to try and avoid it again!

She does have a problem with damp in her house at the moment. She hoovers daily so pet fur and dust will be minimal - she's super houseproud.
posted by mippy at 1:35 PM on June 29, 2010


If she has a problem with damp in her house, there could be a mold problem. Get that check out, pronto. Mold can make you sick even if you don't have allergies/asthma.
posted by Fleebnork at 1:41 PM on June 29, 2010


If she has problems with dampness in the house she may also have mold! Find someone reliable to check this out thoroughly, it has nothing to do with how clean she keeps her home. It can be inside the walls. Mold can make you sick! At the very least, get her a dehumidifier which should help to eliminate the mold.

Could she possibly go stay somewhere else for a few days to see if the attacks become fewer?
posted by mareli at 1:46 PM on June 29, 2010


Somebody correct me if I'm wrong, but those symptoms don't really seem to describe asthma to me...

Also, ditto on the advice about the dampness, especially in the UK. I don't think I know of a single British house that doesn't have at least a minor mold problem.
posted by schmod at 1:50 PM on June 29, 2010


I am not a doctor and cannot speak to how much inhaler usage is "a lot," but I can say that my own personal grandmother got lazy and flippant about taking her asthma medication, and was also a serious gardener. One day she was gardening and got face full of pollen and weed dust, which brought on an asthma attack that killed her.

Impress upon your mother the importance of absolutely not messing around with serious asthma, and avoiding activities that are known to exacerbate attacks. If her usage of her inhaler has spiked, I would highly recommend she see her doctor about what that could mean.
posted by pts at 1:51 PM on June 29, 2010


I'd agree on an air purifier, and maybe you could go in and scrub the walls for her, or get someone to do it - while the smell of smoke is not smoke in the air, I've found it personally triggering.
posted by L'Estrange Fruit at 1:51 PM on June 29, 2010


oh god, mold. there is no quicker trigger for my asthma.

back to the calmness topic: one thing that wasn't explained to me for a long time was that sometimes too much inhaler can actually make things worse - the steroids make your heart pump faster, making it harder to calm down, making you think you aren't breathing any better, making you hyperventilate, making the inhaler unable to help you. 4 isn't too many if they're spread out, but 4 in an hour is a different story. when i've had bronchitis i've been switched to a lower steroid nebulizer - it's also nice because you don't have to breathe as deeply or harshly as you do for a regular rescue inhaler.

don't get sold on the asthma medicines you see on tv - some people claim they're lifesavers - a lot of them also pop up on "drugs doctors would never take" lists.

you might look into "air cleaning plants" - as long as she's not allergic to the actual plants.
posted by nadawi at 1:56 PM on June 29, 2010


a quick googling isn't finding it for me - but just last week i saw a commercial for paint that is supposed to seal in the nicotine stained walls so they don't mess with the air quality any more. i don't know if it actually works, but it might be worth a try.
posted by nadawi at 2:00 PM on June 29, 2010


She takes her inhaler four times a day - is this also a lot for someone newly diagnosed?

Frequency of use depends on the type of medication. E.g. Bricanyl has a short half-life of 3-4 hours, Ventolin even shorter at 1.6 hours. Because these medicines are metabolized very quickly by the body, it is quite normal to have to take them many times a day. I don't think you have any cause for concern.

It'll take a while (i.e. months) and repeated visits for a respirologist figure out the most appropriate type, dosage and frequency of medication for your mum. Quite likely they'll eventually prescribe her a long-acting bronchiodilator which has a longer half-life and only has to be taken once or twice a day.

It sounds like your mum has a VERY mild case of asthma, relatively speaking. Mine is much worse, and can result in me passing out from suffocation. Just be patient -- so long as she can afford the medication and is diligent about taking it correctly, she shouldn't suffer too much of an adverse impact on her life.
posted by randomstriker at 2:04 PM on June 29, 2010


@ schmod - yes, I'm also slightly suspicious of the diagnosis based on symptoms but it's certainly possible that it is asthma (especially if she'd been putting a brave face on some more minor breathing problems for some time, and a new trigger came in). I'd be concerned if mippy's mum hadn't had spirometery done (and possibly also a reversibility test). Misdiagnosis of asthma in older people has been so rampant that in 2008 the British Lung Foundation wanted everyone over 35 with asthma (or COPD) retested.
posted by Coobeastie at 2:04 PM on June 29, 2010


so long as she can afford the medication
Since she's over 60 it's free.

Damn I love the NHS.
posted by Coobeastie at 2:07 PM on June 29, 2010


one thing that wasn't explained to me for a long time was that sometimes too much inhaler can actually make things worse - the steroids make your heart pump faster, making it harder to calm down, making you think you aren't breathing any better, making you hyperventilate, making the inhaler unable to help you

It's not the steroids (asthma prevention inhaler) that do this, it's the bronchodilators (asthma rescue inhaler). Certainly overdosing on bronchodilators is bad due to their stimulant side-effects, especially for old people with weak hearts. The solution is to learn how to properly use your rescue inhaler: i.e. be patient after taking one or two puffs...wait a few minutes for it to take effect before deciding to take more of it. Presence of mind is very important in these situations.
posted by randomstriker at 2:13 PM on June 29, 2010


IANAD, IANHD. Here are some thoughts from a life-long asthma sufferer. First, it is surprising, but not unheard of, that she has had an initial diagnosis of asthma at her age. I would like to suggest, as others have, a mold or other environmental trigger is at fault. If her condition clears up at hospital, you might want to take her to your home for a few days to see if the condition returns or stays away. Then, when she goes home, see if the condition changes. Next, while I do not like to practice medicine, may I suggest that there are other things in us old folks that masquerade as asthma? How has her energy been lately? Does she cough more than you would think normally for a person of her age? Certain heart conditions present as coughing, shortness of breath, minor fluid production. Any (even slight) swelling of ankles or lower legs? I would ask for NHS permission to do an echo-cardiogram to see what might be going on, or a cardiac stress test.

Best wishes.
posted by Old Geezer at 2:15 PM on June 29, 2010


randomstriker - ah yes, you're right on the terms - but that was my point - that too much inhaler can up the freak out and the freak out is detrimental to breathing normally again.
posted by nadawi at 2:42 PM on June 29, 2010


Old Geezer - she has very high cholesterol, which she is being treated for. (Her GP is a bit odd - he believes women are a drain on the health service, and whenever I went in for an appointment he'd spend five minutes asking how my dad was instead of getting down to business - though that's probably concern.) She doesn't smoke or drink, walks the dogs twice daily, and I think her diet is OK. My dad had several heart attacks in his life but I don't think cardiac disease is part of the marriage vows!
posted by mippy at 2:46 PM on June 29, 2010


Well, as a lifelong asthmatic, I have a few suggestions for you.

Ventolin or Proventil is a rescue inhaler - this is probably what she's taking. It's fine. For severe asthmatics, like myself in wet months and my sister throughout her entire life (born prematurely, her lungs were only 3/4 developed at birth - she was barely 6 months), a portable nebulizer is a wonderful alternative to repeated rescue inhaler use. You appear to be in the UK, so here's a link so you know what I'm talking about.

I also take a daily dose of Singulair and Zyrtec, which combined seem to alleviate quite a few of my symptoms without the use of an inhaler (one pill each per day).

Others have had luck with the steroid-based inhalers, but I prefer to avoid them unless I'm sick; longterm inhaled steroid use can weaken the immune system. There are many, many asthma medications, some in pill form, some inhalers; some steroid-based, others, not. Urge her to ask about and try any medications the doctors are willing to recommend/test on her. Also, she should have a full breathing test and allergy panel - they are often co-morbid conditions, and yes, mold is HELL on allergies/asthma, only secondary to actual smoke/gas/chemicals/fumes, in my opinion.

What you're describing to me sounds like adult onset emphysema, which, as a matter of fact, can be genetically tested for. Does glaucoma or arthritis run in your family? What about lymphoma? If so, they apparently have a common DNA/gene marker (somebody smarter than me might correct me on the terminology here) but if she tests positive for the common genetic predecessor, then she's bound to have COPD of some kind, perhaps this article would help?

She should also request a test for Idiopathic Pulmonary Fibrosis, which often occurs only later in life and is also believed to be hereditary in some people. Anecdata: my grandmother was diagnosed with it two years ago after living with a smoking husband for 50+ years, although she never smoked herself. (She died last year, but not before we learned about the genetic testing for the precursor and the family has mostly gotten tested now - you should get tested, too, to be safe, if possible.)

Also, I didn't have asthma until I was 8 or 9 years old and it worsened significantly until I was 18 or so and no longer lived with any smokers. Once I got away from daily subjection to cigarettes, began exercising and taking care of myself, my asthma symptoms decreased significantly. (Does she sound like kittens quietly mewing when she breathes? I did, literally, for years, and would lose consciousness every time I tried to run. Because of this, I was excused from Physical Education classes from age 8 onward throughout school by a physician.)

As long as she has access to her rescue inhaler, it has doses left in it and she USES it, she will be fine. The ONLY time she won't be fine is if she has an attack and doesn't use the meds/the inhaler is empty. If she is unconscious for awhile, yes, she can develop brain damage from lack of oxygen; however, having survived two such attacks myself (once where I had to be intubated because my throat had swollen shut thanks to exposure to 3 cats), I can assure you she'll still be OK if she's able to get to the emergency room in time.

Consider having your sister and your mom set up an emergency asthma attack signal. Example: program your mom's cell phone with a draft of a text message that says "asthma" and nothing else, save it, and have her send it to your sister as soon as she realizes she's in trouble. Then your sister will know exactly what to do and won't worry if the phone rings - if mom can call, mom can talk, therefore only texts should cause alarm.

Let me know if you need more info/help; memail me if you like!
posted by Unicorn on the cob at 4:05 PM on June 29, 2010 [1 favorite]


Yeah, asthma is like being forced to breathe in and out through a drinking straw. Try it. It seems OK at first, but after a couple of slow lungfulls, the panic starts to set in. Controlling the panic is a big key to surviving a bad attack.

(As is having strong breathing muscles- I had a particularly bad bout when I was younger, and when we finally got it under control, my diaphragm and ribcage muscles were really, really sore from doing all that work.)

And asthma attacks rarely (that I know of?) happen out of the blue. There will be triggers. Finding and controlling them is key.

As for the adult-onset-ness of it, that does seem suspect. Is it at all possible she was a closet smoker? Many people (and I have been one) self-medicate asthma with nicotine. It's not particularly effective, but it does work. Had she had a recent case of the flu? Sometimes a good viral infection can render the lungs more sensitive. It is possible she always had sub-clinical asthma and now something else has made it worse?

And I'd also probably make sure other more serious things, like the above mentioned emphasema, or other lung-o-vascular issues aren't being misdiagnosed.
posted by gjc at 6:50 PM on June 29, 2010


IANYD but just wanted to second that it seems likely she could have COPD/emphysema after living with a smoker for so long. Usually people called anything that wheezes asthma, but if she has pulmonary function tests done then they will be able to get more information on the precise lung problem going on.

Either way, the inhalers are the treatment, but certain other inhalers aside from the albuterol will work better for asthma vs. COPD.

What we usually tell people from the emergency department is that they can use their inhaler up to every 4 hours, but if they need to use it more frequently than that (feeling short of breath 2 hours after using it, for example), then they should come to the emergency department, they will need a course of steroids. Some people with lung disease like this can get quite well controlled on home medications and not have a bad attack for years. Other people have bad attacks frequently and end up in the ER, or hospitalized, or worse. It varies by person.
posted by treehorn+bunny at 6:53 PM on June 29, 2010


don't get sold on the asthma medicines you see on tv

Prescription drugs can't be advertised in the UK, so this won't be a problem.
posted by altolinguistic at 2:31 AM on June 30, 2010


Prescription drugs can't be advertised in the UK, so this won't be a problem.

Yes, it's my job to prevent this happening.
posted by mippy at 11:25 AM on June 30, 2010


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