Asthmatics wanted: for anecdotes and advice.
July 8, 2010 4:23 PM   Subscribe

YANAD, but you may be asthmatic with anecdotes! I'm curious about others' symptoms, treatments, etc. Back story and lots of questions!

I was first diagnosed with asthma about 7 years ago. I had some trouble for awhile, went to the ER a couple of times, but continued to smoke. My symptoms have been gone for roughly 3 years. I have been to the ER before for chest pain that may or may not have been related to asthma (the doctors kept telling me it was a panic attack when I knew that it was not that) in those 3 years, but never got even a rescue inhaler or anything like that during that period. This year, I started to cut back on the cigarettes with a plan to quit gradually. I was down to just a couple a day when I got a cold in March and couldn't have smoked if I wanted to and so gave them up. I ended up in my doctor's office because of chest pain and difficulty breathing that seemed triggered by my cold.

My doctor then gave me a breathing treatment and prescribed me albuterol like old times. I have used the albuterol since March and tracked my symptoms for part of this time. A few weeks ago, I returned to my doctor because things were not being maintained with the rescue inhaler. I was getting frequent chest tightness, breathlessness, etc. So he prescribed Advair, as this is something I took when I was first diagnosed. He also gave me a peak flow meter to start tracking how I was doing.

Now, my average peak flow is about 400-450, which is around where I should be, if not a little less. If I am having trouble breathing, it is about 300-350. But the value doesn't always go down when I have symptoms. There is some question as to whether some of my generalized anxiety (which is not treated by medication and I don't feel particularly needs it) is a part of my asthma symptoms, so I wonder if these readings aren't showing that a little. I also don't always get very good relief from the albuterol and just end up still not breathing well and shaky on top of it.

My questions to you:
1 :: Shouldn't my peak flow levels go down if I'm having symptoms? If not, why not?
2 :: Have you experienced anxiety-related asthma symptoms? Can you tell me about them?
3 :: If you care to share, what have you done to help control your asthma (meds, breathing techniques, lifestyle changes)?
4 :: I have not started taking the Advair yet as my doctor wanted me to track my peak flow without it first for a few weeks. If you've used it, how was it?
5 :: What do you do when your rescue inhaler doesn't work or takes a very long time to do so?
6 :: As for the smoking, have you ever smoked while asthmatic and/or had your asthma get worse AFTER you quit?

For the record, I have been googling with seemingly few good answers to my questions. I have also seen this thread about asthma and smoking. People have suggested that my increased asthma symptoms are because my body is cleaning out all the gunk from 10 years of smoking, but I have not had any of the typical ex-smoker stuff happen like coughing things up. I do cough, but this usually seems asthma related as it is very rarely productive.
posted by itsacover to Health & Fitness (25 answers total) 3 users marked this as a favorite
 
I'm a longtime asthmatic. I've been through extreme stress phases where I got panic attacks and breathlessness. And yes, my peak flows were similar - sometimes I'd feel breathless and the peak flow meter would not show it. And of course if you start feeling breathless (for any reason) you can end up panicking, which causes you to feel breathless.. ecch. I usually use my rescue inhaler under these circumstances and try & keep calm - it seems to go away eventually. But I know exactly how you feel.

Another (& related) possibility is acid reflux, which can also cause breathlessness. You could try some OTC medication for acid reflux (zantac or something) and see if you're having reflux and not knowing about it.

I'm not a smoker but I would guess that quitting smoking is incredibly stressful. Stick with the advair - sometimes those preventers take a while to work. Ultimately what worked for me was resolving a shitty work situation and not eating right before bedtime. Good luck!
posted by media_itoku at 4:53 PM on July 8, 2010


I've been asthmatic for most of my life and have been on Advair for probably 10 years now. It works great for me - I almost never need to use my rescue inhaler. I don't have any side effects from it. Over the years I've changed medications several times but Advair has been working for me very well for quite a while now.

I've also had anxiety problems and panic attacks with chest tightness and trouble breathing that didn't respond to my asthma meds - after a while I learned to recognize these as different from asthma attacks. Getting benzodiazapenes for the panic attacks helped; I eventually resolved the anxiety issues with a combination of therapy and getting rid of some stressful things in my life.
posted by pombe at 5:17 PM on July 8, 2010


advair was a LIFESAVER/LIFECHANGER. you need to start it. you need to do it twice a day if that's what your doc said. you need to keep on it because it's a build-up kind of thing, not like your rescue inhaler. REALLY.

when i was young, albuterol was great for me. a few years ago, as an adult, when my asthma came back with a venganace, the albuterol made my heart rush and my head spin and did nothing for my breathing problems, so i was switched to xoponex, which works a treat. you may want to look into a different type of rescue inhaler.

STOP SMOKING. smoking is stupid anyway, but smoking while asthmatic is like the stupidest, ridiculestest thing you can do. for reals, yo.

i also have anxiety. when i have a panic attack i have trouble breathing. it's *kind of* similar to an asthma attack, but only kind of. my asthma was not really *attacks* but more of just a reduced lung capacity overall, with chronic wheezing and a lot of other issues. i rarely had attacks where i straight up couldn't breath and my chest was tight and i thought i was dying. but when i did, that's pretty much what a bad panic attack feels like.


to sum up:
quit smoking.
start the advair. it is a maintenance drug, albuterol is not.
switch rescue inhalers.
if you're having panic attacks so often that they affect your breathing that often, consider meds for that.

so, if you're in the middle of a panic attack and you're doing the breathing test, you're not going to get optimal results. but then, why would you be doing a peak flow test in the middle of a panic attack?
posted by misanthropicsarah at 5:18 PM on July 8, 2010


i don't know what happened to my post. it's all there, but in the wrong order. sorry.
posted by misanthropicsarah at 5:20 PM on July 8, 2010


Two things: the tar keeps the lung less sensitive to triggers, and the nicotine is a bronchodilator. So quitting, while good for you, will tend to increase asthma symptoms.

I'm a big fan of Flovent. Works well.

When you get the chest tightness, try to concentrate on inhaling all the way to the bottom of your lungs. Asthmatics tend to get in the habit of "chest breathing" and this can be counter productive.
posted by gjc at 5:22 PM on July 8, 2010 [1 favorite]


I've had asthma my whole life. When I was a kid in the 70s, during the dark ages, asthma medication for children was abysmal. I suffered for a long time but as I got older I developed better control. When Advair came out, it literally changed my life. I cannot say enough good things about it.
posted by crankylex at 5:30 PM on July 8, 2010


Just clarification: I have indeed quit smoking. Aside from a rare one socially when I'm out at a bar or whatnot, I have not smoked since March.
posted by itsacover at 7:02 PM on July 8, 2010


The best thing I did for my asthma was convince myself that I wasn't going to die no matter what so it wasn't a big deal no matter what I did or didn't do and distracted myself as much as possible. Cleared a significant hunk of my symptoms up because they were anxiety related. It was tough as hell to do though considering how uncomfortable it can be.

Anxiety makes you feel like you can't breathe even though you can. It might be time to get help for that.
posted by internet fraud detective squad, station number 9 at 7:09 PM on July 8, 2010


I am going to go ahead and say that Advair changed my life. I apparently developed asthma (very prevalent in my family) during the last few years. My regular doctor didn't take me seriously when I said I thought it was asthma, so I was prescribed albuterol and relied on it way too much. I used it several times a week with frequent chest tightening and breathing issues.

When I finally took things into my own hands and found the right doctor last year, it was a revelation to start taking Advair and have my symptoms clear up completely. Now I use my rescue inhaler maybe twice a month - if that. The change in my quality of life is huge, and it happened very quickly.
posted by gemmy at 7:25 PM on July 8, 2010


Advair changed my life, too. Seriously. Changed my life. I can't even begin to tell you how much better everything is now. I can go outside, I can hike, I can run, I can snuggle with my cats.

I haven't experience anxiety-induced asthma so I can't help you there.

What really helped for me was to find out what my triggers were. I had an allergy test (the blood test, not the needle test) and found out I'm severely allergic to dust, flower pollen, and tree pollen.

I take Claritin and NasaCort every day for allergies. We removed all of the carpeting from the house and I have washable curtains and slipcovers. The cats aren't allowed in the bedroom. So, minimizing the triggers plus the Advair means that I can live a normal life again.
posted by cooker girl at 7:29 PM on July 8, 2010


This is completely anecdotal, but when I was 3 my doctor suggested I be given tea when I had an asthma attack. It started a lifelong love of the beverage, but I still notice that I often cough productively after a nice cuppa, whether it be white, green, or black with milk. It may not be much, but it has plenty of other health benefits so you may want to try having a strong cup in the morning.
posted by Earl the Polliwog at 7:30 PM on July 8, 2010


Asthma my whole 44 years.

Anxiety - when I was a kid I'd be so anxious and excited about christmas that I'd have a three day asthma attack that ended as soon as we opened our presents. Have not had anxiety related asthma since 10 or so.

Advair - was on it for a year and it completely eliminated all non-exercise related attacks. I only quit taking it because even with insurance it was too expensive.

Smoking - I smoked for a few years and it has definitely had a long-term negative impact on my asthma. Quit!

Never had a rescue inhaler fail on me. And whatever you do, do not use that shit called Primatene. It will damage your lungs. Stuff should be illegal.

Exercise, control your allergies, avoid smoke and get on advair.
posted by DieHipsterDie at 7:31 PM on July 8, 2010


I've also asked a question recently about breathing difficulties that I believe are mostly anxiety/tension related. Anxiety or tension can cause shallower breathing, which then can contribute to other stuff such as my yawning trouble.
posted by Earl the Polliwog at 7:32 PM on July 8, 2010


The best thing I did for my asthma was convince myself that I wasn't going to die no matter what so it wasn't a big deal no matter what I did or didn't do and distracted myself as much as possible.

Perhaps a dangerous attitude as people do die every year from asthma attacks.
posted by DieHipsterDie at 7:33 PM on July 8, 2010 [1 favorite]


If you have an attack, quiet down (even though that's counter-intuitive, sort of like steering into a skid). Remember that you actually need fairly little air, and concentrate on quality, rather than quantity of air. Don't force or strain. Learn to relax into it.

If you practice yoga, you'll find that fish pose can both dispel an attack, and gradually (if practiced regularly) relieve the chronic condition. Don't do fish without a teacher's guidance, though, if you're not a reasonably experienced yoga practitioner.

If there is an allergic aspect, it's real important to get away from the allergen before using your inhaler, relaxing, trying fish position, or anything else. The last thing you want is to relax your breathing pathways in the presence of allergens...thereby letting in more allergen!
posted by Quisp Lover at 7:54 PM on July 8, 2010


True--but after learning what objective indicators meant an actual, honest-to-god, see a medical provider problem, I had to force myself to calm the hell down. If my lips started turning blue or my little breath-o-meter indicated a problem, fine.

On a more subjective note--and this is not a medical opinion but simply from experience--if you can, indeed, distract yourself, you're not dying.
posted by internet fraud detective squad, station number 9 at 7:55 PM on July 8, 2010


Shortness of breath is a common side effect when quitting smoking, but it should go away after a week or two without nicotine.

I have allergy-related asthma. I find that taking Mucinex after an asthma attack helps a great deal. It turns out that a significant amount of the airway restriction caused by asthma attacks is due to mucus in the bronchia, and Mucinex helps clear that away quickly.
posted by twblalock at 8:28 PM on July 8, 2010


I do the mucinex thing too. It does really help and it's part of my asthma program. I also have to agree with switching to xopenex. I used to use albuterol and it made my anxiety worse. Xopenex works sooo much better for me. Plus the doctor has me on Symbicort, which also helps tremendously.
posted by Polgara at 8:49 PM on July 8, 2010


I was asthmatic as a child and then 'grew out of it' as I got older. It has been more than a decade since my last attack. Several things really, really helped me.

#1 is learning different breathing techniques. When I was a teen I got really into learning different breathing techniques. I researched the techniques that singers used, yoga practicers, and so on. Learning how to properly control my diaphragm really helped when I had an attack.

Next was being very obsessed with staying healthy. Whenever my immune system was suppressed I knew an attack was sure to follow. That meant eating right & getting the proper amount of sleep.

Further being clean would help with my allergies. I would vacuum & dust regularly, where a dust mask when doing certain chores & check pollen counts.

Later as I got better & better I started to exercise more & more which was really help me beat asthma in to submission.
posted by cuando at 9:09 PM on July 8, 2010


Since I'm lacking insurance I developed a few ways to help me deal with wheezy symptoms and when I recognize an attack coming, and don't have an inhaler handy.

Breathing techniques:
-Draw in as much air as I can, and continue to suck in just a little bit more until I feel I really need to breathe again. Repeat as necessary.
-Cough as hard as I can, occasionally in combination with forcing air into my lungs. Dislodges some of the shit in my lungs, which tastes just NASTY, but hey it works.

Alternative treatments:
-Weed. No kidding, I took a puff of weed and was just fine shortly after; I just held the smoke in my lungs for an extra bit, ala the first breathing trick above. Bonus: I felt less stressed about the whole thing. If you're not into getting stoned, this option is not for you. (I'm not a pothead, just the very rare once-a-year 'Hey let's smoke a bowl' kind of potsmoker.)

Something that might help with learning how to breathe and also making your lungs stronger is swimming. I don't get competitive with it; I just dork around in the pool, and as long as my lungs are underwater they get a bit of a workout. As time goes by, you get used to regulating your breathing with the water pressure and have greater lung capacity. One awesome side effect is it can get your whole body into better shape, and that's never a bad thing!

I smoked for a while. I had childhood on/off exposure for months on end, so I don't think it affected me as much when I quit. I do notice years later now that my symptoms aren't quite as bad, though -- and the last time I had a cig, it tasted like shit, I felt like crap afterwards, and my lungs really hated me.

Albuterol: If I'm REALLY having an asthma attack, I'll be fine if I take a hit. If not, I get really jittery and spastic for a while. With any rescue inhaler, if I can't taste it then I know I really needed it. Over time I've figured out when I should use the less-powerful orangey-tasting one (I don't remember what it is, but it always tastes citrusy to me) and when I should break out the heavy artillery albuterol, which tastes like I'm sucking on a pill.

I don't take Advair because I take loratadine, and I finally realized after a week of taking both that I really wasn't sleeping AT ALL. That was not a fun week.
posted by Heretical at 10:17 PM on July 8, 2010


I had chronic, severe Asthma from age 6-30, numerous emergency trips, hospitalized several times a year, a 14-month stint at an inpatient Asthma treatment center, almost died three times. Essentially symptom-free since I turned 30, 13 years ago.

Several things happened close together that turned it around.

1) I started riding a bike. I firmly believe that pushing your lungs when you're feeling good helps strengthen them for when you aren't. The whole "cleaning out the gunk" thing goes with this, too.
2) Inhaled steroids, eventually Advair. I'm on a low dose now (100/50), and it's been revolutionary.
3) Better treatment for my sinus issues (polyps).

Those three things turned my asthma around.

I don't think the home peak flow meters always reflect your symptoms. I know I can wheeze a lot and still blow fine.

As for rescue inhalers, a few things:

1) Get a spacer. A spacer significantly improves the efficacy of the inhaler, and for my money, gives me the same relief as a nebulizer treatment (like you'd get if you went to the ER).

2) If the rescue inhaler fails, I'd say go to the hospital.

3) There are some other things you can try, though. Drink hot water. The hot water can help relax the muscles in your throat, etc, which can provide some relief. Make it as hot as you can stand, and drink as much as you can, like 3-4 cups.

4) Also relaxing and focusing on breathing. Getting worked up does make it worse. If you can breathe in through your nose and push the breath out through pursed lips, that can also help. Dunno why, but it does.

Not sure why people say you aren't going to die, though. If I stop breathing, I die. When I was sick, unless I got immediate treatment, I was in danger of dying. Different people may have different severities of the disease, and perhaps some people have attacks that aren't life-threatening. Until you find a rescue inhaler (or easy to access emergency treatment) that reliably works for you, be careful.

Some other things you might consider:

1) Are you allergic to anything?
2) Is your doctor a pulmonologist? A lot of doctors nowadays know the basics of asthma management, but a specialist might be useful to help you scope out your illness.

Sorry to be long-winded :-)
posted by Gorgik at 11:15 PM on July 8, 2010 [1 favorite]


I had chronic, severe Asthma from age 6-30, numerous emergency trips, hospitalized several times a year, a 14-month stint at an inpatient Asthma treatment center, almost died three times. Essentially symptom-free since I turned 30, 13 years ago.


Wow. Glad you are doing better.
posted by DieHipsterDie at 7:58 AM on July 9, 2010


This is what I have learned living with asthma for 15 years.

2) I think someone already mentioned it but albuterol, especially if used frequently, can absolutely make you feel more anxious. It makes you shaky and increases your heart rate.
3) Hard wood floors are better than carpet for asthmatics because they can be kept free of dust and pet dander more easily. If you have pets and your asthma is related to them they should not be in the bedroom (much of asthma symptoms are clustered around nighttime), dust mites that live in pillows and mattresses also increase asthma symptoms so you might consider pillow and mattress protectors. Or alternatively, you could buy new pillows more frequently.
4) I take Symbicort, which is like Advair but it has a different long acting albuterol-like compound. It has helped significantly. Just remember it is not to be used in place of albuterol if you are having an acute attack.
5) If the rescue inhaler isn't working you need to see a doctor. You may also need a home nebulizer. Ask your doctor about that.
6) I can't speak to the smoking issue.

If your asthma is allergy-related then you could ask about allergy shots. They are a commitment but they really work for some people. Also, Singulair is very good for asthma and allergies, but very expensive. Your doctor can tell you if either of those options might be suited for you.
posted by teamnap at 8:00 AM on July 9, 2010


I've been asthmatic since childhood, but not as severe as others. One of the main things that has helped me is understanding symptoms and triggers and treatments.

I know for me that allergies absolutely trigger my symptoms, treating my allergies also treats my asthma. Another big problem for me is colds. A small sniffly cold that most people would get over in 3 or 4 days will take me 2 weeks need to be treated with a steroid pack and a nebulizer treatment. I get about one of these colds a year (except for last year I kept a cold as just a cold, yay!).

This is related to your question of what to do if your rescue inhaler doesn't work. The answer is go to a doctor, if not an ER. (Hint: saying you're Asthmatic with breathing difficulties always gets you the next open appointment.) Nebulizer treatments are liquid albuterol mixed with oxygen, and they kick ass. I've known people with home nebulizers, but it sounds like you've got less extreme options to try first.

Advair has been so so awesome for me. Yeah, it costs $160 (w/o insurance), and comes with that "may cause sudden death" warning. Both are great reasons for you and your doctor to see if your asthma may be well controlled with out it.

I also understand now that every time I hear rice krispy sounds in my lungs, it's just part of having Asthma. You can't treat Asthma just when you think you have symptoms. You in fact will always have Asthma.

Smoking, ugh. My freshman year of college a great place to hang out (as we couldn't go to booze bars yet) was a hooka bar. I some how convinced myself that since it was filtered it wasn't going to be bad for my lungs. It took 3 nights out, each followed by terrible asthma and colds to put 2 and 2 together.

Exercise is also important. I was kind of always terrified of aerobic exercise as a kid because I knew I had Asthma, but didn't really understand it. I know my symptoms are controlled, and keep my rescue inhaler on me when exercising. Even just regular brisk walking makes a big difference. Your heart and lungs work together, so make both of them strong.

Other fun lung facts, moist membranes are important in gas exchange. Drink lots of water, and consider if you need a humidifier. Also asthmatic bronchi are very sensitive to cold, and will inflame with sudden temperature changes. Does ice water or milkshakes sometimes make you cough? Thats why. Scarves are super important in winter. Keep your throat warm, and wrap it around your mouth and nose when it's really cold. Breathing through it will warm the air, and keep it moist. Obviously, very cold weather is not a good time for asthmatics to exercise.
posted by fontophilic at 10:26 AM on July 9, 2010


#4 I've been on Advair for ~3 years, it's going well. Previously I was on Ventolin as needed for exercise, then I moved to a more allergen-ridden area and found I was using Ventolin several times a day and I was often waking up wheezy. The Advair has completely gotten rid of these - now the only time I'm wheezy is around cats, or with exercise below freezing or awful humidity, then I usually use a single Ventolin puff to help.

#5 I asked my doctor about this: once or twice I got so wheezy I was dizzy, flushed, and feeling faint. She said in this situation, take the rescue inhaler (Ventolin) every 5 min until it starts to improve. If it isn't better by 15 min (or getting worse), then call emergency or go to emergency. (I'm curious what other people's experiences are here, I've never been to emergency.)

#3 I have exercise-induced and allergy-triggered asthma, so for me the more regular, steady aerobic exercise the better. And avoiding allergens, using antihistamines. I also love yoga for calming, refreshing exercises including breathing exercises. Yoga could help with anxiety.

I never much used a peak flow meter, I'm a non-smoker, no unusual panic attacks. I'm in Canada.
posted by SarahbytheSea at 4:42 PM on July 9, 2010


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