Asthma frustration, is there anything else I should be doing?
March 2, 2020 3:23 AM Subscribe
YANMD, but maybe you can help me bug my doctor about what's next. When I have a Asthma flare up, it is taking a long time and lots of medicine to get me back under control. Details inside. Is there anything else I should be looking at?
When healthy, my pulmonary function is average for my age (mid 30s female) most recent function test was less than a year ago. I have a lifetime history of asthma. My controller medications (brio, singular) seem to work until I get a health trigger (like a cold) and then I'm on a spiral of daily meds, predizone bursts . It's taking between 10 and 14 days to reduce medicine use. My peek flow is fine but I experience a ton of shortness of breath with activity. There is definately wheezing. I require duoneb about every four hours. This time around 50mg predizone burst for 5 days failed, I'm now on a second round doing the 4321 method instead. This is now typical for me. I don't get better quickly. My lungs are irritated, I'm exhausted and prednisone is an emotional rollercoaster from hell.
I've seen my PCP and my pulminologist in the last two weeks, due for a follow up this week because I'm still not better . Is there anything I should bring up? Next tests? Things to do?
Other relevant info, i have sinus tachycardia which i take a heart med for (ivabradine as i can't take betablockers), echocardiogram was normal for my age. I am occasionally experiencing palpitations but aside from having a fast heart rate when unmedicated no rhythm abnormalities have been found. Hypothyroid as well, those tests are in the normal range on my dosage and don't account for my heartrate.
When healthy, my pulmonary function is average for my age (mid 30s female) most recent function test was less than a year ago. I have a lifetime history of asthma. My controller medications (brio, singular) seem to work until I get a health trigger (like a cold) and then I'm on a spiral of daily meds, predizone bursts . It's taking between 10 and 14 days to reduce medicine use. My peek flow is fine but I experience a ton of shortness of breath with activity. There is definately wheezing. I require duoneb about every four hours. This time around 50mg predizone burst for 5 days failed, I'm now on a second round doing the 4321 method instead. This is now typical for me. I don't get better quickly. My lungs are irritated, I'm exhausted and prednisone is an emotional rollercoaster from hell.
I've seen my PCP and my pulminologist in the last two weeks, due for a follow up this week because I'm still not better . Is there anything I should bring up? Next tests? Things to do?
Other relevant info, i have sinus tachycardia which i take a heart med for (ivabradine as i can't take betablockers), echocardiogram was normal for my age. I am occasionally experiencing palpitations but aside from having a fast heart rate when unmedicated no rhythm abnormalities have been found. Hypothyroid as well, those tests are in the normal range on my dosage and don't account for my heartrate.
I stopped eating dairy when I found out I was lactose intolerant. In the 10+ years since, my inflammatory arthritis and asthma dramatically improved. Eating dairy tends to bring on an attack of asthma.
posted by theora55 at 6:42 AM on March 2, 2020 [1 favorite]
posted by theora55 at 6:42 AM on March 2, 2020 [1 favorite]
A couple of things that helped when I had a weeks-long asthma flareup from the flu, 30-some years ago:
Eating spicy food, spicy enough to make your nose run. This thins your mucus temporarily, making it easier to cough up and can make lungs feel clearer. Indian food reliably does this for me, or you can make a quick spicy broth by adding cayenne pepper to chicken or vegetable broth. I usually add some vinegar as well to make a hot and sour broth.
The breathing exercises in this book. I'm sure there are other, more modern sources but this is where I learned them and they did help. I did not become a "former asthmatic" but the exercises did often bring relief during an attack.
A third thing I will mention: I take 600 mg of NAC daily to help with ADD and OCD symptoms. NAC has shown some limited success in easing the symptoms of COPD. I can't exactly vouch because I have never taken it specifically for an asthmatic flare. But on the other hand, I take it daily and I haven't had any asthma symptoms in a while (knock wood.) Just thought I'd mention it as it has been studied.
posted by Serene Empress Dork at 7:07 AM on March 2, 2020 [1 favorite]
Eating spicy food, spicy enough to make your nose run. This thins your mucus temporarily, making it easier to cough up and can make lungs feel clearer. Indian food reliably does this for me, or you can make a quick spicy broth by adding cayenne pepper to chicken or vegetable broth. I usually add some vinegar as well to make a hot and sour broth.
The breathing exercises in this book. I'm sure there are other, more modern sources but this is where I learned them and they did help. I did not become a "former asthmatic" but the exercises did often bring relief during an attack.
A third thing I will mention: I take 600 mg of NAC daily to help with ADD and OCD symptoms. NAC has shown some limited success in easing the symptoms of COPD. I can't exactly vouch because I have never taken it specifically for an asthmatic flare. But on the other hand, I take it daily and I haven't had any asthma symptoms in a while (knock wood.) Just thought I'd mention it as it has been studied.
posted by Serene Empress Dork at 7:07 AM on March 2, 2020 [1 favorite]
I agree that limiting my dairy intake has helped. But for me the best offense is good defense. My issues don't seem to be quite as severe as yours, but I have the same situation, where a minor cold often develops into a full-blown flare up that can take weeks to recover from. I combat this by upping my medication dosages and adding Qvar to my medication regimen in the fall and winter, which are my trouble seasons.
It seems like Breo is similar to Qvar, so maybe you need to go another step up the chain in strength for your trouble times. If I start to take the Qvar as soon as I feel that tickle in my nose from ragweed season, I do much better.
posted by backwards compatible at 8:00 AM on March 2, 2020
It seems like Breo is similar to Qvar, so maybe you need to go another step up the chain in strength for your trouble times. If I start to take the Qvar as soon as I feel that tickle in my nose from ragweed season, I do much better.
posted by backwards compatible at 8:00 AM on March 2, 2020
It me, and boy I wish I had good advice for us. One thing, have you tried different meds? I've been on advair for a long time and it works.... Ok, until I get a cold. But at one point my insurance insisted I try singulair, and then I was noticably worse. So back to advair. Also, xoponex has worked well as a short-acting drug, whereas Albuterol will reliably give me palpitations and make me so shaky.
posted by Dashy at 8:25 AM on March 2, 2020
posted by Dashy at 8:25 AM on March 2, 2020
ENT doctor here. I second the above opinion regarding allergy testing. Even if you are only mildly allergic to a few allergens there is good evidence that allergy immunotherapy can improve baseline asthma symptoms as well as flares. You will also learn what you’re sensitive to so that you can possibly avoid triggers. Find an allergist who is close to home or work in case you do decide to go on shots.
posted by Fritzle at 9:18 AM on March 2, 2020 [3 favorites]
posted by Fritzle at 9:18 AM on March 2, 2020 [3 favorites]
Asthmatic with other stuff here (though mine mostly doesn't flare badly.)
I've been told by multiple medical folks that lung healing in specific a) takes a long time (for up to a year after a serious flare, you're more susceptible to more), and b) draws heavily on Vitamin A in specific. This shows up in me as a desire to eat all the dairy (where it tends to be more readily available), so now when I see that happening or have a flare, I add a supplement.
I started using a CPAP machine about 18 months ago, and allergy shots about 6 months before that: the combo has brought my reactivity down substantially. In particular, the fact that the CPAP machine means I'm breathing filtered humidified air for a third of the time seems to just make everything better. If you've been contemplating sleep testing, it might be worth it to try out, but otherwise, testing humidity and air filtering and what works for you especially in your bedroom may pay off.
(And the allergy testing means I have a really good sense of what I'm most likely to react to, which helps in making choices about priorities for cleaning/lifestyle changes/etc.)
posted by jenettsilver at 9:34 AM on March 2, 2020 [1 favorite]
I've been told by multiple medical folks that lung healing in specific a) takes a long time (for up to a year after a serious flare, you're more susceptible to more), and b) draws heavily on Vitamin A in specific. This shows up in me as a desire to eat all the dairy (where it tends to be more readily available), so now when I see that happening or have a flare, I add a supplement.
I started using a CPAP machine about 18 months ago, and allergy shots about 6 months before that: the combo has brought my reactivity down substantially. In particular, the fact that the CPAP machine means I'm breathing filtered humidified air for a third of the time seems to just make everything better. If you've been contemplating sleep testing, it might be worth it to try out, but otherwise, testing humidity and air filtering and what works for you especially in your bedroom may pay off.
(And the allergy testing means I have a really good sense of what I'm most likely to react to, which helps in making choices about priorities for cleaning/lifestyle changes/etc.)
posted by jenettsilver at 9:34 AM on March 2, 2020 [1 favorite]
My allergist told me the same thing as arabidopsis’ - use a different inhaler the second I start feeling a cold coming on, and then keep using it for a few days until the cold is over. I haven’t had to test this yet, but I had similar problems to you - needing prednisone and an antibiotic after every chest cold, due to wheezing and coughing up thick phlegm that would not go away.
posted by umwhat at 2:47 PM on March 2, 2020
posted by umwhat at 2:47 PM on March 2, 2020
My spouse has somewhat similar asthma problems, but they have been reduced with a couple of things. He got an allergy test and made it partway through the course of shots, added Xyzal as a regular thing he took, and at this point we have an air filter running at home most of the time. The allergy shots made the largest dent of the three, so you could try a referral for an allergy test and see how it goes.
I would also echo Dashy's comment about Advair vs. Singulair - my spouse's insurance made him switch to Singulair a while ago, and it didn't work nearly as well as his usual Advair, so he and his doctor had to badger them for a while until they'd let him switch back. Maybe give Advair a shot for general management?
posted by tautological at 2:59 PM on March 2, 2020
I would also echo Dashy's comment about Advair vs. Singulair - my spouse's insurance made him switch to Singulair a while ago, and it didn't work nearly as well as his usual Advair, so he and his doctor had to badger them for a while until they'd let him switch back. Maybe give Advair a shot for general management?
posted by tautological at 2:59 PM on March 2, 2020
The low-tech things that have helped me is adding a humidifier to the air when it's dry, and doing nasal lavage. I'm in a very dry climate, so keeping things moist and the fluids moving about has really helped. This is the first year I haven't been sick all winter, and it's the year I've been religious with the humidifier at work at at home.
posted by answergrape at 3:01 PM on March 2, 2020
posted by answergrape at 3:01 PM on March 2, 2020
Response by poster: Update: saw my pulmonogist I'm tachycardic not wheezing. So changing up regimine to be stricter when I neb based on peak flow only and not how I feel. And reducing predizone faster.
And seeing a cardiologist again. So I guess my question is a different one.
posted by AlexiaSky at 9:00 AM on March 3, 2020
And seeing a cardiologist again. So I guess my question is a different one.
posted by AlexiaSky at 9:00 AM on March 3, 2020
This thread is closed to new comments.
The recovery timeframe sounds about normal from his experience - he finished the step down steroids about a week ago and is still using his backup inhaler in addition to the regular daily one.
Possible things to look at: allergist testing - is there anything else compounding the asthma that could be addressed with lifestyle changes, different bedding, etc. Can you go swimming more? Something about the regular breathing exercise helps his lung function.
posted by brilliantine at 5:18 AM on March 2, 2020