[Closed] Asthmatics Assemble! (slowly)

I'm not as severe as you, but do have a cough that is pretty persistent, mildly annoying over the last 18 months as I feel I need a t-shirts with the words "It's Asthma, not Covid" printed on it.

I've had various tests at hospital over the years and they've all ruled something out but never confirming anything. I too know my triggers and have basically accepted this as not going anywhere soon.

Not sure if that helps.

I feel I need a t-shirts with the words “It’s Asthma, not Covid” printed on it.

If nothing else, I think perhaps we should start a company selling these!

At my last asthma check the nurse actually said I should take up all my carpets, get rid of any pets, and move to the country.

Lol! She just wants you off her list. 🙂

All this is verrrry familiar.

I have a very similar symptom profile to you. Usually takes an hour of cycling to get my lungs cleared of phlegm.

Yes, your asthma is poorly controlled, probably worse than mine - I tend to have one course of steroids a year on average for flare ups.

Obviously reducing allergens can't be a bad idea. If your house is a dust-fest, then that won't help. We've all been spending more time inside houses in recent months, for some reason. Do you know what your triggers are - dust mites etc?

As regards 'You're on the maximum dose of everything', I'm not sure, and it may be worth trying some other combination if your current drugs aren't working.

I have the max dose of Seretide, which is roughly the equivalent of Symbicort. I also have montelukast, which is a specific anti-inflammatory aimed at the airways. It works for some people, has zero effect on others.

I'm also on a COPD/Asthma treatment called Tiotropium Bromide, which has made a noticeable difference to me. Might be worth enquiring - maybe even giving seretide a go instead of symbicort for a bit?

Granny sucking eggs time, but have you checked your inhaler technique properly recently? Do you use a spacer? Do you use a peak flow meter and record your readings, including time of day?

Are you on any other medication which may be an irritant, eg eye drops/nasal sprays?

Have you tried Soprobec? I don’t have asthma but my wife does and with symbicort it gave her shakes but they have gone since she switched. Her asthma also seems better controlled.

Edit: martinhutch puts it better than me but people react differently to different medicines so an alternative might be worth trying.

Have they tried changing your preventer? My asthma was basically uncontrolled as my old inhaler was basically doing nothing and I was relying on a reliever, which I’d got used to. Our local doctor got proactive when just before Covid took hold and seemed to review everyone with asthma. I was switched to an inhaler with a combination of two drugs that has worked miraculously. I have got away with two hay fever seasons and two winter heating systems without an attack and barely a wheeze.

Had Asthma for - 40+ years. Moving out of London suburbs to Herefordshire, switching to Symbicort and riding lots (based on the advice of my MTB mad doctor) has definitely made a difference. When we moved here, we went all wooden floors - partly due to vague recommendations around carpets and asthma.

We do have two shedding labs and two cats so I'm not sure it makes that much difference.

I rarely use my ventilin now, but cold/damp weather definitely brings on wheezing/shortness of breath during exercise. I think the best advice I had from my doc was to accept you've got less than brilliant lungs, so start slowly and try and stay aerobic, not anaerobic. HRM definitely helped.

Clearly your asthma is way worse than mine, but I can't help thinking removing a few triggers made a massive difference.

Thanks all.

Might be worth enquiring – maybe even giving seretide a go instead of symbicort for a bit?

Granny sucking eggs time, but have you checked your inhaler technique properly recently? Do you use a spacer? Do you use a peak flow meter and record your readings, including time of day?

I was on Seretide for years and they moved me from that to Symbicort. Not sure why. Technique is fine, did do peak flow morning and night and still do if ill, but I'm generally around 'normal' for me (which is quite a bit lower than it should be for an otherwise healthy person of my age and size).

Have you tried Soprobec? I don’t have asthma but my wife does and with symbicort it gave her shakes but they have gone since she switched. Her asthma also seems better controlled.

Nope, I'll take a look, thanks.

Have they tried changing your preventer? My asthma was basically uncontrolled as my old inhaler was basically doing nothing and I was relying on a reliever, which I’d got used to. Our local doctor got proactive when just before Covid took hold and seemed to review everyone with asthma. I was switched to an inhaler with a combination of two drugs that has worked miraculously.

Yes, this is what Symbicort does - I was on Seretide as a reliever for years which really made a difference for me - not quite life-changing, but not far off. Symbicort is a combined preventative and reliever.

Moving out of London suburbs to Herefordshire, switching to Symbicort and riding lots (based on the advice of my MTB mad doctor) has definitely made a difference. When we moved here, we went all wooden floors – partly due to vague recommendations around carpets and asthma.

Well, we're in Bath - up the hill, so away from the depression where the traffic pollution settles - and have probably more hard floors than carpets.

I rarely use my ventilin now, but cold/damp weather definitely brings on wheezing/shortness of breath during exercise. I think the best advice I had from my doc was to accept you’ve got less than brilliant lungs, so start slowly and try and stay aerobic, not anaerobic. HRM definitely helped.

Yep, cold/damp weather is definitely a trigger.

I would stress that simply accepting that things aren't going to get better, whether it's via extra medication, or some other intervention, isn't the way to go.

Like me, you appear have a mild form of brochioectasis - that's the abnormal build-up of phlegm in your large airways. It may be that you have environmental triggers that are making this worse, and you can do something to reduce those.

I'm certainly considering whether to ask for sensitivity tests to see if I'm reacting badly to something in my house, be it dust mites/pet dander or fungus spores.

In the meantime, it could be worth working on your technique for clearing excess mucus - reading up on it, there are both techniques in forced expiration which you can learn which may be better than simply hacking your guts up every couple of hours. It's pretty much what I taught myself to do anyhow without any assistance. There are also devices like an inhaler you can get hold of which produce an oscillating airflow to loosen mucus.

eg

https://bronchiectasis.com.au/physiotherapy/techniques/oscillating-positive-expiratory-pressure-therapy#pari

Thanks Martin!

I need to thank you, actually. My asthma has been a bit shit this year (too much time stuck in the house, I suspect), so this has motivated me to try to improve things over the winter. 🙂

I had asthma in my early teens to early 20s, but only mild, and it tended to start in early winter, and die down in spring. Since then I've had 20 years of no asthma at all.

Until last summer, out on a regular shortish loop, and after about 45-60 mins I started wheezing....hmmm, that's strange. Got home, and after 15 mins it stopped. From then on, apart from one ride, it kept recurring, and was getting slightly worse. So knocked the cycling on the head for a while, and tried to get a Dr appointment. By October, was given, the usual Ventolin inhaler, but didn't have the desired affect.

Finally got a proper face to face appointment, had a few checks, and everything was clear; so was given Fostair, as well as the Ventolin. Since then, it's worked, and I now have to take it every day - but it was only during cycling it would flare up; in everyday life there were no issues.

I'm on symbicort and montelukast as well. Started going to the clinic about sixish years ago and at that time I was on a medium dose of beco something out of a brown inhaler with a completely useless blue inhaler. For whatever reason the reliever has never really done anything for me except give me the jitters. Switching to the symbicort and montelukast has made things a lot more stable.

Mine is excercise induced so I've got to manage my exertion levels really quite carefully or I get to a point where I just can't get my breath back. This used to happen a lot more frequently with the old meds, whereas I now find that I've got a bit more leeway in terms of pushing it before I hit the point of no return.

I don't really get triggered by allergens (thankfully) and (touch wood) not had any issues with colds etc. Heavy pollution is no bueno and riding in the cold causes my airways all sorts of grief, so have to be pretty careful in winter. Luckily I live in a small village in South Wales, so don't have to worry too much about smog, but I'll notice it if I spend a few days in central London.

I think (like many health related things) that asthma is a pretty broad set of issues and getting a decent treatment regime that works for you is largely down to landing with the right doctor/nurse who's got the right knowledge and can work with you. The nurse practitioner who runs our local clinic is brilliant and I've avoided ever telling them I moved for precisely that reason.

If your coughing a lot - your asthma is not well controlled and you need a review.
Have you tried bricanyl as a reliever rather than ventolin? I found ventolin was pointless.
There are other routes to go - they’ll take a bit of fighting though - autoimmune meds.
I had to abandon winter riding due to chest infections- took up winter hillwalking instead. One thing that did make a difference was protecting throat and upper chest by wearing scarf when outdoors.

However, I have always had a prolonged cough and (disgusting bit, sorry) regularly (i.e. every couple of hours) produce phlegm.

Another 40+ years of asthma here too. Mine is very well controlled these days (generally has been since I quit smoking 20 years ago #whatanidiotbutitwascoolonce????).

About 10 years ago I had a persistent cough, for over a year, producing various shades of phlegm from light green to dark brown - what a treat. Anyway, after a further year of the consultant testing me for just about everything he could including changes to my known allergies, reflux etc., he finally prescribed a longish course of Azithromycin. I have not had any bacterial lung infections since.

End of 2019 I was moved from Seretide, as a preventer, to Relvar (same stuff different type - powder versus whatever Seretide was) and after first month I'm still all good. I have not had any lung issues until 4 weeks ago when Covid properly boll**** things up.

Forgot to say - check your on the 400/12 and not the 200/12 dosage for symbicort.

Have you had a blood test? Do you have raised white blood cells (called eosinophils)? Have you taken rescue oral corticosteroids? I spent over 10 years developing mepolizumab (Nucala) for Severe Eosinophilic asthma. There are other injectable biologicals for uncontrolled Severe Asthma you might like to discuss with your consultant, and they mostly work the same way by blocking these particular white blood cells from causing tissue inflammation. Disclaimer: IANAMD and these are my personal views.

I think (like many health related things) that asthma is a pretty broad set of issues and getting a decent treatment regime that works for you is largely down to landing with the right doctor/nurse who’s got the right knowledge and can work with you.

Yep, I think at our place it's very much a 'tick box' review, particularly at the moment!

If your coughing a lot – your asthma is not well controlled and you need a review.
Have you tried bricanyl as a reliever rather than ventolin? I found ventolin was pointless.
There are other routes to go – they’ll take a bit of fighting though – autoimmune meds.

Nope, not heard of bricanyl. Will read up.

Forgot to say – check your on the 400/12 and not the 200/12 dosage for symbicort.

200/6 here, but I've been told twice by the "asthma nurse" this is the highest I can get. Sounds like it isn't though!

Have you had a blood test? Do you have raised white blood cells (called eosinophils)? Have you taken rescue oral corticosteroids? I spent over 10 years developing mepolizumab (Nucala) for Severe Eosinophilic asthma. There are other injectable biologicals for uncontrolled Severe Asthma you might like to discuss with your consultant, and they mostly work the same way by blocking these particular white blood cells from causing tissue inflammation.

Absolutely no idea. Good to know there's possible other options though.

Thanks everyone for your input.

Have you had a blood test? Do you have raised white blood cells (called eosinophils)? Have you taken rescue oral corticosteroids?

YOU may qualify for the latest in monoclonal antibody technology - it's the best-kept secret in respiratory medicine! Ask your doctor today for their latest deals!

Seriously though, that sounds interesting, is that generally only prescribed in secondary care?

NHS are currently trying to get people off symbicort to use an out of patent generic brand because it is expensive. Tried it with me last year - I had such a bad time trying serotonide/becotide told them no.

I use bricanyl as a reliever - ventolin was utterly rubbish - max dose and still no help on.

Good to know about the MCA treatment - they kept that quiet!

NHS are currently trying to get people off symbicort to use an out of patent generic brand because it is expensive.

Yep, I had a real problem getting more than two inhalers at a time from the doctor as apparently they cost the NHS £35ea (!!!). Since I'm supposed to be using it as a reliever and preventer I wanted one to carry with me and one at home and a spare, but they wouldn't budge.

Mine is clearly quite mild and well-controlled compared to many on here.
I think it is always worth trying to change things to find improvements, even if you think it's fairly well controlled. If the changes don't make things better you can always revert back to your previous regime.
Regarding inhalers, I'm on ventolin (which has always been great for me) and I buy them over-the-counter when I'm on holiday in Spain - way cheaper than the cost of a prescription here.
When I was younger, I found swimming helped mine a lot - something to do with the moist air. And moving to the West of Scotland from the East aslo helped (for the same reason I think).