The fact that asthma is really a disease of chronic inflammation which needs to be controlled and not one of infection/bronchospasm (though they do play their roles) has been a difficult concept to instill in a LOT of the practitioners I’ve worked with over the decades. Every two years I’d have to trot out my powerpoint on the topic (with appropriate updates) and re-instill those concepts. I retired before I could update it with the GINA data.
However, it was nice to discover that after a few cycles of doing that, our rate of sending out patients to the ER for exacerbations had dropped by more than half, thanks to getting folks on appropriate maintenance treatment. I finally felt like I’d made a system improvement for once. A rare feeling!
Is that where they make you breathe into a tube? If so, yes, I have to do that every time. The first time I had significant um… restriction/blockage or whatever, the second time I was at 100%.
Sounds more like Peak Flows than full pulmonary function testing. That’s a good way for a quick eval of how you’re doing. It’s good that the 2nd time (after using albuterol?) was better than your first. But if it drops back down to significant low numbers later, you might need more aggressive treatment than just albuterol inhaler. Hopefully your steroids kick in soon (they usually do). Just don’t hesitate to return/call for help if you’re having trouble breathing.
That’s the peak flow. Which measures that one number: your peak flow velocity. One standard approach is to have one of those at home and to know your own personal best peak flow. When it drops below 80% of that number you ramp up your plan. Under 50% get help now.
The pulmonary function test is a slightly bigger deal. It measure the whole flow volume loop and often includes a challenge and demonstrating reversiblity.
What @DSeid said (as usual). They should be able to write an asthma control plan for you at your allergist’s office, and teach you how to use a peak flow meter at home. Anyone who needs to be on maintenance steroid inhalers should really have their own personal asthma control plan prepared by their asthma care expert. It’ll tell you how to assess your degree of respiratory impairment, and what steps to take at various levels.
Feel free to contact me if you want more info. I was the ‘guru’ for asthma in two different organizations over the decades (which only means I just kept current with and practiced the expert recommendations, like any good primary care provider should), and put together a LOT of educational materials, some aimed at patients, others aimed at health professionals. I’ve a powerpoint aimed at patient ed, explaining the basics of asthma, if you’re interested.
My “brilliant” pneumomediastinum pick up was coming into the room and feeling supraclavicular crepitus. Oh my. Kid wasn’t in much distress actually and the lungs had stayed inflated. It just dissected up.
When we had med students coming through part of my spiel was about learning to go beyond trying to recognize what the condition was, to realizing when it wasn’t. Recognizing that there is a mismatch, that it isn’t, or at least might not be, the usual thing, even if you have no idea what it actually is going to be, is the skill that saves you in a busy practice. The back pain with fever during flu season that turns out to be spinal epidural abscess. (That was a fun one! Initial MRI missed it too with psoas lighting up as the pus was draining there, and radiology calling that myositis.)
Can’t give any advice, but I did have a 4-6 month period in my early 30s when I could not stop coughing, day or night. I never got diagnosed with asthma but I recognize Symbiocort as one of the inhalers I took during that period. That was almost 20 years ago and I’ve never (so far) repeated the experience. Hope the doctor(s) find a better solution - coughing so much is really no fun at all.
You are getting a lot of good advice here. The best thing you can do for yourself going forward is learn about asthma (if what you are experiencing is confirmed to be, and sounds like Qadgop has some great materials!) and be prepared to push back against doctors. Getting a breathing treatment (a nebulizer is a machine that pushes air through liquid medicine to make a breathable mist) probably should have been offered to get you some immediate relief and give the higher dose of steroids time to kick in. Unfortunately I have had similar experiences to you in the past where I’ve sought urgent care for my asthma and the doctor was not going to do anything - I had to insist on receiving a breathing treatment, which of course immensely helped, and the doctor almost seemed surprised
Thank you. I’m doing significantly better today and I just picked up the stronger steroid (Prednisone). I actually got a couple blocks of sleep in last night. Relief is in sight!
I love those ‘attaboy!’ moments when I’m actually smart and it makes a difference. They are so fine!
As opposed to those ‘oh shit’ moments when I’ve been barking up the wrong tree and it led to a less than ideal outcome. And one ‘oh shit’ erases 10 ‘attaboys’.
Glad you’re doing better, @Spice_Weasel! As liirogue notes, educate yourself and be ready to push back against cursory care to get what you need acutely. Get that asthma care plan written up in cooperation with your doc, and wave it in the face of others as needed.
Although my point to the students is that it isn’t a matter of being so smart. I was not so smart that I knew about spinal epidural abscess let alone the possibility of it being missed due to drainage of the pus into the psoas (we actually published it as a case report after the fact). All I had to know was that it was something other than the usual, that it did not fit, and that this was the one to keep digging at. You don’t have to have the answer on your ddx yet, you have to suspect that the answer isn’t there though.
To students and residents that the emerging skill: in the tertiary center where they mostly train you knee jerk hunt for zebras every time. That is not life in busy primary care. But there is the time to say wait a second, a horse shouldn’t do this … huh?
Also happy to hear you are improving @Spice_Weasel - now study QtM’s power point and don’t be shy about politely advocating for yourself tomorrow.
I just feel smart whenever I’m not actively being stupid/acting completely on autopilot. I’ve learned to set my own personal bar for ‘smartness’ pretty low in that regard. ;-D
This grizzled crusty old night nurse of 41+ years thoroughly agrees~especially the wave it in the face of others as needed part. Carry it around in your purse. Have a pdf of it on your phone. Makes sure Mr Weasel is conversant in the plan too and can do that waving-in-the-of if you’re too out of breath.
Can’t remember if you have a quick acting inhaler (albuterol) to use, but if you do, do you have a spacer to use it with? A spacer can really enhance the effective administration of a quick acting inhaler if used correctly. Ask the pharmacist to show you how to use a spacer and get the most out of your inhalers~that’s why they went to school all those years. A spacer is lots cheaper from Amazon than from the pharmacy (mine were less than $20).
