Asthma with a good peak flow

[jerry3571]

Hello,
I have had for 25 years or more (aged 40 now) a problem with breathing and still maintaining a good peak flow.
My worst Peak flow has been about 520 and can feel bad at over 620. I am male and 175cm tall.
I use Symbicort 200 inhaler and up the dose when things get tight.
There is Hazel Pollen about at the moment but I have had a better spell of breathing but now it has decreased lately somewhat.
I have had problems with gas being trapped and thought that this may be a problem with Gas pushing up on my diaphram, a good burp usually helps a lot for the problem to gradually return. Not sure whether i swallow air or have a GERD type issue. Gurgling in the sternham usually a sign of progress as gas escapes. Trying to get the top end of my breathing seems to be the tricky thing too.
It has been going on for a huge length of time and I think over the last few years been getting a bit worse. I also have suspicions on stress also.  

Does anyone have any ideas on how this all works?? I have heard that it is possible to have breathing problems which the Peak Flow doesn't pick up. Also had a good Spiro; the Nurse said one of the best she's seen.
I've been a keen cyclist and feel my lungs now are not quite good enough to race any more; I do sendentry riding now.

Thanks Jerry

[jerry3571]

Thanks for all that, I didn't realise this thead was running.
I am using Omeprozole for Gerd type thing and Buscopan too for IBS.

This could all be Anxiety related and that is another cuase of action down the line,

Thanks for all that

-Jerry

[hava]

Do this pranayam for 30 minutes, twice a day to help with the asthma. The extra oxygen going into the lungs will definitely help. Let me know when you start to feel the benefit, then I will post something for the gas problem.
Build up your timing gradually.If you feel tired or dizzy, stop and resume after one minute.
Anulom Vilom pranayam –
Close your right nostril with thumb and deep breath-in through left nostril  
then – close left nostril with two fingers and breath-out through right nostril  
then -keeping the left nostril closed  deep breath-in through right nostril
then - close your right nostril with thumb and breath-out through left nostril.
This is one cycle of anulom vilom.
Repeat this cycle for 15 to 30  minutes twice a day.
Children under 15 years – do 5 to 10 minutes twice a day.
You can do this before breakfast/lunch/dinner or before bedtime or in bed.Remember to take deep long breaths into the lungs.You can do this while sitting on floor or chair or lying in bed.
March 17, 2011

[MeganPixel]

Just another idea to add to the thread... I started having what I thought were very severe asthma symptoms and none of my meds would work - not rescue inhaler, not corticosteroid, not even a nebs treatment of albuterol (at the urgent care).  At one point they even had me on 80 mg daily prednisone (which for me is very high) but never completely cleared up the attacks.  I had a reasonably good peak flow - my best is around 510 and I was averaging around 480 at the time - spirometry test which showed 'above average' performance, and even several chest x-rays and a lung CT to rule out persistent pneumonia or a blood clot.  I was having other symptoms too like chest pain, tingling, headaches, dizziness, etc.

After all the testing (that mentioned above AND then some!) had given me a clean bill of health physically the doctor suggested I might be suffering from anxiety.  So she prescribed some Xanax, told me to start with the lowest possible dose, and take for a couple days (and if I felt like it was working/I needed more, to get in to see her because no one should take Xanax long term, it can be addictive).

Lo and behold the day after I started the Xanax the symptoms 'disappeared.'

Anyway, that may be something additional to check out or talk about with your doctor, if you are able to rule out any other causes. One thing I might mention - an anxiety attack to me felt different from asthma. Asthma would make me cough and wheeze, and anxiety would feel like someone was sitting on my chest and I couldn't get my lungs "full."  I'm sure everyone experiences these things differently but maybe you can notice a difference between the attacks.

[bsmsl]

Hello,

A little late to this thread.  I have a few thoughts that might help.

First, you do need to get your acid reflux better controlled.  Laryngealpharyngeal reflux does not have the typical symptoms of acid reflux like heart burn.  Also, you may want to see about having an EDG done (a scope of the esophagus and stomach) to check for a number of things that contribute to reflux including hiatel hernia, and h-pylori infection.  They wil also look for Barrett's Esophagus which is basically scarring from long term acid exposure.  

Another test that might help with identifying what needs to be done to control your reflux is an impedance study.  This is an esophageal Ph test only it tests for bot acidic and non-acidic (bile) reflux.

There are other options for GERD medications if you need them.  I have found the probiotics and digestive enzymes are very helpful in controlling my reflux. I refuse to go one day without my probiotic it makes such a big difference for me.  Just make sure that you get a good one with a variety of organisms and and pretty high volume.  

Beside the pilllow, what life style changes have you made to control you GERD?

Your original question was about peak flows.  They are highly personal.  I start to have symptoms at 530 but I am a 5'8' women.  My doctor is trying to switch me over to an FEV1 measurement, but it just confuses me.  Peak flows measure the function of the larger airways.  FEV1 is a measure of how well the smaller airways are doing.  Unless the doctor that did the spiro had a history of you healthy, what looks like a good test can be really miss leading when it comes to treating you.  For example, 445 is supposed to be a good prediction of a healthy 5'8' woman my age.  However, I have sung and played the flute most of my life.  I feel horrible at 445 and to quote my doctor, "Your lungs sound cra ppy."    My personal best peak flow is 590.  WAY above what would be predicted for me.  A good doctor will go by trends in peak flow and always be watching for a personal best.  More importantly, they should go by what your lungs sound like, not some number a statistician tells them should be good for you.  I "fired" a pulmo for not listening to my lungs but saying I was well.  I knew how I felt.

You mentioned being on Montelukast.  I believe we call that Singulair in the US.  Singulair is a leukotriene modifier meaning that it blocks leukotrienes from trigger more reactions..  You may want to add an antihistamine like Zyrtec (at least a second generation antihistamine).  

Since allergies are an issues for you, you may want to try a nasal steroid and/or a nasal anitihistamine.  What about sinus rinses? Are yo doing them?  Pets in your bedroom?

Ok, I think that is about all for now.  

Feel better.

[jerry3571]

Thanks for that.
My breathing still ok on the Montelukast but it maybe in a good spell as the hazel pollen has lessened. I use Omoprozole and zantac if my prescription runs out.
I used to have a wedge for me sleep on and it did help. I also did a food intolerance thing (Addenbrook thingy) and it was a little inconclusive.
I also don't get heartburn but have suspected some kind of Gerd; my Dad's guts are related to his stress levels so i follow in that pattern.
So far so good with the new drugs....

-Jerry

[Tammy2009]

yay! hopefully it stays that way

[jerry3571]

Thanks for that.
My breathing still ok on the Montelukast but it maybe in a good spell as the hazel pollen has lessened. I use Omoprozole and zantac if my prescription runs out.
I used to have a wedge for me sleep on and it did help. I also did a food intolerance thing (Addenbrook thingy) and it was a little inconclusive.
I also don't get heartburn but have suspected some kind of Gerd; my Dad's guts are related to his stress levels so i follow in that pattern.
So far so good with the new drugs....

-Jerry

[Tammy2009]

Update from my end too .....

No asthma (relief? not sure lol) since I only dropped 12% on 16mg/ml of methacholine - the cut off for asthma is 20% drop in FEV1 with less than 8mg/ml.  Since atrovent works a lot better for me than the ventolin (which lately barely does anything) it must be something with the large airways according to the respiralogist.  He said the number 1 thing that affects large airways is acid reflux.  So we are trying some environment things (raising bed, not eating before bed etc) to see if that helps.  

So at this point, all or almost all (my tests 2 years ago showed likely asthma) the breathing issues is not from asthma at all but probably acid reflux.  I'm suppose to try the diet/lifestyle changes and if it doesn't help go to family doctor or wait until my follow-up in June.

So something I learned .... shortness of breath, wheezing and coughing to the point of feeling like your suffofocating - and 80% peak flows for weeks at a time can all be related (possibly) to only acid reflux.  And this is reflux with no heartburn.  

So maybe your symptoms are more of acid reflux or the reflux is bothering mild asthma.  

oo.. I bought zantac and tried it today, helps the chronic tightness I get but not all the time and only lasted about 6-8 hours instead of the 12 it's suppose too.

[jerry3571]

Trying a drug called Montelukast 10mg and things seem to be better. Not sure whether this could be another false dawn but a few days in and all is not too bad.
We'll see!!

Thanks Jerry

[jerry3571]

Must admit to knecking a load of Indigestion pills last night, had a few large burps and the lungs filled with air finally. My partner said my gurgling in my belly kept her awake so must be pretty loud.
Crazy thing which no one has the answer. Bonkers!

-Jerry

[Tammy2009]

I'm in the middle of this .... asthma drugs were working well contolling "asthma" symptoms and then they suddenly stopped and I got really sick.  That was in december (flare started in october) and I still feel like crap.  

However I do have large lungs - way above average for my size now that I've been on advair etc.  However, I did just do a methacholine challenge test (suppose to be gold standard for asthma testing) and I had a negative test, no spasm in lungs.  

I haven't had time to research but I have the typical asthma symptoms (however, no triggers it seems - the breathing just gets worse and worse over a period of days).  I would follow if there was a type of asthma that was purely inflammation without the bronchospasm.  I slowly get worse or better but it takes days or weeks for severe symptoms to develop but there are hard to treat and get rid of.  

GERD definetly worsens asthma/breathing so make sure you get t tested and treated if that is the case, it may be all your breathing problems are from that.