Nutrition Health Chat: Tuesday, Dec. 8th, 5-6 PM Eastern. Learn how vitamins, minerals, and phytonutrients affect your health. Free live Q&A. Join us!
Member Comments are provided by individuals and reflect their personal opinions only. Under NO circumstances should you act on any advice or opinion posted in this forum. ALWAYS check with your personal physician before taking any action regarding your health! MedHelp International and our partners, sponsors and affiliates have no obligation to monitor any comments posted on this site, or the content and/or accuracy of such exchanges. MedHelp International does not endorse the views of any user.
Respiratory Disorders (Expert Forum)
Diagnosed asthma but after 6 weeks pulmicort not working
Answered by
This forum is for questions and support regarding lung and respiratory issues such as: Allergies, Asthma, Bronchitis, Colds - Flu, Chronic Cough, COPD, Cystic Fibrosis, Emphysema, Fibrosis, Lung Abscess, Nasal Polyps, Pleurisy, Pneumonia, Sarcoidosis, Sinusitis, Tuberculosis.
Diagnosed asthma but after 6 weeks pulmicort not working
by ClareS, Apr 22, 2004 12:00AM
Thank you for answering my questions!!
Symptoms: Chest tightness (behind the breast bone, mainly in middle), shortness of breath for five months, (no wheeze). Often worse at rest than when excercising. - The symptoms are more or less constant and sometimes climax into a panic/asthma like attack.- ventolin brings no relief and can make me feel worse.
Went to see chest physician and he diagnosed mild/moderate asthma from basic spirometry. Chest Xray clear - just too much air in lungs. Spent two weeks on flixotide but felt worse and have now been on pulmicort and long acting bronciodilator for 6 weeks but hardly feel any better at all, although my peak flow has increased a little.
My GP is not convinced that my problem is all about asthma as my peak flow 380-450 (Female 29) is not bad. Blood tests came back normal apart from one for H-Pylori which came back positive - I have been on antibiotics for this and PPIs for GERD (There is no indication that I have GERD but the doctor says
it is worth givig it a go)
Questions:
Where should I go from here? Would a CT scan be any use, what does this show? and ditto for a broncoscopy and the same procedure for the stomach (cant remember the name)
I am seeing my chest physican again on Tuesday is there any procedures i should push for; I am afraid that because my peak flow has increased a little he will say I am better, but am not
Are there any other asthma drugs could suggest to my physican that might help if the pulmicort/flixotide/becotide hasnt?
Are there any specific drugs for chest tightness?
Symptoms: Chest tightness (behind the breast bone, mainly in middle), shortness of breath for five months, (no wheeze). Often worse at rest than when excercising. - The symptoms are more or less constant and sometimes climax into a panic/asthma like attack.- ventolin brings no relief and can make me feel worse.
Went to see chest physician and he diagnosed mild/moderate asthma from basic spirometry. Chest Xray clear - just too much air in lungs. Spent two weeks on flixotide but felt worse and have now been on pulmicort and long acting bronciodilator for 6 weeks but hardly feel any better at all, although my peak flow has increased a little.
My GP is not convinced that my problem is all about asthma as my peak flow 380-450 (Female 29) is not bad. Blood tests came back normal apart from one for H-Pylori which came back positive - I have been on antibiotics for this and PPIs for GERD (There is no indication that I have GERD but the doctor says
it is worth givig it a go)
Questions:
Where should I go from here? Would a CT scan be any use, what does this show? and ditto for a broncoscopy and the same procedure for the stomach (cant remember the name)
I am seeing my chest physican again on Tuesday is there any procedures i should push for; I am afraid that because my peak flow has increased a little he will say I am better, but am not
Are there any other asthma drugs could suggest to my physican that might help if the pulmicort/flixotide/becotide hasnt?
Are there any specific drugs for chest tightness?
Doctor's Answer
by National Jewish, Apr 26, 2004 12:00AM
, Apr 26, 2004 12:00AM
Generally testing for asthma starts with a simple breathing test called spirometry. This test provides detailed information about how your lungs are working. It will show if there is obstruction in your airways. To really test for asthma this test may be repeated after using a rescue inhaler, like the bronchodilator Ventolin® Inhalation Aerosol (albuterol sulfate). This measures how much the bronchodilator helps your lungs by reversing the problem. When there is a 20% increase the test is positive for asthma.
There is a complex asthma test that is the gold standard for diagnosing asthma. This is called a methacholine challenge. You will blow into a spirometer before and after each increasing dose of an inhaled medicine. This test is positive for asthma if the result after the inhaled medicine is 20% lower than it was before the inhaled medicine.
Normal values for peak flows are averages that depend on age, height, gender and race. It is more important to know your personal best rather than the normal values, because some people will be higher than the normal values and some will be lower. Peak flow meters do not measure changes in the small airways of the lungs. This may explain why your peak flow has increased a little, but you are not feeling better. However spirometry does measure what is going on in the small airways of the lungs. When you see the chest physician on Tuesday you will probably repeat the spirometry testing to see what change has occurred with the Pulmicort Turbuhaler® (budesonide inhalation powder) and the long acting bronchodilator.
Gastroesophageal reflux disease (GERD) is the back flow of stomach contents, including digestive juices, into the esophagus or food tube. This is most commonly called acid reflux or heartburn. Your symptoms could be caused by esophageal spasm from heartburn.
This reflux can come all the way up into the mouth and nose. When this happens the material can be aspirated, dribbling into the windpipe and lungs. This could also explain your symptoms.
GERD can cause the following symptoms:
· Heartburn or a sour taste in the mouth;
· Pain occurring in the middle of the chest;
· Coughing and/or choking while lying down;
· Increased trouble breathing while asleep; and
· Even no symptoms at all. This is called “silent reflux” and it is common.
Even though you have been taking a protein pump inhibitor (PPI), it is possible that it has not helped your symptoms because it is not controlling the GERD. A pH probe is the best test to find out if you truly have GERD and/or if the medicine is controlling it. This test measures the acid in your esophagus to see if digestive juices are coming up from your stomach. Please read our Gastroesophageal Reflux Disease MedFact at http://www.nationaljewish.org/medfacts/reflux.html for more information about things to do to lessen GERD. A gastroenterologist is the type of specialist to let you know if further testing is needed to identify GERD and the best treatment.
You have been treated with medicines that work very well to help asthma. Since you have not been helped by the asthma medicines another possibility to consider is vocal cord dysfunction (VCD). This is a condition that can mimic asthma. However, VCD is not helped by asthma medicines.
While inhaling the vocal cords should open to let air into the lungs. With VCD the vocal cords close together during inhalation. This makes it difficult for air to get into the lungs. A lot of the same things that trigger asthma can trigger VCD including upper respiratory infections, fumes, odors, GERD, cigarette smoke, singing, emotional upset, postnasal drip and exercise. Sometimes the trigger is not known. These attacks are also often seen with panic attacks.
Testing needs to be done while you are having symptoms. Spirometry may be normal, but the “breathing in” or inspiratory part, also called an inspiratory flow volume loop, will show little airflow while you are inhaling. A laryngoscopy is a procedure done by a specialized doctor using a camera at the end of a flexible tube to see how your vocal cords open and close.
VCD is treated by a speech therapist that will instruct you in open throat breathing techniques. Counseling can help you identify and deal positively with chronic stress, which may be an underlying factor in VCD. Please read our Vocal Cord Dysfunction MedFact at http://www.nationaljewish.org/medfacts/vocal.html for more information. It is important for you to be evaluated by a doctor to determine the diagnosis and appropriate treatment.
There is a complex asthma test that is the gold standard for diagnosing asthma. This is called a methacholine challenge. You will blow into a spirometer before and after each increasing dose of an inhaled medicine. This test is positive for asthma if the result after the inhaled medicine is 20% lower than it was before the inhaled medicine.
Normal values for peak flows are averages that depend on age, height, gender and race. It is more important to know your personal best rather than the normal values, because some people will be higher than the normal values and some will be lower. Peak flow meters do not measure changes in the small airways of the lungs. This may explain why your peak flow has increased a little, but you are not feeling better. However spirometry does measure what is going on in the small airways of the lungs. When you see the chest physician on Tuesday you will probably repeat the spirometry testing to see what change has occurred with the Pulmicort Turbuhaler® (budesonide inhalation powder) and the long acting bronchodilator.
Gastroesophageal reflux disease (GERD) is the back flow of stomach contents, including digestive juices, into the esophagus or food tube. This is most commonly called acid reflux or heartburn. Your symptoms could be caused by esophageal spasm from heartburn.
This reflux can come all the way up into the mouth and nose. When this happens the material can be aspirated, dribbling into the windpipe and lungs. This could also explain your symptoms.
GERD can cause the following symptoms:
· Heartburn or a sour taste in the mouth;
· Pain occurring in the middle of the chest;
· Coughing and/or choking while lying down;
· Increased trouble breathing while asleep; and
· Even no symptoms at all. This is called “silent reflux” and it is common.
Even though you have been taking a protein pump inhibitor (PPI), it is possible that it has not helped your symptoms because it is not controlling the GERD. A pH probe is the best test to find out if you truly have GERD and/or if the medicine is controlling it. This test measures the acid in your esophagus to see if digestive juices are coming up from your stomach. Please read our Gastroesophageal Reflux Disease MedFact at http://www.nationaljewish.org/medfacts/reflux.html for more information about things to do to lessen GERD. A gastroenterologist is the type of specialist to let you know if further testing is needed to identify GERD and the best treatment.
You have been treated with medicines that work very well to help asthma. Since you have not been helped by the asthma medicines another possibility to consider is vocal cord dysfunction (VCD). This is a condition that can mimic asthma. However, VCD is not helped by asthma medicines.
While inhaling the vocal cords should open to let air into the lungs. With VCD the vocal cords close together during inhalation. This makes it difficult for air to get into the lungs. A lot of the same things that trigger asthma can trigger VCD including upper respiratory infections, fumes, odors, GERD, cigarette smoke, singing, emotional upset, postnasal drip and exercise. Sometimes the trigger is not known. These attacks are also often seen with panic attacks.
Testing needs to be done while you are having symptoms. Spirometry may be normal, but the “breathing in” or inspiratory part, also called an inspiratory flow volume loop, will show little airflow while you are inhaling. A laryngoscopy is a procedure done by a specialized doctor using a camera at the end of a flexible tube to see how your vocal cords open and close.
VCD is treated by a speech therapist that will instruct you in open throat breathing techniques. Counseling can help you identify and deal positively with chronic stress, which may be an underlying factor in VCD. Please read our Vocal Cord Dysfunction MedFact at http://www.nationaljewish.org/medfacts/vocal.html for more information. It is important for you to be evaluated by a doctor to determine the diagnosis and appropriate treatment.
