This is the worst my ashma has ever been(27yrs old)

[WorkingMan]

I have had Asthma as long as I can remember as a young child. It was much worse when I was younger, and usually once or twice a year I would make a trip with my mother to urgent care or the ER for a breathing treatment. I have had an inhaler for most of my life. I'm an athlete, I grew up playing high school/college basketball, Golf, and Baseball. So I've managed it. However, I have grown out of a lot of the issues I had when I was younger. Before this year, I would maybe use my Inhaler 5-10 times per year. Usually triggered by cats, outdoor and indoor allergens. From what I know, my Asthma is allergy induced. For the past 8 or 9 years, I would usually use my inhaler so infrequently, that it would expire, or I would lose it due to such infrequent use. I purchased a home last may of 2009. I have been using my inhaler more frequently since I moved to my new house, but nothing too alarming. I attributed that to newer indoor allergies my body wasn't used to.

Well, now it's May of 2010, and this is the worst I can ever remember my asthma being. I went for a breathing treatment this morning, got my inhaler refilled because I have been using it 3-5 times per day for the past few weeks, and have been waking up in the middle of the night struggling to breathe. This severe onslaught of my asthma has been going on now for a few weeks, and it's frustrating the heck out of me! This has also been accompanied by a productive cough which sometimes produces mucus, usually yellow, and on and off nasal congestion. Other then that, I feel fine, no fever, no tiredness, malaise etc. I'm starting to get a little worried. When I take my ventolin(albuterol), it helps, but not like it used to................

[WorkingMan]

Continued...

The main reason I went to urgen care this morning was my ventolin inhaler wasn't cutting it, which it always did before! They also put my on prednisone, which I took the first 20mg pill about 2 hours ago. I also went through a breathing treatment, which felt great after. However, a few hours later, as I'm typing this, the wheezing and tightness started back up again. For the time being, do I have to wait several more hours to take my inhaler again? At the moment, I'm very tight, wheezy, and extremely uncomfortable due to restricted breathing.

Final comment/question. I also have a dog, I've had him since he was a puppy. I've never had a reaction to any kind of dog that I can remember, so I suppose my dog couldn't be helping the situation. And lastly, I have an appointment with an allergist on Monday. I've never been to one, so hopefully that leads to some relief. Any suggestions, help would be greatly appreciated. I figured I would

Sorry this is so long, just wanted to give you the proper info/background, Thanks in advance!

[David Tinkelman, M.D.]

The natural history of asthma, and histories vary from one person to the next, is that it varies in severity, at times often markedly, throughout one’s life.  The degree and frequency with which one’s asthma worsens is deemed, at least to some degree, to be innate.   That is to say, it is genetically driven.  In contrast, but not unrelated, is the variation in clinical severity that is driven by environmental exposures, allergic and non-allergic or irritant.  Worsening of your asthma may thus be an expression of your specific natural history of the disease, secondary to environmental exposures in the home, at work  or in the atmosphere (allergens and air pollutants) of the geographical area in which you live or, most commonly, a combination of the two.

You can’t change your genetic make-up but you often can change the amount of your exposure to the substances that precipitate your asthma and an important part of the efforts of you and your doctor(s) should be an attempt to identify any and every substance in your environment that might have precipitated your asthma worsening.  You mention your having a cough, productive of yellow mucous and that raises two possibilities:  infection and/or an allergic reaction to infectious agents, most often bacteria and fungi.  There is a condition, not infrequently associated with asthma, called Allergic Broncho-pulmonary Mycosis (ABPM), the most common form being a response to the fungus Aspergilla (ABPA), that usually requires treatment with oral, systemic corticosteroids.  My point is that you and your doctors should make an all-out effort to determine what, if any, environmental factors are the cause of your worsening asthma.  They should also be open to the possibility that what you are experiencing is not just worsening of asthma but worsening of asthma secondary to another, superimposed pulmonary disease.  That is why, regardless of what measures you and your doctors undertake, you should request consultation with a lung specialist (a Pulmonologist).


That your asthma should have worsened at all, following your move into the new home in May 2009 is definitely significant.  It raises the question of your being allergic to something within the home (indoor allergens), the immediate vicinity of the home and the local area in which you reside.  You mentioned cat dander.  Cat dander can linger in homes (especially carpets and drapes) for years after the cat has left.  Were that the case, I would have expected your asthma to worsen when the weather got cold and I gather that didn’t happen.  It could just be a coincidence but the fact that your symptoms worsened in May of 2009 and now, in May 2010 raises the valid concern that your asthma is worsening in response to one or more seasonal allergens.  At some point, it might be appropriate for you to contract with an Industrial Hygienist to evaluate your home for allergens and irritants.

Simultaneously, you and your doctors should immediately initiate pharmacologic therapy to gain control of your airways and alleviate all outward signs of asthma.  This is important not only to quickly restore you to normal or near normal health, but to quickly eradicate the inflammation in your lungs; the longer it remains uncontrolled, the more difficult it may become to completely control your asthma.  You have used the right medication for the relief of symptoms but the long-acting form of this drug (albuterol) is superior to what you have been using.  In addition your asthma is definitely of a severity that the immediate, effective use of another drug, an inhaled corticosteroid must be added to your regimen.  It may even be necessary for you to be treated with an oral steroid, short term, to quickly gain control of the asthma process and the underlying inflammation.  

This is not time to delay.  The top priority at this time is to seek medical evaluation, including a chest X-ray, and for your doctor to initiate optimum therapy.

The goal should be to immediately relieve your asthma symptoms and then keep you symptom free for the rest of your life.  Nothing less will suffice.


I suggest that you contact your primary care physician immediately and arrange to be seen today for a face to face evaluation. Your description of your present condition suggests that you may be at very high risk and should have very close medical supervision.  If you are unable to be seen by your physician today, I suggest that you return to urgent care or a local emergency room for reevaluation and continued observation until the physician caring for you is certain that you are responding to the prednisone are no longer in immediate danger.  It would be best if a friend or relative could take you to the ER.  

In this circumstance, it would be inappropriate for you to wait at home waiting for the medication to reverse this asthma attack.  If your asthma continues to worsen between now and the time when you can get further care, you should not hesitate to call 911.

Good luck