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Upper Respiratory Infection Triggered Asthma Attack
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Veritas_Woman posted:
Hi all. I've been doing pretty well with control of my asthma until an upper respiratory infection set in early Sunday morning. Until the weekend my asthma symptoms and attacks were all allergy related-I had gone disc golfing on Saturday with friends and felt fine-no allergy or asthma symptoms at all then early Sunday when I awoke around 3am with a 102 degree fever and congestion in my chest that felt like a ton of bricks did I start having issues. Why the sudden onset? I'm still fairly new to this asthma stuff and I think this was one of my worst times with it yet. I couldn't even draw enough breath to sneeze let alone get a dose of my inhaler to help. I almost went to the hospital Sunday night but opted to try and hold out to see my Dr. Monday since my insurance isn't helping all that much and I still owe my "in network" allergy asthma Dr. quite a bit. When I wen to the dr. Monday-I had to go to my gen. practitioner as my allergist won't see me if I have a fever, he gave me a nebulizer breathing treatment another prescription of Prednisone, an anti biotic and cough syrup with codene. It is slowly getting better with the pred. but I still seem to be having a hard time taking my inhaler. He also gave me a sample of Symbicort until i can inhale enough again to get back on the Advair. Is this all normal? Is my asthma getting worse since it seems the allergies had nothing to do with it this time? Will this keep happening every time I get the slightest cold? Any advice is appreciated!
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Aqua14 responded:
Hi Veritas, sorry to hear about this. It's very common for asthma to worsen when you get a cold or other upper respiratory infection, so unfortunately, yes, you should come to expect this. However, if you are proactive you can minimize or sometimes even avoid a prolonged or serious flare. With experience you'll be confident that you know what to do.

What you should do for the future is work with your allergist to develop what's called a written asthma action plan. Here's an example of a template for an action plan: http://www.nhlbi.nih.gov/health/public/lung/asthma/asthma_actplan.pdf

The keys are to (1) recognize when you are getting sick (regardless whether you recognize that your asthma is getting worse); (2) monitor your asthma via peak flow readings if you aren't having overt symptoms; (3) start increasing your asthma meds right away per your asthma action plan; (4) keep monitoring your asthma; (5) get in to see your allergist ASAP if you are not getting better, or if you are really bad, go to the ER as soon as you can. Early action is really important, and don't feel like you should wait.

Have you ever used a spacer? You could try that with the Symbicort (won't work with the powder version of the Advair, though). Either your doctor can give you one, or he can prescribe one (they're pretty cheap, between $10 - 20).

Hopefully these thoughts help. Hang in there, and I hope that you are back to good health soon. Judy
 
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coughy16 responded:
Hi Veritas, I am glad to hear that you were doing better prior to this flu or whatever you now have. Judy gave you lots of great advice, unfortunately, it is very common for asthmatics to get sicker than the average person when they contract a uri. The key as Judy said is catching it as quickly as possible, hopefully before your asthma gets totally out of control. For problems with getting the inhaler in, have you tried using your rescue inhaler 5-10 minutes before using the steroid inhaler? Sometimes that can open you up enough to get the meds in you. I am surprised that your allergist won't see you if you have a fever. When I get a uri, I always go to my allergist because it sends my asthma out of control & she is the one who can best handle that. That said though, your primary seems to have done the right things. Hope you are well soon, keep in mind that it may take awhile before you get your asthma completely under control again.
 
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Veritas_Woman replied to Aqua14's response:
Thanks Judy and Coughy. It is a little annoying that my allergy asthma doc wont see me when a fever is involved but thankfully my general D.O. is pretty good about getting me at least to a good start and has the capabilities to get me a breathing treatment in office. I did almost go the ER on Sunday but I was so scared of the potential bills that might result. I did e-mail my insurance contact today to ask about that kind of thing and if there was anything I could do in those types of situations as well as some more details on what is and is not covered. I was able to get a spacer from the pharmacy last night and it is helping the inhaled medications for the moment. I was also able to borrow a nebulizer from a friend whose kids had asthma when they were younger-she had new tubing and a mouthpiece for it and I was able to get my dr. to call in a prescription for the nebulizer albuterol. That is helping immensely. I used it before bed last night and probably got the best nights sleep I had all week so far. I'm still coughing up and getting a lot of green, sticky mucus out of my nose and throat but at least it is finally coming out rather than just sitting there causing a problem. No sign of the fever since Tuesday so I think I may finally be getting over the top of this flare.
I will definitely be calling my allergist to develop a better plan for when a cold is coming on-I had no idea that the slightest infection/cold could send me into a flare especially since I thought I knew all the triggers and none really involved cold symptoms. At least I know that now and that none of my before asthma "I'm getting a cold" remedies worked at all this time. He hasn't suggested peak flow monitoring up and to this point but it may be worth a try especially if it could detect the earliest onset of a cold. My D.O. was not impressed with the readings in his office on Monday.
 
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coughy16 replied to Veritas_Woman's response:
Glad to hear that you are doing a little better. I went through the same shock as you the first time I got a respiratory infection after finding out I had asthma. My asthma had never been so bad & I was really scared. Now I know what to expect & what to do, & it has made a huge difference. But the best thing that you can do is take as many precautions as you can (flu shots, avoiding sick people, etc) I hope you continue to feel better.
 
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Aqua14 replied to Veritas_Woman's response:
I agree with Sue (coughy) -- the times I've been most scared about my asthma is when I get a cold or bronchitis.

Veritas, if you're thinking about a peak flow meter, I've really liked the Piko 1 electronic peak flow meter which is actually more of a pocket spirometer. Gives very accurate readings and has a nice memory function. Using it gives me comfort that things aren't going down the tubes.

I have learned through painful and stubborn experience over the years that as soon as I start feeling sick I need to ratchet up the asthma meds per my action plan. Sometimes it's a false alarm and sometimes I feel neurotic about doing that, but better to get a jump on it than to suffer needlessly for a long period of time. An ounce of prevention, etc.

Feel better soon! Judy
 
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Veritas_Woman replied to Aqua14's response:
Slowly getting back on top of it all and trying to be patient but it is so frustrating! I realized that I did have another question and it probably should have been asked a while ago, but are there any good indicators of when symptoms can wait and when they need more immediate attention? I've been rather thankful that when allergies are the trigger the onset of symptoms has been fairly slow but on Sunday when this cold, URI progressed rather quickly and my chest felt like it was holding a ton of bricks it was in my usual nature to wait it out for a day but should I have gone to the urgent care or ER? Would I have been any better for it? Since I wait it out for most things before consulting a physician I've applied the same to asthma since I can usually fix it myself at home but perhaps this is the wrong view/logic to take with asthma symptoms vs any other medical ailment? Is there a good indicator when to go to the urgent care or ER vs when to treat it at home?
 
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Aqua14 replied to Veritas_Woman's response:
Take this with a grain of salt since I have never gone to the ER with my asthma (knock on wood) -- but after learning from experience, when it comes to asthma I jump on things quickly. Once you have an asthma action plan you will be able to know what quick actions to take at home to help yourself, and those are certainly worth doing first, but things can get very bad very quickly so you have to be careful about waiting too long.

Hopefully Sonya and Sue and others will jump in to share their experiences, but hopefully my thoughts help somewhat. Judy
 
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Veritas_Woman replied to Aqua14's response:
Thanks Judy. I do hope of course I also never have to have an ER visit but sometimes I don't know if i'm down playing the symptoms and they are even more serious that I know or especially at the moment Its very hard to tell what chest discomfort is from the cold/URI and what is from the asthma/inflammation. I don't want to be totally on edge about it-because of the importance of staying calm but of course I also don't want to get into an asthma situation that could be life threatening if I don't get medical help. Perhaps If I start using a peak flow meter so that I have a better indication of when its ok to wait and when it is more of an emergency it will help in those determinations. Sometimes I wish I had a little more guidance from my Drs as to when it is an emergency and when it is a mild flare but the resources I've read and used and the advice I can get from others here does help and offer some solace. It also seems I really have to prod the drs for information and answers - they don't ever just seem to say. Perhaps the drs just think that I am an adult and would know when the decision to call them or go to the ER would be obvious but so far that has been my remaining, unanswered question. I do understand that the decision is different for everyone since everyone's symptoms and severity are different.
 
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coughy16 replied to Veritas_Woman's response:
I would just tell the doctor that you don't know how much you should be worrying & that you are afraid that you won't know if you need to go to the e.r., or what to do when your asthma worsens. Hopefully they will give you an action plan to follow in those situations so you don't have to wonder. With time, you will know how your asthma normally reacts to various things & it won't be so difficult for you. I can almost always predict when I will flare, when I will need oral steroids, how long I can be near a trigger without getting too sick, etc. It all just takes time. Now when I know that I need steroids, I just call my allergist & let her know. It will take awhile, but just try to see how you react to various things. For example, now you know to expect problems if you get a cold or whatever, so next time you can take precautions & you will know to pay close attention to your asthma at those times. Don't worry, before too long it will become automatic & not nearly so complicated!
 
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Veritas_Woman replied to coughy16's response:
A nurse friend at church has been helping me out a lot through suggestions and support-she has taken extra classes on asthma specifically. There is a respiratory specialist that comes to the Drs office where she works and she is going to try and get me an appointment so that I can get a more defined action plan set up.I ordered a Piko-1 peak flow meter over the weekend and am hoping between that and setting up a more defined action plan, every time I get a small cold won't be a total catastrophe. Yesterday got pretty rough again as I finished my last dose of Prednisone, I used the nebulizer twice as much as in the days before. I slept fairly well but feel totally exhausted today and am just trying to get through the work day/week. I'm really hoping that the congestion I still have doesn't turn into pneumonia or something. I still have a few more days of the antibiotic left and really hope it takes care of it. I'm not sure whats worse, the tightness in my chest or the exhaustion-but i'm praying it all clears up soon. It sounds like a lot of people even in this community are dealing with the same crud-at least we can sympathize and encourage one another!
 
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Veritas_Woman replied to Veritas_Woman's response:
This morning I woke up not feeling very rested at all. I used the neb last night as per normal for the last week and got to sleep pretty fast. But this morning it took almost all of my energy and breath just to even get dressed. I took my Ventolin with use of the spacer- i still need to take a dose in 2 breaths as I can't seem to get the whole dose in one breath yet. I needed to take the Ventolin again on my way to work about 1/2 hour after the first dose as my chest tightened back up and my breathing became labored once again. Today marks my second day off the Prednisone and I think I may need to get the refill and get back on it. I think I may call my allergist/asthma dr. today and see what he thinks. I have 2 days left of the antibiotic and about 1/2 a week left on the cough syrup with codeine. The sheer exhaustion and breathlessness is getting rather annoying. Anyone have any additional thoughts?
 
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sgbl88 replied to Veritas_Woman's response:
Hello Veritas, you know I have been under the weather as well which why I have been less visible. Quite frankly I just read through your thread here.

Everyone seems to have given you good advice. I am open with my doctors. I point blank tell them that I might be making much ado about nothing, but I am not willing to take chances. Now, I do have good insurance with a relatively low co-pay which makes that a lot easier for me than a lot of other people.

As the others have stated, we can't afford to wait to start treating our asthma. We must jump on the first hint of a symptom or trigger.

I think for now while you are in the learning curve of dealing with asthma and still struggling to really get control of your asthma initially that will mean see a dr ASAP for guidance. In the case of waking up in the middle of the night as you did, that should probably warrent an ER trip, especially since you were ill prepared without a nebulizer to treat yourself. You should talk to your allergist about keeping albuterol neb around and possibly get your own neb if your friend will need hers back.

With this last bug that my husband gave me, I have definitely learned to value the neb. I could not use an MDI. My breathing was way to shallow for it to be effective. My allergist adjusted my action plan to switch to pulmacort neb in such cases. I felt like the air was hitting a brick wall as soon as it entered my lungs. Gradually my lungs have opened back up and I can almost take a full deep breath now, but that was consistant use of the neb. I also worked at breathing as deeply as I could without starting coughing while nebbing.

I strongly suggest that you get into see your doctor again today. Hoepfully your allergist will see you now, but if not your primary seems well equipped to deal with things.

Take care and keep us posted.

Sonya
Sonya http://exchanges.webmd.com/fragrance-and-odor-issues http://exchanges.webmd.com/pediatric-asthma-parent-support http://exchanges.webmd.com/politics-and-health-debate-exchange
 
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coughy16 replied to Veritas_Woman's response:
Hi again Veritas. I would definitely call your allergist. It could be that the pred taper was not strong enough or long enough to get the inflammation out of your lungs. What dosage did you take & for how many days? Typical for me is to start at 40 or 60 mg & then decrease by 5 mg every 2 days. If after 2 days at the max dose I don't feel I have improved enough I hold there for a couple more days & then reduce from there. My taper is typically 16 days I think. I got a new allergist & my first time seeing her sick was in the spring when I had a horrible flare, the worst in a really long time. She gave me a 60 for 2 days, 40 for 2, 20 for 2 & off taper. I totally could not jump all the way down to 20 after 4 days. I could never have stopped after 6 days either. Now she knows that doesn't work for me! I ended up on the taper for an extra long time in the end. Every patient is different, & you & your dr are still learning how your asthma acts. As far as going to the e.r., like Judy, I have never gone for my asthma. I am sure that I have flares that other people would have gone for, but my allergist was always extremely accessible by phone, so my first call was always to him. I always kept extra pred around the house, then if I needed it & it was the weekend or whatever & I didn't want to call him, I would just start taking it & call him on Monday. Hopefully you will develop that kind of give & take with your dr as well. But as you are newly diagnosed, it is really important to stay in communication with your dr so that you can both get a grip on things. Good luck to you, hope you feel better soon!
 
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Veritas_Woman replied to coughy16's response:
since my fever broke, i did call my allergist and got in around 11 to see him today. Supposedly all my pulmonary tests came back relatively well at 80-90% and better than last time I was there but oh did i feel so much worse! -I still dont really understand how the tests can come back almost normal when i fell like i'm struggling so hard to catch a breath. I actually thought i might pass out. He put me back on the Prednisone and we are trying a taper this time starting with 40mg and I'm going to step up the daily nebs a little too. He thinks i'm almost done with the cold so that was good to hear. I'm getting in to see a respiratory specialist next Wednesday and we're going to try and track an monitor peak flow as well as set up a more defined action plan based on the peak flow system. I think these steps will help especially when its a question of whether or not to get help. The prednisone is kicking in and I think I'm out of the water for today, this morning was my scariest flare yet.


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