Tag Archives: asthma nurse

World Asthma Day 2014 Q&A

Today is World Asthma day and in an attempt to raise some awareness about what it is like to live with asthma (from my perspective) I’m going to be answering some questions that my followers have e-mailed me. [Sorry for the late reply for those of you who have asked me questions!!!]

[Note: I have paraphrased some questions]

How were you diagnosed with asthma?

I was having issues with symptoms when I was exercising and people in my Cricket club were starting to make comments when we were playing matches about how loud my wheezing was, or they would ask me if I was having an asthma attack etc. So I headed off to the GP who sent me to the asthma nurse for a Spirometry. Basically, at that point, my Spiro was normal (because I wasn’t having symptoms) so my nurse and I decided to try a peak flow for a few weeks. Based on the massive variance in my peak flow, coupled with symptoms, I was diagnosed with asthma.

Do you see a consultant for your asthma?

Nope, I’m under the care of an Asthma Nurse (who is actually a Diabetes Nurse) and my GP. I don’t have severe asthma so I don’t need to see a consultant.

Why did you start this blog?

Basically, I started this blog to try and raise awareness about asthma and other chronic illnesses, and also to share my experiences with asthma (and bad joints) with other people. I found it extremely helpful to read blogs after I was diagnosed, so you never know… someone might find this blog helpful.

Are you worried about going to University?

Erm… I’m going to presume you mean, am I worried about my asthma. Well that would be a yes and a no. I’ve never had severe asthma, or had attacks that have landed me in hospital and I feel quite safe in the knowledge that I can manage my asthma, and attacks, fairly well by myself. And, of course I know when I need to see my GP. But then I am slightly concerned about being able to afford my medication, thankfully there are pre-payment schemes that are cheaper in the long run but there is always that worry in the back of your head. I’m very fortunate to live in a country with a National Health Service that subsidises the cost of medications, otherwise I would be forking out a fair bit of money.

Does asthma affect your life much?

Well, asthma is always in my thought processes when I go out… Money, check. Bag, check. Inhaler, check. But overall asthma doesn’t play a massive role in my life, I don’t have severe attacks, and I am pretty well managed. But of course, those nights when your asthma isn’t behaving it’s self as well as it should are rough, or if you are having a bad day, that’s hard. You can’t completely separate your life from asthma because you are living with it, but I am lucky enough that I don’t have to think about carrying around a portable neb or bringing umpteen different inhalers with me.

How do you go about getting an asthma plan?

I asked for one… When I was getting put on my first combination inhaler (Seretide, AKA Advair) I figured it was time to have a better understanding of my asthma and what I should do when.

If I were you, I would either ask your GP/asthma nurse or your consultant, if you see one.

How did you find out your triggers?

The hard way… i.e. by being triggered. I don’t have allergic asthma so allergy testing would be pretty useless for me, so I just made a note of when I h attacks/exacerbations and what caused them. Of course it isn’t always that easy, and sometimes multiple factors play a role e.g. having a cold and meeting another trigger, or having a cold and meeting something that doesn’t normally trigger you, which causes an attack/symptoms (or at least, it does for me).

 

So that was my Q&A for asthma, I have another one to raise awareness about Arthritis/bad joints that I will post in the next few weeks.

If and if you have any questions feel free to comment below or visit my “Contact me” page.

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Bye Symbicort.

As I said in my last post, Symbicort and I haven’t been getting on very well and although I am grateful that Symbicort has pretty much calmed my lungs down, I am finding it hard to deal with a potentially serious side effect… Paradoxical bronchospasm. According to my GP the coughing I have been experiencing after taking my Symbicort is actually a reaction to the medication but we both believe that it is a result of Symbicort being a dry powder inhaler rather than the actual medication itself.

This morning I phoned my GP to try and swap Symbicort to another combination inhaler which contains Formoterol as I feel that this LABA works better for me than Serevent ever did. Unfortunately, my GP isn’t that clued up on asthma meds and wanted me to try Clenil 100mcg (dark brown inhaler) twice a day which is ludicrous since I am just about controlled on 600mcg of steroid (which would be Clenil 100 3 puffs twice a day) and on top of that, Clenil doesn’t contain a LABA. I explained all of this to my GP who was really understanding and asked what medication I would suggest. I told him that the only two combination inhalers that I know of, which contain Formoterol, are Flutiform and Fostair. I don’t really know of much difference between Flutiform and Fostair, other than the steroid component so I figured it didn’t really matter which one I tried since I could always swap to the other if things went pear shaped. So it was decided that I am going to try Flutiform and see if that causes any coughing, and if it does then we shall try Fostair.

Flutiform contains Fluticasone as it’s steroid component and Formoterol as it’s LABA component and comes in 3 doses. I have been prescribed the middle dose of 125/5 with two puffs twice a day. My GP has said that my script is waiting at the Surgery’s reception for me to go and collect but unfortunately I can’t collect it until Wednesday or Thursday. I tried to explain this to the GP and asked if he would be able to send it to a pharmacy nearer where I go to college but because I didn’t know the fax number for any of the pharmacies near me (not many people would, I imagine) it wouldn’t be possible. So now I am staying on Symbicort until Wednesday or Thursday but I have been told to use Ventolin before I take Symbicort and to keep it near by in the hours following a dose to try and prevent/reduce the severity of the paradoxical bronchospasms I experience. Thankfully, after I have got this initial prescription, I can order my Flutiform online into a Pharmacy closer to my college so I can get it more easily.

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I am still going to be sad to see Symbicort go since I have been on it for over a year, which is the longest I have ever been on any asthma medication, other than Ventolin. I’m really hoping that I won’t need to change medications again, and that I am able to reduce the amount of medication I need back down to Clenil or even nothing at all, however that isn’t a reasonable expectation right now. But it is a hope for the future.

Bonfires, fireworks and asthma – not the best combination

Smoke never used to be a huge trigger for my asthma. It used to make me get slightly tight and maybe cough but it was never a massive trigger like chlorine or humidity are for me.

Today is bonfire night which is basically a night where everyone goes crazy with fireworks and bonfires (surprisingly).

Today I also had my driving lesson (which, may I say, was chaotic due to all the fire engines and ambulances on shouts for, most likely, fire related injuries and probably respiratory problems too). Now normally where I live is quite busy during bonfire nights with a lot of fireworks being set off, but today I drove past 3 huge bonfires (all of which the fire brigade was in attendance for) and the smoke was so thick everywhere. It was like driving through thick fog.

I seriously didn’t think that my lungs would be too bothered by all the smoke as, in the past I have been okay, otherwise I would have mentioned this to my asthma nurse yesterday and not decreased my Symbicort dose to 2 inhalations twice a day, today. I posted this on Facebook, which pretty much explains today’s situation:

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Luckily, I did take my inhaler with my while I was out driving, and I did already have 4 puffs (400mcg) of ventolin on board due to my lungs being sucky (from the smoke) in the hour leading up to my lesson. And fortunately because I did have my inhaler with my, I was able to prevent an attack, although I was wheezing and coughing up a storm and it did feel like an elephant had been sitting on my chest.

Today I have taken a total of 800mcg of ventolin and I have also increased my Symbicort up to 4 inhalations twice a day, just until my lungs settle down and I can reduce it back down to 3 inhalations then (fingers crossed) down to 2 inhalations. I was also trying to decide what to do regarding my ventolin usage, as I really don’t want my lungs to get worse, and although I am pretty good for about 4 hours after taking ventolin, I can still feel it wearing off and then I’m practically back to square one. But I have spoken to my friends with asthma and although my original plan was to take 4 puffs of ventolin every 4 hours (my old plan says 4-10 puffs every 4 hours if I need it) I have decided that PRN is probably best and so I will be taking ventolin as and when I need it. Thank you Annie for helping me out with this!

I will be honest, today I did underestimate my asthma, and I am really kicking myself for it. I tried to reduce my Symbicort too quickly and I chose a stupid day to reduce it. I didn’t think that the smoke would affect me, and when it did, I didn’t cancel my driving lesson and stay in the house with the windows closed. And I didn’t anticipate how unpredictable asthma can be. These are all the things I would have done when I was newly diagnosed, but now, I should at least be able to draw from past experiences and use some common sense. At least now, I know that bonfires and fireworks DO affect me, and so I can avoid them in the future.

Adios accuhaler, welcome back evohaler!

This morning I had an appointment with my asthma nurse mainly to get my flu jab but also to discuss a few other issues I have been having.

First of all we talked about my peak flow and although she had a few issues with certain things such as the “pretty significant morning dip” and the two asthma attacks I had a week or so ago and the symptoms I still get fairly often we agreed that I am doing a LOT better than I was last time I saw her. And there is a significant difference in my ventolin usage since we increased my dose of Symbicort to 3 inhalations twice a day…

My home people flow this morning was 340 which was done at 7AM and by 9AM my peak flow was 360 (of course there is a variable in the peak flow device used) but that is the highest peak flow I have seen on a morning in a long while so I was pleased with that! I’m slightly (too) excited to see what this evenings peak flow will be.

She asked me what I think my major triggers are now and although they haven’t really changed I still feel that since increasing my dose of Symbicort has enabled me to work better when I am teaching swimming as I can actually speak in full sentences by the end of the session. But I feel that that I still haven’t grasped how to deal with weather changes and how they affect my asthma, particularly thunder storms. I still struggle during sudden thunder storms to control my asthma in a way that I am comfortable, I mean no asthma symptoms are comfortable but if I can avoid having an attack then I’m happy.

About a month ago, I was having issues with my heart palpitations while I was taking Symbicort, particularly since the palpitations would wake me up at night and I would get them frequently throughout the day, and so I spoke to the nurse about this. She said I was using a lot of ventolin that weekend in addition to Symbicort which didn’t really answer my question since I stopped the Symbicort because of the palpitations and then was struggling with my asthma because of missing the Symbicort and ended up need ventolin. But I guess since I haven’t had palpitations for a good month, it is just something to be aware of in the future.

I didn’t mention the wheezing issues I had last night. For those of you who don’t follow the MyLungsMyLife Facebook page, I posted about how I was just about to get to sleep when my lungs decided that they were going to start wheezing out of no where. So I ended up needing ventolin and staying up till 12 just incase my lungs decided to wheeze again. It is odd that I started wheezing though because it is so uncharacteristic to start wheezing before I cough, but then asthma can be unpredictable so I should be expecting the unexpected. But I mean apart from needing my ventolin a few times a week at most and a couple of attacks a month, I do feel really good. So I told her that I wouldn’t mind trying to lower my dose of Symbicort and she agreed that, that would be fine. She also said that she can see from my peak flow diary that I know what to do, when to increase my dose and when to lower it again even though I don’t have any sort of official plan and so that she is going to give me “free-reign” on dosing my Symbicort myself which I think is pretty cool, although I do that anyway.

I do absolutely love my peak flow diary, and I find it super helpful in tracking how my asthma has been and I write what has triggered each attack/exacerbation and why I have increased my dose etc so because it was so apparent to her that I do like to track my asthma (apparently other patients aren’t as good as keeping it up to date) she gave me another peak flow diary, despite the fact that I still have 8 months left on the one I am using right now. She had ran out of the official Asthma UK diaries so I got a generic NHS one but hey, it’s still good!

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I also asked if I could switch back to the normal ventolin MDI for a few reasons really:
1) I can’t take a ventolin accuhaler on pool side in case it gets wet
2) during an attack it is hard to breathe in deeply enough to get all the medication out and it is also hard to hold your breath for long enough, whereas when using and MDI and spacer you can use tidal breathing
3) the accuhaler is REALLY loud, especially to use in a quiet room
4) I am sick and tired of people asking me what on earth I am using… Clearly people haven’t seen many accuhalers around

So the nurse prescribed me a ventolin MDI and put it on my repeat prescription. She said that I didn’t need to get a new spacer as the one I have is only just over a year old and so, in theory, should still work. So it is adios accuhaler and a welcome back to the evohaler!

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And then I decorated it with some sheep Sellotape (my apologies for the slightly over exposed picture)

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To be honest, I wasn’t totally sure if I would be prescribed ventolin as my prescription says salbutamol which is the medication in ventolin (ventolin is the brand name) but a few people I know who have has salbutamol on their prescription have been given salamol at the pharmacy which is the generic version of ventolin. And I’m an pretty sure that it would have been fine but a) salamol is smaller than ventolin and so is harder to use, especially with stiff, sore and swollen hands and b) I wasn’t sure that the delivery system would be the same but as my friend GG assures me, the delivery system is the same and plus it doesn’t matter if you are going to use a spacer.

But anyway when I was at the pharmacy I asked if Salbutamol meant I was going to get ventolin or salamol, to which the pharmacist replied that ventolin IS salbutamol. But then again salbutamol IS also salamol, and that’s what I said… She looked pretty miffed with me, apparently pharmacists don’t like patients to correct them.

Anyway that was today’s events… I don’t need to be seen by the asthma nurse again until around May unless I am having issues that I can’t fix by upping my Symbicort. I did forget to mention about my hiccups but I haven’t had any since last week, so maybe that was just a phase.

Mexican waving lungs

Asthma was really kicking my behind yesterday, it wasn’t so much asthma attacks but the constant shortness of breath… Getting out of bed is normally a struggle, mainly because of the joint issue but yesterday was ridiculous.

When I woke up, my initial thoughts were “Oh, hi dyspnea!” Not the first think I like to think in the morning! I figured that since I was only short of breath and wasn’t wheezing or anything that I could manage without ventolin. WRONG!

My lungs decided to go a little crazy at me while I was in the shower, I guess it must have been the steam? So ventolin to the rescue it was then.

On the way to college I was still having a tough time breathing, not so much with wheezing but just being majorly short of breath. By that time, I realised I needed to stop kidding myself and take some more ventolin adding up to a grand total of 400mcg before 9AM, not a record for me but since I’ve been doing pretty well for so long. I was not best pleased.

To be honest my peak flows have been doing a bit of a Mexican wave over the last few weeks, jumping around a little more than usual:

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I’m thinking that my lungs are having a bit of a disagreement with the weather changes as Autumn is taking hold. My lungs really hate humidity, almost as much as chlorine, and since the humidity has been around 75-80% for a couple of days in a row, it makes a fair but of sense why my lungs are having a bit of a hissy fit.

But I am booked in to see my asthma nurse at the end of the month so if I am still having issues I’m sure she will be able to sort it out! Until then, I’m going to bide my time and if necessary increase my Symbicort once more, although I am hoping that things won’t come to that.

Symbicort and heart palpitations

Over the last few weeks I have been getting more and more heart palpitations (when your heart rate become more noticeable). For me my heart rate doesn’t go very fast, maybe around 120bpm but each beat is so strong it feels like my heart is going to jump out of my chest. (I also get tachycardia where my heart goes pretty fast, 200bpm or higher but this post is only on the palpitations).

So last weekend I woke up in the middle of the night with palpitations which is a first for me and that really freaked me out. I have had more palpitations since I increased the Symbicort to 3 puffs a day so I figured it can’t hurt to miss one dose and see what happens. So I missed my morning dose and although I was still getting palpitations they weren’t as bad as before.

My peak flow is a fairly good indication of if I am going to have an attack (unless I end up coming into contact with a trigger I didn’t anticipate) and my peak flow was hanging around 350 even after a missed dose and my lungs were feeling good. So I figured that I would still be okay to miss another dose.

I missed 3 doses of my Symbicort in total. That’s 900mcg of budesonide (steroid) and 54mcg of formoterol (LABA). Quite a lot if you think about it. I can usually feel it if I miss or am late with my Symbicort but I didn’t really feel it until the evening of the next day. My peak flow was around 300 by that time which isn’t terrible, about 65-75% of my best depending what you class as my best (I still think 450 is my best but my asthma nurse thinks 400 is my best). So I decided it was time to start taking the Symbicort again. And since then I haven’t had too many issues with palpitations!

I am still pretty certain that the Symbicort was playing a role in the palpitations by I think extreme stress was the major factor in the palpitations and it was just made worse by the Symbicort.

I am due for an appointment with my asthma nurse this month and there are a few things I would like to discuss with her:
1) what should I do if i get these palpitations again?
2) I really want to go back onto normal ventolin MDI inhalers rather than my DPI that I am on now

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3) I am wanting to trial a prescription antihistamine for when I go swimming or teaching at a swimming pool to see if it will help with the skin reaction and asthma issues triggered by the chlorine
4) and of course, I need to get my flu jab!

Asthmaversary

Well today is my first Asthmaversary. Well technically it is my 5th year of having asthma but I have only been officially diagnosed for a year.

So I thought I would show you some of my asthma family, or should I say, inhaler family.

Over the last year I feel that I have matured a lot. I have learnt how to manage my prescriptions, manage doctor appointments and travelling to and from my doctors and nurse appointments. And I have also learnt how to manage attacks and exacerbations. I know when I should increase my preventer inhaler and I know when I should drop it back down to the original dose. I know the sort of area that my peak flow should be in and although I haven’t managed to keep it in the green zone for the majority year, I feel confident enough to deal with any symptoms and I do know when it is time to see my nurse or the doctor.

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So those has been my asthma pals for the last year. I must admit 3 inhalers are missing, two ventolins and one Symbicort. One of the ventolins had water damage, and since it is a dry powder inhaler I meant that I couldn’t use it again. And the other ventolin and Symbicort are in the pharmacy. I should be picking them up early next week.

Technically it has been over a year since I got my first ventolin so I thought I would show you my asthma journey from then until now.

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So originally I just started out with a reliever inhaler and I had this for 2 weeks before I had another inhaler added on.

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So like I said above after 2 weeks of only being on ventolin, my asthma nurse added clenil modulite to help prevent asthma attacks and symptoms.

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After about a month of being on ventolin and clenil, serevent was added. Serevent is the small green (it doesn’t look green, but it is green) inhaler. Serevent is a Long Acting Beta-2 Antagonist. Which basically means that it keeps my airways open for 12 hours rather than just 4 like ventolin does. Serevent is a controller medication, added when you asthma is not controlled with only inhaler corticosteroids (such as clenil) and reliever inhalers (including bricanyl, ventolin and xopenex).

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Then we decided to add seretide which is a combination inhaler, rather than having 2 inhalers to take morning and night, my nurse and I agreed that it would be easier just to have one inhaler morning and night. It was at this point that I also switched to a dry powder ventolin as I felt that it was a lot easier to use when my hands were sore and stiff.

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So early this year my nurse and I agreed that I wasn’t doing very well with seretide. Especially since I kept wheezing after I had taken it. Initially the nurse thought it was the dry powder but since I didn’t have issues with the dry powder ventolin she figured it was the serevent component of the seretide, which had caused some issues earlier.
So I was swapped to Symbicort which I feel has made a massive amount of difference. And although for the majority of the year my peak flow was hanging around 60-70%. But when I did get a cold, which was fairly frequently, the attacks weren’t as they had been before I started the Symbicort.

I have said previously that I am pretty settled on Symbicort, of course there is fine tuning needed, but I have been on Symbicort longer than any other medication (except ventolin).

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It is thanks to the Symbicort and the ventolin that I have been able to live my life to the full most of the time.

But if I didn’t have asthma, I think it would have taken me longer to learn certain things about myself, as I wouldn’t need to be in a position where I would need to know these things. Such as, in an emergency I can stay calm. This doesn’t strictly apply to asthma since my attacks are not bad enough to be called an emergency. But the inability to breathe during attacks is scary and I still manage to think clearly throughout. Even a couple of months ago when I was choking I stayed calm and was able to clear my airway on my own.

I also feel like I am a better advocate for my own health, and I help make the decisions about my health care rather letting health care professionals decide certain things for me, and that makes me feel like I am in more control of my health than I was before.

And if hadn’t been diagnosed with asthma, I would not have this blog, I would not speak to new people daily about asthma and other chronic illnesses. I would have never joined twitter in the aim of finding people who I can connect too. I would still be naive of some chronic conditions such as diabetes, both type 1 and 2 (thanks to GG and Scott and Navy Kitty for teaching me so much about diabetes, I really appreciate it). I have also “met” people over twitter with cystic fibrosis, people who have had heart transplants, liver transplants, lung transplants, people with mitochondrial disease, people with lupus and other rheumatic conditions and of course other people with asthma. I must say having a blog has been an eye opening experience, and I haven’t even had this blog for a year yet! I wonder what will happen between now and my next Asthmaversary. This is an adventure.

Oh and I forgot to say, I bought myself a phone case for my Asthmaversary, not because I have asthma but because I have learnt so much and survived this year pretty unscathed.

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