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Confusions Questions And Frustrations About EIB Asthma

I'm pretty sure I've had asthma since I was a kid. I know I had problems during high school. And in my late 20's I was diagnosed with EIB asthma. It made sense. What I'd been experiencing over the years turned out to be symptoms of asthma. I hadn't  wanted to just assume it was asthma. And I didn't want to sound like a hypochondriac. So when I'd have the symptoms I'd cough my brains out have a hard time bringing up congestion wonder if my breathing sounds actually were wheezing and think "nah this is probably fine". And then I got the diagnosis.

It's been years since I was diagnosed and I'm still confused by my own asthma. Every time I go to the doctor my lungs sound fine (unless I have a cold that's gone to my chest and THEN they hear it because it usually exacerbates my asthma). One doctor even told me I wasn't sick it was just my asthma. My oxygen stays in the middle to upper 90's. I hardly ever wheeze unless I'm having an attack. And last spring we had red tide here in Florida and it took 9 weeks to recover from being exposed to it. It totally exacerbated my asthma and my primary care doctor had me stay inside for the first week of the 9 weeks.

But then there will be times (not always in line with my seasonal allergies) when I'll wake myself up coughing at night and sometimes have an asthma attack. Or I'll find myself short of breath. If I laugh a lot I get symptomatic every single time. And sometimes if I start feeling symptoms I won't reach for my inhaler because I feel like if I'm not wheezing it will ease up on it's own. So when the doctors ask me how often I use my inhaler I can't really give an accurate answer.

I recently was at my allergist (a new one) and he told me my lung function was good. So it all confuses me! I'm not very physically active (I have chronic pain so that makes it hard). 

I guess what I'm wondering is do other people who have EIB asthma have similar experiences? 

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  • K8sMom2002

    Amma, welcome … can be very confusing. Like you, my asthma went undiagnosed for many years. I thought everyone felt like their lungs were stomped on when they ran or did really intense exercise. I was only diagnosed after a long bout of bronchitis. 

    What you are saying about your — exercise, strong emotions, and periodic flares — sounds a lot like my story. 

    Amma posted:

     One doctor even told me I wasn't sick it was just my asthma. My oxygen stays in the middle to upper 90's. I hardly ever wheeze unless I'm having an attack. 

    I hate that this was said to you … asthma is a disorder that can be managed, but it must be managed with care.

    I don't have an audible-to-the-naked-ear wheeze unless I am very, very sick. But my doctor has told me that during an asthma attack, I have a definite wheeze that can be heard with a stethoscope. 

    Other members here have said very similar things about asthma and wheezing and pulmonary function. Here are some of their comments on older threads …

    • Re: 
    • Re: 
    • Re: 

    One thing that has helped me was going through the . I learned a lot about my asthma — and how controlled it really was — through this course. 

    Has your current allergist worked with you to develop a good that covers how to deal with all your triggers? Are you waking up more than 2 x a month with asthma symptoms?

  • Emelina

    Hi Amma, welcome! You sound like me, I started off as mostly just EIB and chest colds that always go to the chest. Your story of having lungs that sound ok and good lung function (except when sick) but occasional issues with waking at night and flaring with exposures or triggers (strong emotion) sounds very familiar (mine!). 

    A few suggestions for talking with your allergist/asthma doc: I’d keep a little journal of when you need your rescue inhaler or when you wake up at night. Your doc can use that as a gauge (if needing rescue > 2 times/week, waking up more than 2 nights/month, etc) that can be a sign that you’ve moved from mild intermittent eib to a mild persistent asthma and could use a low dose steroid to simmer down the lungs. Spirometry and asthma can be confusing, but it can happen that you have normal lung function between flares! Also, not all asthmatics present with loud wheezing and abnormal lung exams (like me, I tend to air trap).

    you could also ask him/her if peak flow monitoring could help. Sometimes I’ll have little minor coughs/wheezes that don’t drop my peak flow by much and I’ll just breathe through them; others are bigger and drop me down into the yellow zone and that’s a good reminder to whip out the albuterol.

    if you are confused or wondering if your diagnosis is right, you can always ask your doc about other possibilities like post nasal drip or vocal cord dysfunction or reflux. Sometimes doctors will order tests such as methacholine to investigate asthma but that has its own risks/benefits.

    like Cynthia mentioned Check out the asthma care class! It is amazing and a great overview of every aspect of asthma care including eib.

  • LK

    Welcome AMMA!  

    Great advice given above!

    I have cough variant, adult onset, severe asthma but not EIB.  Even when I am having a bad asthma flare the doctors always say my lungs sound clear, no wheezing.  Laughing would set me to coughing and I used to just think the cough wasn't really indicative of an asthma flare but have learned that it is for me.  For the longest time I resisted using my rescue inhaler because I didn't think it would help.  Found out that, for the most part, if I use it in the early stages of even a small flare it greatly reduces the length and severity of the flare.  

    Are you on any asthma maintenance medicines or just the rescue inhaler?  I am on several asthma medicines and also two reflux medicines.  My asthma is one of my triggers for my reflux and my reflux is a trigger for my asthma.  One sign of my reflux was that I would cough when I lay down.  

    A good rule of thumb is to ask your doctor whenever you are not clear on when you should use your rescue inhaler or when you have any questions.

    Hope this helps! 

  • Amma

    Omg @K8sMom2002 and @Emelina thank you so much! I'm sorry you go through it too but I'm so glad I'm not the only one (I didn't think I could be lol). I can remember very clearly in high school being told that in gym class were going to do a fitness test that required a 1 mile run around the indoor track. I can remember thinking "great I'm never going to be able to do it I'm probably not going to be able to finish and I'm going to have that weird coughing thing if I do". And sure enough I couldn't run the whole mile. I had to walk the last half of it short of breath feeling like an elephant was standing on my chest and coughing. By the time I got to my next class I couldn't stop coughing. I was literally coughing until I was gagging. I was so embarrassed. I remember the kid in front of me finally turned around looking confused and asked me if I had asthma. Of course I wasn't diagnosed at that time and asthma only looked like what you saw on TV so I said no. NOW I know I was sitting there having an asthma attack and now I wonder why didn't a teacher notice my distress and offer me help? 

    Peak flow and writing everything down is probably my best bet to track everything. I know laughing triggers it and anything that gets me out of breath for any length of time. Cold air is another trigger for it. And I can't stand smoke. Last year the red tide here was so bad I was using my inhaler twice what I usually do. I had symptoms everyday and attacks at least once a week if not twice. Dust sometimes gets me (and my allergies too). 

    Thank you so much for your input and suggestions. I feel better knowing that this is kind of "normal" for EIB asthma. 

  • K8sMom2002

    Amma … it sounds like you and I are very much alike. I love Em's suggestion about keeping a journal. A helped me figure out all my triggers — now my asthma doesn't surprise me out of the blue. 

    And Lisa's questions and tips are great, too! Using your inhaler won't make you "dependent" on it — as my doctor explained it to me, the only way that your inhaler meds can help is if they come in contact with your lung tissue, and the only way that they can do that is if you're still moving enough air to get that medication down into your lungs. 

    My doctor also pointed out this seeming contradiction: if I used my inhaler earlier, I'd probably use it less often. She was right! If my lungs get super twitchy and I resist using my inhaler (like I used to do, but no more!), then they will react to things that they normally wouldn't be bothered with.

    An honest conversation with my doctor about my triggers and my concerns about using an inhaler really started the ball rolling toward better asthma management.

  • Emelina

    Ah yes, cold air! That provoked one nasty attack when I thought it would great to run in below freezing weather, since then I’ve learned to bundle up and wear a scarf to keep from inhaling that cold dry air. 

    I will echo the excellent advice from lisa and Cynthia. It’s so much better to pounce on a flare or trigger early then let it keep building. My husband used to have to twist my arm to get me to use my rescue inhaler … maybe it was stubbornness or denial or not wanting to appear sick/weak, but now I’ve learned. The most important thing is to keep the lung irritation down otherwise you get into the vicious cough, irritation, cough more cycle that can easily spiral out of control. One thing that used to work for me was taking controller meds when I knew a bad season was coming up (allergy season) then I could wean off and go back to as needed albuterol.

    the trigger journal is great, it helped me identify triggers like viral infections, cold dry air, strong emotions (crying does it for me, rarely laughing), pressure changes and menstrual cycles.

  • Amma

    I have a question. I'm wondering if this happens to anyone else. Last night I had a dream that I was drinking tea that contained one of my food allergies. Within minutes I started coughing and couldn't stop. My daughter who was in my dream was noticing I was in distress. At that point I woke up and I was actually coughing and coughing in real life. Does this happen to others? I sometimes wake myself up coughing but not usually beacuse I was dreaming that I was coughing. Sometimes I'm even wheezing when I wake up coughing. Once it was like a full blown attack and I had to get up and use my inhaler. 

    And totally separate question. Is a peak flow reading of 350 bad?

  • Shea

    I have asthma and allergy dreams a lot. I might be dreaming of being around a cat because my asthma is trying to wake me up but my dream incorporates it into it because my body is so tired and wants to stay asleep. My real life asthma might be triggered by dust mites or just because of drops in cortisol levels overnight or weather pressure changes — because I dont live with cats and avidly avoid them so even though it might be caused by one thing in my dream… It is typically not whatever is setting it off in real life. I relate it to (Not sure if youve had this type but I know others have) the dreams when you have to go to the bathroom in real life and in the dream your looking for a bathroom everywhere.

    Im not sure about peak flows because I dont take mine.

  • Amma

    I get what you mean @Shea I have dreams sometimes that I'm eating foods I'm allergic to and then going into an all out panic in my dream lol.

    I'm going nuts today though. I'm only coughing a little bit and I'm not wheezing but I feel short of breath. My oxygen is around 95 and my peak flow is about 350. But I still feel short of breath. With my numbers being ok I don't know if I should use my inhaler or just ride it out. It's so frustrating. 

  • Emelina

    Hi amma, 

    sorry to hear about your dream! I haven’t ever had one quite like that!

    regarding peak flow interpretation, it all depends. Have you taken your peak flow daily for 2 weeks when not sick? That will help you determine what your personal best is. Then you can calculate your zones. Anything over 80% is good. You can go online and figure out what your predicted peak flow is based on your gender, age and height but remember this is just predicted. Were you having symptoms with your 350? 

    Hope this helps! Best em

  • Emelina

    If you feel short of breath, I’d try using your inhaler and seeing if that helps and be sure to check your peak flow right before you use your puffer and 30 minutes later 

    i will wheeze occasionally, but more often than not I don’t. Asthma is such a strange disease. Whether or not you’ll wheeze depends on where the narrowing is (little bronchioles vs larger airways), the severity of the narrowing and how well you are moving air. Usually my peak flows are a better indication of how I’m doing. Hope you feel better soon. 

  • Melissa G

    @Amma, I had that happen when I was first diagnosed and my asthma was not controlled yet. It is very scary. 

    As for your peak flow meter readings, I would check in with your dr where your readings should be. Do you have an