Friday, August 30, 2013

I am an asthma conundrum

What is frustrating about my asthma is that I feel worse than I look.  Seriously!  I feel like I can't get a full, deep breath in, and I can feel that I have air trapping when I exhale, but I don't look short of breath at all.  The only way the people around me know I'm short of breath is because I tell them, and I think that deep down my wife probably wonders if I'm making it all up.  But she loves me and so she trusts that I'm telling the truth. 

That's the delimma I have with my asthma.  I was actually having a really good summer asthma wise, until about a week and a half ago when I was rummaging through boxes in my basement.  Since then I've felt this way.  I currently have no allergy symptoms and no signs of a cold.  It feels, to me, like pure asthma.   I've used up a ton of ventolin, via both the inhaler and nebulizer route.  I've gone through at least 2 full inhalers, and who knows how many Albuterol nebulizer treatments. 

The treatments help open me up and make me feel better, although in the end I still don't feel perfectly opened up.  Still, my regular routine of life has not bee effected.  Although, considering I've been pumping so much ventolin into my system, I've been extremely anxious lately, as might be expected.  This is probably exacerbated by the fact I've been getting up several times in the night to puff on my inhaler.  Or, worse, to take continuous breathing treatments in the morning hoping to catch my breath so I can get back to sleep.  But usually, after taking this action, I'm so wired I can't sleep.

So I'm working tonight, and I'm walking around doing my work, when I feel tight.  Well, I've been mildly short of breath all night and all day yesterday, but at the moment I was feeling worse.  So I went back to the department to give myself a breathing treatment, when I decided to run myself through the whole gammut of tests. 

I did a pre and post peak flow: 
  • pre: 750 (maxed device out)
  • Post:  750:  (maxed device out)
Then I did a pulmonary function test on myself:
  • Pre Duoneb breathing treatment
    • FVC: 4.42 or 85% predicted
    • FEV1: 3.64 or 88% predicted
    • FEV1/FVC: 82
    • FEF25-75: 3.66 or 96% predicted
    • FEF Max: 10.09 or 103% predicted
  • Post Duoneb breathing treatment
    • FVC: 4.42 or +3
    • FEV1: 3.90 or +7
    • FEV1/FVC: 86
    • FEF 25-75: 4.64 or +27
    • FEF Max: 11.20 or +7
Based on these results, you can see that all of these tests show greater than 80% or predicted, which would show that I have normal lung function.  Now from the graphic, you can see a slight obstructed patern, although nothing significant.  However, there is a nice improvement with the Duoneb, so the PFT does shoe a benefit with bronchodilator. 

Still, this is frustrating for me, because I feel like I have air trapping.  I feel like I don't feel normal, so I started myself on a prednisone pack today, yet I really don't fee significantly better after doing that.  What stinks is I was hoping doing this PFT would help me decide what the next course of action is for me to do if these steroids don't kick in soon.  I actually was thinking of going to the ER after work, and I was hoping these tests results would ease my mind a bit.  But not so. 

It could be all in my head, I suppose.  However, as I take a deep breath, and feel that something is in there.  And as I exhale, my exhalation is prolonged and wheezy.  Welp, tis the life of being a hardluck asthmatic.  Yet as you can see here, none of these tests match how I feel. That peak flow meter is about useless to me. 

Now, one more thing I want to add.  You might find this awkward, and I sometimes wonder if any other asthmatics have had the same thing happen.  Once all my kids are up, and things are situated around the house, I go into the basement and do my workout.  Yes, I even run on the treadmill (or wog, or whatever you call it. But at least I do it).

Even yesterday morning, after getting out of bed and telling my wife "I'm still having trouble breathing," I said, "And I'm going into the basement to run on the treadmill."  She said, "How can you run on the treadmill if you can't breath."   I said, "Life must go on." 

My point there was that for some reason my asthma doesn't seem to get worse when I'm running on the treadmill.  Why that is I have no clue.  But I'm going to take advantage of it, because I know from my experience if I let myself get out of shape, I get dyspneic from being overweight, and then everything gets nasty.  So if I can, I work out.  And I have.  But I do a light workout as opposed to a vigourous one when I'm like this.  It goes along with the asthma experts who insist that you should always exercise even when  you have hardluck asthma, or no matter how bad your asthma is. 

So I started a medtol pack after much delay, mainly because it's normal for me to dilly dally, to hymm and haw, and to come up with excuses not to do anything.  Asthma can be so awkward at times.   My asthma is awkward.  It's a conundrum.  It'a a major riddle.  I yearn to see if any of my asthma friends have ever experienced anything like this: where your asthma does not match your appearance, and all your tests are normal, even better than normal (such as your PFTs).  Thoughts?

4 comments:

  1. Sounds like air trapping to for sure. Most asthmatics have some degree of air trapping and it could be that you are just more sensitive to the symptoms than most.

    Air trapping in asthmatics is usually caused my micro mucus plugging and/or inflammation rather than alveolar wall integrity as seen in emphysema. In people with fixed airway disease you would expect to see a reduced FEV25-75 and maybe a higher than normal TLC, but that's not always case with asthmatics. Most health asthmatics have totally PFTs .Im sure that a CT scan would show some diffuse air trapping in the periphery of your lungs.

    You mentioned that it could be "all in your head". Well, yes and no. Again, it could be that your lungs are wired to your brain a little differently than some, making you hypersensitive to lung over-inflation, which manifests itself in the form of breathlessness. This of course can make you anxious, which makes the feeling of breathlessness even worse.

    I have severe air trapping myself ( my FEV25-75 is only 6% of predicted) and it usually gets worse at night. To quell the feeling of breathlessness associated with it, I take .25mg ativan every evening along with extra nebs and it works wonders. In fact Ive been on benzos for 12 years now.

    I think you are doing the right thing by performing objective tests to make sure that acute bronchospasm isnt the culprit. The two can mask each other. Stomach or abdominal bloating can blur things even more. I wish I had a remedy for you, but the fact is, you usually just have to wait until your lungs decompress.

    I hope this helps a little.

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  2. As always, your asthma wisdom is appreciated.

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  3. I have similar problems with my numbers always being high. I've had doctors not believe me because objectively my PF and PFT numbers are always too high. On average my PFTs are in the mid-low 90s now, but I use to hit 130-140% of expected.

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  4. Finally! I don't feel so "weird". My asthma has been atypical from day one, making docs diagnose me as "just anxious" and over-prescribe me benzos which I then got hooked on. My PFTs are always in the 90 or 100 percentile even when I feel bad. It seems it takes A LOT to get my peak flows to drop.

    And weirdest of all, my symptoms are almost exclusively in my left lung. My right one seems unaffected.

    I've never had a doctor be able to explain that one to me though...

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