I’m looking to see if this sounds familiar to anyone. I just spent 3 days in the hospital with bronchial spasms,hyperinflation (at the lung bases) and wheezing in my lungs.
Basically, looking back, I had been tired for a couple days. We’ve all been fighting a respiratory thing ever since our trip, but I’ve been regularly holding 2 sports/day for a couple weeks. On Tuesday Jamie and I headed out for our usual bike ride and I was pretty out of breath from the start but just figured it had something to do with my previous days lack of energy. It was about 30C so nice and warm. So I kept pushing the pace (as would be normal for me). At one point we were chased by a dog and I put a LOT of energy out and shortly (2-5 min?) afterwards I started having trouble breathing. I started hyperventilating and finally pulled over. I was coughing uncontrollably on the expiration but not the inspiration but could only take 1/2 breaths. Jamie then headed home, got the car and took my to the hospital. I think we were in the ER about 2 hours after everything started (maybe less) and they treated me with O2 and nebs. I’m not sure of my O2 sats but they were 78% at one point and 74% another time (on room air and coughing). They nebulized me with Pulmicort and Combivent (salbumamol and ipratoprium) for quite some time and after that I was MUCH better but then would cycle with spasms of expiratory coughing and tremors. I think was only nebulized once though. I was observed for quite a while but pretty much any talking would bring on a spasm of coughing so eventually I was admitted. I was on nebs every 2 hours then every 4 hours then every 6 hours and stayed that way until discharged. I was discharged on the 19th but my O2 sats dropped to the 70s again during a coughing and I was readmitted. They then added hydrocortisone and loratidine (Claratin) to my meds with nebs every 6 hours. I was sure I’d be discharged last night (2nd night at the hospital) but still had too much lung wheezing (I personally could not hear any wheezing but they could with the stethoscope).
This morning (after 3 nebs between 7pm and 7am this morning) the wheezing was gone and I could once again take deep breaths.
They said it wasn’t asthma but a bronchial spasm and one doc mentioned maybe a pleural irritation (covering of lungs) causing the spasms. It seemed to me that I got better quicker after the hydrocortisone injections but maybe it was just the accumulation of nebs. Yesterday I found I could breathe deeply wihtout any trouble for about an hour after a nebulization and then began coughing (dry on expiration). Today I did not have that problem but I do find that I’m coughing a lot when I’m up and around but not on deep breathing. (just tried)
I have never smoked. I have never had asthma. I have never had ANY lung issues.
Docs say this was probably an isolated incident but can’t say why or what caused it. Does it sound familiar to anyone? Any advice?
Sorry to hear about it. I got an inhaler from my doc after I told her that I was having trouble breathing after hard work outs. She said it might not be asthma but broncospasms. I’ve never had asthma in my life but I do have bad allergies. Whatever it is, it works for me. It feels like my lungs are a 100% rather than at 75% when working out.
Your experience sounds similar to one we went through with our 4 yr old son many years ago. After multiple trips to the emergency room during the course of the first day we finally were seen by a doc who was competent in treating asthma and our son was admitted for a few days until he was stable.
I would seek out a competent specialist and get tested for asthma. We ended up seeing an allergist to identify the various triggers for our son’s asthma. I wouldn’t accept the ‘isolated incident’ diagnosis.
Bronchospasm is 1 of the 2 hallmarks of asthma. The other is airway inflammation/mucus plugging. You had what sounds like an “asthma-like attack”. It could be an isolated event caused from an infection/allergy or it could be the start of a recurrent illness (asthma). Time will tell. I’d highly recommend you take it easy for a month or so and do light exercise only. You could follow-up with a pulmonologist and get a series of pulmonary function tests or you could wait and watch. You should consider taking an inhaled steroid for a couple months and you should always carry an albuterol inhaler (and spacer/aero-chamber) just in case. Pulmonary function tests may be more reliable if you wait a few months to test and let things settle…as always a good primary doctor to keep and eye on you and advise you is key…as internet medicine is a bad idea.
EIB (Exercise Induced Bronchospasm) induced by viral infection. The exercise just made it worse. I have a lot of experience with this. They should have had you on prednisone or prednisolone for 5 days to prevent the reccurances.
At least you now know what to watch for. Overly fast respiratory rate and that horrible coughing is your queue for the albuterol and then pulmicort (budesonide) if it returns within a few hours. You might not ever experience it again though because in your case it might have only been started by the viral infection and the inflammation just pushed you over the cliff. But now you know the signs, so I’d get a scrip for an albuterol inhaler and budesonide inhaler (or for the nebulizer) just in case.
EIB (Exercise Induced Bronchospasm) induced by viral infection. The exercise just made it worse. I have a lot of experience with this. They should have had you on prednisone or prednisolone for 5 days to prevent the reccurances.
At least you now know what to watch for. Overly fast respiratory rate and that horrible coughing is your queue for the albuterol and then pulmicort (budesonide) if it returns within a few hours. You might not ever experience it again though because in your case it might have only been started by the viral infection and the inflammation just pushed you over the cliff. But now you know the signs, so I’d get a scrip for an albuterol inhaler and budesonide inhaler (or for the nebulizer) just in case.
THis is what I’m leaning towards also after spending the morning with Dr. Google. They didn’t have me on prednisone or prednisolone but did have me on 100mg hydrocortisone IM q.8 or q.12 for the last 2 days and they gave me a script for indomethicin but that stuff looks scary so I’ve not taken anything but loratidine (also advised by them) and betamethasone (you can’t get it in the US - Celestine a combo on loratidine 5mg and betamethazone 0.25 mg) that has helped me feel a bit better this am. My chest is still a bit tight but deep breaths are still okay. This has totally thrown me for a loop as I just Do Not Get Sick and have never had lung issues and just walking around has me coughing today. Guess I’m not going to get my run or swim in either. Hospital docs said to rest for a week and then see how it goes.
Bronchospasm is 1 of the 2 hallmarks of asthma. The other is airway inflammation/mucus plugging. You had what sounds like an “asthma-like attack”. It could be an isolated event caused from an infection/allergy or it could be the start of a recurrent illness (asthma). Time will tell. I’d highly recommend you take it easy for a month or so and do light exercise only. You could follow-up with a pulmonologist and get a series of pulmonary function tests or you could wait and watch. You should consider taking an inhaled steroid for a couple months and you should always carry an albuterol inhaler (and spacer/aero-chamber) just in case. Pulmonary function tests may be more reliable if you wait a few months to test and let things settle…as always a good primary doctor to keep and eye on you and advise you is key…as internet medicine is a bad idea.
Where do you live?
Dave
My mind is just totally rebelling at the idea of asthma. I’m 50 years old and I can’t believe it could come on like this, but who knows. I’m in southern Mexico, well out of the current norte (22) but 23 is on its way and temps will drop to 16C one night soon before getting back to 20C (night) and 30s (day). I will definitely get tests done if this happens again and thanks so much for the advice on when (few months versus now). They suggested salbutamol (albuterol/ventolin/etc.) but I’m not exactly certain when/if I should take it - they just said “as needed”. I’m wary of taking the inhaled corticosteroids as my CBC definitely reflected a big change in WBC and neutrophils just from the 3 days of treatment.
Pleurisy? seems like the docs would’ve caught that, though.
Sorry to hear you were in the hospital. I hope things get better from here.
tc
Thanks so much. They first thought (in the ER) collapsed lung but the chest xray ruled that out I think it is probably all related to the respiratory illness we’ve been fighting and maybe the hard exercise just pushed me over the top. Time will tell. Right now, I’m just aiming for being vertical without coughing.
Sorry to hear about it. I got an inhaler from my doc after I told her that I was having trouble breathing after hard work outs. She said it might not be asthma but broncospasms. I’ve never had asthma in my life but I do have bad allergies. Whatever it is, it works for me. It feels like my lungs are a 100% rather than at 75% when working out.
thanks. They did suggest an albuterol inhaler but I’m not sure if/when I’d use it. I’m just going to wait and see for now.
Also, try to stay out of the cold air as much as possible. If you absolutely have to go out, keep it short and wear a scarf over your mouth so that you breath in the warmer air trapped by the scarf. Or put the collar of your coat over your mouth and nose so that you’re breathing in the warmer air from inside the coat. Really cold air deep in the lungs while this is going on can cause sudden and hardcore bronchospasm. It’s not fun.
EDIT: I didn’t realize you were in the tropics, so N/M about this, but it’s still sound advice for others like me who are freezing our butts off today with below zero temps.
Also, try to stay out of the cold air as much as possible. If you absolutely have to go out, keep it short and wear a scarf over your mouth so that you breath in the warmer air trapped by the scarf. Or put the collar of your coat over your mouth and nose so that you’re breathing in the warmer air from inside the coat. Really cold air deep in the lungs while this is going on can cause sudden and hardcore bronchospasm. It’s not fun.
thanks, but totally not a problem here. currently 33 C today. (low to mid 90s for Fahrenheit folk?)
Considering the amount of inflammation you must have had in your lungs - I’d consider continuing the inhaled steroids for a while to calm everything down…and the changes in wbc with systemic steroids is essentially meaningless and to be expected from decreased margination. Inhaled steroids - esp. short-term is well worth it my opinion (and systemic effects usually are nil or very minimal)…but again - that’s why you want a good primary doc…
Albuterol - I’d consider using it every 4 hours for a few days/until your cough is almost gone…then maybe before exercise for a few weeks or if you feel tight/cough…then carry it in case you have another bad attack.
Considering the amount of inflammation you must have had in your lungs - I’d consider continuing the inhaled steroids for a while to calm everything down…and the changes in wbc with systemic steroids is essentially meaningless and to be expected from decreased margination. Inhaled steroids - esp. short-term is well worth it my opinion (and systemic effects usually are nil or very minimal)…but again - that’s why you want a good primary doc…
Albuterol - I’d consider using it every 4 hours for a few days/until your cough is almost gone…then maybe before exercise for a few weeks or if you feel tight/cough…then carry it in case you have another bad attack.
Adult-onset asthma definitely happens.
Good luck with all -
Dave
thanks so much. I’ll have DH pick up the albuterol.
See a very good pulmonologist. An emergency room physician without the benefit of an extensive history, possibly an MRI, and lots of experience with asthma/bronchitis patients will miss asthma. You don’t give your age. I didn’t get obvious asthma until age 62, when I collapsed at IM Florida. It was initially diagnosed as having EMPHYSEMA by some bonehead at the VA.
Also, have your serum ferritin levels checked. Females lose iron quickly, particularly if they are training hard and are still of menses age.
Good luck to you and don’t get disappointed. Asthma is very treatable.
I had symptoms similar to you, and like you, I’d never smoked, nor had I had any other lung issues. I had a few chest x-rays and the general practitioner Dr’s treated me for Bronchitis. The antibiotics didn’t seem to knock it out the first go around, so a second round was ordered and although I felt a little better for a few days I relapsed into shallow breathing. (Deep breaths were possible only intermittently). After two months of the Dr’s scratching their heads I went to a pulmonologist and in relatively short order he found that I had Bronchiolitis Obliterans Organizing Pneumonia or BOOP for short. It took a ten month cycle of prednisone to reverse it. BOOP, I’m told is quite uncommon and because of that it often goes undiagnosed. It takes a lung biopsy for them to know for sure if that is what is going on. The chances that you do have BOOP are quite low, but since it took my doctors so long to find what I was suffering from I wanted you to be aware of the disease. You can get a better idea of what it is from here: http://www.mayoclinic.com/health/bronchiolitis-obliterans/AN00307
I’ve has asthma forever - and being doing sports to combat it forever too.
My asthma is now undetectable, and I’ve not taken drugs for more than 10 years. But sometimes, I’ll get asthma like symthoms for no reason.
But having had them before, I know where I am. So I can give a few pointers:
/ Don’t panic, that produces adredaline, that makes stuff worse.
/ Don’t cut the effort that you where doing all of a sudden.
/ Force yourself to breathe a slow constant rate - really force yourself. And not to cough, harder said than done (exoiring slower that inspiring helps).
/ Go to a hospital if the above don’t work.
Go see an pulmonologist/allergist, someone qualified to diagnose. You may have had low lying asthma for years and has now come to light…some allergen may have been to blame? Folks with asthma can lead a normal life when treated appropriately with inhaled corticosteroid. Problem is that most FP/GP’s have no clue how to treat and will hope for the best with albuterol and/or Advair
Did they look for a pulmonary embolism or say there was some pneumonia? Did you drive to Mexico? The low sats is very disturbing to me. Typically those with such severe bronchospasm that results in low saturations in the 70s are in a hell of a lot more trouble than what you described. Asthma can cause significant hypoxia (low oxygen) but this is typically not seen right off the bat (although it is known to happen). It would be my guess that there was some other component in addition to the bronchospasm to cause low sats. Perhaps you inhaled something that resulted in inflammation of the lungs (aka pneumonitis).
If you don’t feel better in a couple of weeks, I’d see a pulmonologist or perhaps get you PCP to set you up with an xray/CT
See a very good pulmonologist. An emergency room physician without the benefit of an extensive history, possibly an MRI, and lots of experience with asthma/bronchitis patients will miss asthma. You don’t give your age. I didn’t get obvious asthma until age 62, when I collapsed at IM Florida. It was initially diagnosed as having EMPHYSEMA by some bonehead at the VA.
Also, have your serum ferritin levels checked. Females lose iron quickly, particularly if they are training hard and are still of menses age.
Good luck to you and don’t get disappointed. Asthma is very treatable.
-Robert
Thanks so much. I had 3 different ER docs (they did rounds in the am as the internist came from 80km away) and an internist for afternoon rounds (who eventually dc’d me). I’m 50 and I’m always borderline anemic (CBC showed 11.1 Hb and 33.2 Hct) - even when we didn’t live here (Mexico) I had a hard time giving blood as I was always under normal levels. I really should do something about that.
I’m really shocked that you were DXd at 62. I thought asthma was ALWAYS dxd early in childhood, so thank you so much for your experience. I’m still hoping for a one-time issue though. I will definitely see a pulmonolgist and get testing if it happens again though.
They first thought (in the ER) collapsed lung but the chest xray ruled that out I think it is probably all related to the respiratory illness we’ve been fighting and maybe the hard exercise just pushed me over the top. Time will tell. Right now, I’m just aiming for being vertical without coughing.