My very first cough asthma attack

The purpose of this blog is not to blog. It is to be my own personal journal. I am making it public in case it can help someone else to get through what I have just experienced.

I just had my very first asthma attack. I am at the tail end of it still, more than 5 days in.

What a rude awakening this has been to me! I have been diagnosed with cough variant asthma 2 years ago, after having struggled for quite a number of years with awful coughs - mostly in the winter and night time. The definite trigger for me is cold air. I have been able to keep my coughing under control relatively easy with inhalers and never seriously considered the possibility of an attack...

The run up

I had been coughing for about a week, thinking that it is a cold coming on. I also had a slightly sore throat and the odd sneeze. I tried to treat it with OTC cough medicines, including a cough suppressant and antihistamines. It did not stop the cough, but neither did it turn into a cold. I never even considered that it might be my cough variant asthma (CVA) until someone asked me if I am using my inhalers still... I was using my preventer inhaler twice a day but thought I'd perhaps try adding the reliever to see if it would help. This was 6 days ago (Wednesday). It did not help much, but I still thought it would get back under control quickly.

Perhaps I should also look at the weeks or months before the attack as I now think (hindsight is 20:20 vision!) that I should have taken more notice of the decline in my asthma condition. During the summer, which was a record warm one, I was coughing quite a bit and had to use my preventer inhaler every day, twice a day, to keep the coughs at bay. I was cough free every day, but as soon as I stopped the preventer, the coughs came back. So I kept using it through the summer - for the first time.

During the couple of weeks before, I have noticed in the gym that I was not quite able to do the cardio to the level I used to before. I just couldn't achieve the same goals, in spite of putting in the same effort as before. I sometimes experienced a bit of tightness in my chest as well. I put this down to not being as young as I used to be. Perhaps I should have taken more notice of that.

After a day of using the reliever inhaler with no result, I pulled out my 2 year old asthma plan and started on the amber section! I do remember very clearly when I was given this plan what I thought: "I'll never have to use that part of the plan." Hah. I am so grateful for the asthma nurse who gave me the plan and that I had filed it away neatly and that I could find it again! I increased the medications according to the amber plan for the rest of Thursday.

The attack

It still feels to me like I should not call it an asthma attack. I did not have any tightness in my chest or inability to breathe, like a 'normal' asthma attack would have. I just experienced excessive coughing. But I also know that what hit me on Thursday evening/during the night, was no ordinary thing. I certainly experienced it like an attack.

I coughed. And coughed. And coughed even more... The intensity and frequency increased throughout the night and sleep was very difficult. The reliever inhaler would provide a short period of respite but a tickle in the throat, the need to clear my throat, a barking cough or a series of racking, lung wrenching coughs were never far away.

By Friday morning I knew that this was something else and that I needed help to get on top of it. I made an appointment with the GP (I'll be eternally grateful for the wonderful NHS!) and by the time I saw him, I was coughing non-stop. I was feeling out of control, teary and incredibly tired. He prescribed oral steroids "5 to 7 days but if you feel better after 5 days, stop taking it". I popped the 8 pills in a single dose, as prescribed, and thought that would be that. I stupidly thought that once I've taken one dose of steroids, the attack would abate and I would be 100% back to health. In about an hour I did feel like the cough was getting under control and I could carry on with my normal day.

I was very ignorant (and probably still have loads to learn) about managing an asthma attack. I thought, since I am on a high dose of steroids through the tablets, that I should no longer use my inhalers - they are full of steroids too, aren't they? So for the rest of Friday, I did not use my inhalers apart from in the evening before bed when the cough started getting a bit rough again. I only used one puff at a time, as I didn't want to overdo the steroids. I think it was a big mistake to stop the inhalers at this time, as the cough got worse again on Friday night. On Saturday and Sunday both the days and nights were rough. I frequently felt out of control of the cough, fearful and confused. I stayed in bed for 2 days while dear hubby fed me tea, water, food, treats... He's been a rock! Just a note... it turned out that the best thing to do when you have an asthma attack is to keep moving as much as you are able to, and not to stay in bed! Mistake number two!

I used these two days to educate myself about asthma in general and how to manage an attack. I have put together a blogpost about the lessons I have learnt (knowing that in a few weeks or months, I will have forgotten most of it). You can read it here.

I did find the support of the Asthma UK forum extremely helpful (as is their website). There are a lot of people on there who are willing to support you emotionally, put your mind at ease, tell you what worked for them and point you to sites with more information.

It took a good 5 days of implementing the lessons I have learnt before I felt that the cough was getting under control again (yesterday). I am still coughing and still on the amber section of my asthma plan. I am still taking the oral steroids and as there is only 1 day's left and the cough is not completely gone yet, I'll take that tomorrow. I have also heard from others on the forum that it may even take weeks for the asthma to settle down completely and become the meek and mild thing it was before this attack. I say meek and mild very flippantly, I know. It was because it was not difficult for me to tame the coughs in the two years before. Response to the inhalers was instant and usually the coughs stopped after one or two puffs.

The tail end

I shall be making an appointment with my asthma nurse. The surgery had no appointments available and could not book any until a new block of appointments is released later this week. It is likely that I shall only be able to see her in 2 or 3 weeks. In the meantime, I'll continue monitoring my medicines, peak flow, symptoms, etc. I shall have to make a judgement call about when to go back on the green phase of my asthma plan as I don't really know for sure.

Shapeshifter

I came to the conclusion after doing much reading and chatting to people on the forum, that asthma likes to be different. No two people with the same diagnosis (mine being CVA) has the same symptoms, same reaction to medication or the same intensity of attacks. And to complicate things further, asthma can change for people over time.

My asthma started off as a seasonal (winter) cough, easily brought under control with inhalers.
Then it became a more permanent resident when the cough stayed with me during the summer.
Then it became devious - attacking me in the middle of the night, using my ignorance to trip me up!

I hope to tame the CVA so that I can continue to live a healthy life. But how to fight a shapeshifter?! I'll have to keep learning about it and be vigilant about my signals so that I can contain it...

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Side effects of medications

Oral steroids and increased use of inhalers do come with side effects! These were mine...

• slight headache directly after taking oral steroids, lasting for about an hour
• shaky, nervy feeling in the stomach and body, coming and going throughout the day
• blurred vision started on second day
• slight nausea every now and then
• constant indigestion (heartburn, belching, acid reflux) after about 4 days of treatment

Prescibed medications

Preventer: Clenil Modulite 

Reliever: Salbutamol

Oral Steroids: Prednisolone

Lessons I had to learn very fast!

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I am sure it is not necessary to point out that these lessons are very personal to my experience and that I am in no way attempting to give medical advice of any sort!
I am merely sharing what I have learnt about my cough variant asthma in the hope that it may help someone else who find themselves newly awakened to asthma, like I did recently. Perhaps others will share their valuable lessons so that we can continue to learn about living with asthma.

About asthma

• Don't take your diagnosis lightly. Asthma is a changeable thing and can hit you out of the blue, even after years of being rather docile and obedient.
• Until you have experienced an attack (even a non-life threatening one like mine), you have no idea what nasty things asthma can do to your body!
• Every person experiences asthma differently but we can still share our lessons and learn from each other. The emotional support and knowledge that "I am not the only one" works miracles.
• Seek help. If have found the Asthma UK forum tremendously helpful. 
• Educate yourself. I had to learn quite a lot this past weekend about the basics of asthma! The Asthma UK website has a wealth of information.

Keep a record

• If you have to take your asthma medication more frequently, it is impossible to remember when you last took your reliever or how many puffs. Keep a record!
• Paper records don't work for me, but my phone is an extention of my hand. I tried a few apps (this post on the Asthma UK forum has a good summary of what is available). I decided on Asthma tracker and it does all I want it to do with a few workarounds eg entering the oral steriods, the preventer inhaler and a change in my condition as notes. I now have an overview of each day's events and can track how long the reliever inhaler is helping before I start coughing again, which really helped me maintain a balanced view. At one point I felt like I was taking the reliever with no effect, but found that more time had lapsed than I thought.

Peak flow

• Peak flow is important. Take regular readings and keep a record. The Asthma app is perfect for this as it shows your highest PF reading on the overview, but keeps individual records of readings (time and reading) in the breakdown of each day.
• Understand how PF works. There are some good posts on the Asthma UK forum, but this post on the Asthma UK website gave me a good overview.
• Your personal best PF depends on a lot of different factors. I found Emma's comment on this post helpful.
• PF is only one factor. Your PF may be good but you still have asthma, or low and no symptoms. For me, I regret not keeping a record of my PF earlier as I think it may have warned me of the possibility of an asthma attack. In hindsight, I can see that my breathing had been affected in the days/weeks before the attack but since I didn't take readings, I can't correlate. Learn from my mistake! Even if you feel good, record your PF!

Use your inhaler correctly

• I had become very lackadaisical about how I use the inhaler and did not get the best out of it when it was crunch time. I had to research again how to use it properly and found it did make a difference. This post was helpful to check and improve my technique, in combination with this video.
• Use the spacer. I had been carrying my reliever inhaler in my handbag, using it without a spacer. It is not as effective.
• I still am not sure whether I am supposed to breathe in and out, or breathe and hold. I think the breathe and hold is more effective but if you can't hold, the tidal breathing technique is advised.
• I rinse my mouth each time after using the reliever inhaler, and brush my teeth and tongue twice a day after the preventer inhaler. I developed thrush (fortunately mild) in the summer because of being complacent.
• Care for your equipment properly. I thought rinsing the spacer once a week was sufficient, but found that it needs washing in soapy water, no rinsing in clean water afterwards(!) and letting it air dry. Watch the video on this post.

Asthma plan

• Dig out your asthma plan if you have one. Get one if you don't! When I got mine 2 years ago, I never realised how useful it would prove to be! Thank you to the asthma nurse who gave me one from the onset! Then I thought I'd never need to use the amber section, but this weekend I had to. Praying I never have to use the red section!
• It is easy to get confused or forget what you are supposed to do when you are feeling panicked and out of control during an attack. It helped to have a set of guidelines to follow.
• I have taken a photo of my asthma plan and saved it to a location on my phone where it can be easily found. I don't always have the paper version with me, but the photo is there for me to refer to any time. (For me the best location is Dropbox. I wish that it could be linked to the Asthma tracker app but that option is not available.)

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Read this post by Emma for her lessons and experiences, which are VERY valuable!