Asthma.. Wheeze on the inhale??

[hammerpcp]

The asthmatic wheeze is caused by alveolar mucus plugging, often described as a "one way valve" or a "trap door" that generally lets air in, but constricts air out- which causes the telltale expiratory wheeze.

Asthma is a obstructive pulmonary disease characterized by inflammation of the bronchioles and bronchospasm. Yes there is also an increase in mucous production but perhaps you are confusing asthma with other types of COPD like chronic bronchitis. Wheezes are caused by air being forced through narrowed airways. What you describe would produce a coarse crackle type sound or rhonchi.

[Eydawn]

Speaking as an asthmatic w/o VCD, it is definitely possible to experience inspiratory and expiratory wheezing that can be both audible with or without ascultation. I usually do. My typical attack pattern is onset of SOB, feeling "tightness" in my chest, coughing with increased mucus production, starting to feel dizzy, audible expiratory wheezing (and the rest I've been told by those treating me), progression to (ascultated) inspiratory and expiratory wheezing, diminishment in the bases, cessation of coughing or progress to a dry, nonproductive cough. Following use of the albuterol, slowly decreasing audibility in expiratory wheezes, opening lower bases, only wheezing in the uppers, and finally resolution. So you see.. folks can hear me wheezing inspiratory and expiratory (usually across the room) and the wheezing and diminishment travel around in my chest during the course of an attack.

Now, as to your poor friend...

If albuterol makes her feel that sick there are other fast acting bronchodilatory rescue inhalers that her doc could prescribe for her.

If she's baseline wheezing for 90% of the day her asthma is nowhere near under control. She shouldn't have to live with such a diminished capacity and quality of life (and trust me, it wears on you makes damn near anything you want to do impossible). Let's figure out what she's doing that ISN'T working so she can present a nice picture to her doctor (or to a new doctor, which it sounds like she may need) and get this under control so she doesn't HAVE to take the albuterol to function. Living on albuterol is really not fun, and yes, you will just give up and quit taking it after a while if you get frustrated enough. Been there.

What controller is she taking? Is it a corticosteroid (Flovent, Q-VAR) or just a long acting broncodilator (Serevent)? Is she taking a combo thereof? How many times per day does she take it at what dose, and is that the dose level she started at? Is she using a metered dose inhaler? Does she use it with a spacer (Aerochamber, Aeroflo)? If she's taking a dry powder disk inhaler, has she been instructed in its proper use? They're tricky (Advair, for example). Is she taking any oral steroids (prednisone)? Is she on any other medications (for example, if she's taking atenolol, which is a beta blocker, it will interfere with the beta agonist effects of albuterol); how about any antihistamines?

How long has she had asthma? When was it diagnosed, and how? Is it allergy or exertion related or both? Does she have any other allergies? What are her specific allergic triggers or does she know? Does she wake up in the middle of the night with symptoms? Apart from the baseline SOB and wheezing experienced throughout the day, does she experience concrete "attacks"? How many times per day? How long do they last? Has she ever had an ED visit due to asthma? Has she ever lost consciousness due to her asthma symptoms?

Any other health problems? Any throat surgeries, etc? History of intubation- ever?

What is her environment like? Dry, humid, hot, cold, central heating, radiant heat, A/C, etc.? How long has she lived there? Apartment or house? What's her work environment (if she is able to work) like? (Same questions for work environ). Where is she from originally? Is this her native state/city? Family hx of asthma/allergies? Does she own pets? Smoke/live with someone who smokes? Does she have a specific location where her symptoms get worse or better? Specific time of day where she feels worse or better? Does she have improvement or worsening, in general, with rainstorms? (think humidity and pressure and temperature change on that last one- how do they affect her?) Does she use body sprays/perfumes/highly scented candles, soaps, shampoos, laundry detergents? Is she a wine drinker? (sulfites in wine will aggravate asthma). Does she like cinnamon candy? The artificial color and flavor in some cinnamon candies will cause attacks/sensitivity in some asthmatics.

That'll do you for starters; I'd suggest printing it out, going over it with her, writing down the answers, and then you can choose to update us or not. In any case, take the answers to the next doc appointment. Do it soon- I hate going to the doc, but I like breathing more, and it's relatively easy to fix once you figure out a lot of this stuff and get the right medications/environment changes going.

Good luck to both you and her!

Wendy

CO EMT-B

MI EMT-B

[AnthonyM83]

I used to have sickness induced asthma as a kid and at least as I recall it, the wheezing would really be on the way in. THAT was the hard part b/c you really had to tripod to get that pressure to take in air. Exhaling was a relief and easy.

BUT I also have a cat allergy. THAT makes me wheeze on exhalation.

[windsong]

At age 15 months I had pneumonia, growing up as my parents were told like any other child was normal, pneumonia, bronchitis, repeats of that over time.

I was 18 when I ended up in the hospital with bronchitis so bad, the ER doc said to me, do you have asthma, and I just looked at him and he said dont be afraid to tell me, it's ok.

All my life I suffered like this and they said it was normal, after being referred to a specialist: He told me from my case history I had asthma since I was a baby, and it was a matter of time before it got worse.

My second oldest sister used to smoke, she quit along time ago, she was diagnosed with Asthma/Emphysema and she is 54, turning 55 Dec 1st. Her son when he was little had it as well, and supposedly grew out of it, but it's returned he's 20 yrs old and he smokes and is becoming an Emr in the new year. Smoking causes a lot of muscus to develop.

I was a guinea pig for research of new drugs coming out for asthma, they know me well at the Special services building at Foothills Hospital over the years.

If you have asthma like me and you shovel the walks, wear something over your mouth and nose, so that your breathing your own air and it's moist, breathing cold air causes you to wheeze more. Household dust makes it even more worse, animal dander (that means if you dont have pets, dont start).

When taking your inhaled steroids, they tell you to rinse your mouth and throat out with water, even gargle with mouth wash, hopefully your not allergic to the alcohol in it, so they say rinse well, well not always can you do this, sometimes (powered inhalers) can leave behind residue, and thus you get a yeast infection in your throat.

Most drug companies dont make inhalers with cfc's anymore, the propellants are different, (remember I was a guinea pig) I know this stuff so well. It was cool some of the things I got for being a guinea pig, got free stuff out of it, from the drug companies sponsoring this.

As for your friend, tell her this nightmare if she doesnt take her illness serious, she could end up in a serious situation where they cant do anymore for you, it comes down to that, ventilators, ICU. It's a wake up call.

Now for the good part, being good to yourself, treating the body as a whole, seriously I want to live forever, I will not let my asthma rule me, I will rule it.

Yes there are other asthma srugs out there that could be more better for her.

[Doczilla]

I'm skeptical. The inspiratory sound you describe sounds more to me like stridor (an upper airway obstruction), not wheezing (lower airway obstruction). It's also not very common to be diagnosed with true "asthma" at that age. I have yet to see anyone with even severe asthma have wheezing all day every day, even the ones who end up on a vent. If it doesn't wake her up in the middle of the night, I am even more skeptical.

A lot of things can lead to upper airway obstruction. Masses, paralyzed vocal cords, strictures....the list goes on. Probably the most common thing that I see is anxiety-related. She may consider a fiberoptic bronchoscopy with an ENT doc to rule out some worrisome things. She may also undergo pulmonary function studies and possibly a methacholine challenge to test her airway responsiveness and differentiate asthma from other disease processes.

'zilla

[1EMT-P]

It sounds to me like your friend needs to be re-evaluated. If she is not tolerating her Albuterol, she might want to talk to her family doctor about changing medications and having allergy testing and spirometry done.

[ergo343]

It has been a while since I've had a chance to check this page, as I'm not home (I'm in Israel for the year) and my internet access is limited... However, I right now am getting the chance to take a few minutes and look things over.

I appreciate everyone's suggestions and insights into the situation.

There is an update however in the medical situation of my friend that makes everything a lot clearer.

About a month ago doctors found a tumor on her trachea, which accounted for most of her symptoms. I haven't seen her recently, as am 6000 miles away, but from what I understand she is doing much better.

I have to run, as I have class to attend. But thank you all again

--Elkie

[beckoncall62]

I have asthma and have experienced wheeze on both inhale and exhale.

[EMSm0nster]

Yeah, personally I don't fully trust Docs anymore. I have asthma and still have stridor upon inspire NOT expire (wheeze lower airway). Albuterol does get her dizzy, that's one of the side effects. LIke others stated, evaluate her. I would be fun to auscultate a friend too.

[tniuqs]

Sorry to get in way too late on this thread...

Inspiratory wheeze = possible Intrathorasic Airway Obstuction.

PFT and Chest XRay is the way to go for definitive Dx.

cheers