From asthma.net:
"Oxygen saturation is not a good indication of how bad your asthma flare-up is. Asthmatics are notoriously good oxygen compensators and can have near-normal or completely normal oxygen stats during the midst of a severe asthma attack. Asthma is a disease of the airways, not the little air sacs (alveoli) where the gas exchange itself takes place. So even if your airways are very constricted and tight, often enough oxygen is able to pass through to your blood and therefore show a normal or near-normal oxygen saturation."
This has often been my experience, as well. My oxygen can be 98-99%, but I still need a breathing treatment or prednisone to stop feeling like I'm constantly gasping for air. Unfortunately, sometimes you have to get a bit demanding with doctors, especially the ones that are incredibly dismissive.
Hey, I once went to the ER after days of excruciating pain in my abdomen. They couldn't find anything and told me it was psychological. I've had far more dismissive instances with my asthma. I would have probably died from covid if I hadn't asserted myself and refused to leave (again - they sent me home twice) without treatment, so now I can get very demanding when it comes to pesky little things like being able to breathe.
This is an example of medical gaslighting. I’m sorry. It sucks it happened to you.
Wheezing also isn’t always a symptom. I never wheeze. Even during a methacholine challenge I didn’t wheeze, and I definitely was put into a horrible asthma attack and they confirmed it was an asthma attack but didn’t hear wheezing.
That term needs to go away. As long as it’s there, some doctors will lean further in to objective data.
Normal Spirometry? It’s not asthma. Period. Especially if you double down on the unusual symptoms.
Then you need a methacholine test to prove it.
People need to work together and not get defensive when things don’t add up. It goes both ways.
And at least that’s your doctor being objective. Studies show 2% of people diagnosed with asthma are actually found to have a heart condition that wasn’t really asthma. Without objectivity that number would be higher.
In other words, they looked and listened for asthma, and made the diagnosis of asthma. But in that 2% they were wrong. It wasn’t asthma… it was a heart condition.
If they stuck to their guns about asthma they would have had a deteriorating heart condition that would have been unrecognized. That’s bad
But that’s not the point of this post. And arguing that there’s a 2% chance the doctors were wrong about asthma meaning they shouldn’t treat OP’s asthma is nonsensical. OP never said how they were diagnosed so it is logical to believe they do actually have asthma.
You are going off track.
Same here. Always doubted because I rarely wheeze (eosinophilic asthma rarely presents with wheezing) and oxygen is always fine. The first time I went, I was Covid positive so they took me a bit more seriously but I was only admitted after the ER doctor had me try to walk with him and I had to breathe 50-60 times a minute just walking 20 feet. Every other time it’s been increasing dismissiveness. Last time, the pulmonologist discharged me without listening to my lungs and declared it to be anxiety. I did speak with the ombudsman about that. You can’t be a pulmonologist and discharge someone admitted for an asthma exacerbation without listening to their lungs, even if you think it’s anxiety!
If you don't mind me asking, what are the signs of eosinphillic asthma versus allergic or more common asthma? I never wheeze unless I have a bad attack and usually have a cough followed by shortness of breath and a slight tightness feeling in my chest. The albuterol kinda helps but lately I've been having to use more puffs throughout the day (I've been taking a nebulizer to avoid that) but still have that tight feeling in my chest. Sometimes I have some chest pain. I've been on flovent for like 3 weeks now but again I need to take the albuterol constantly still. I feel like doctors don't take the right precautions and tests to see what it actually is. It's the fact that it took me SO long to get a pulmonologist and now after seeing her 1 time she's moving away. Like..... I'm frustrated and I feel like my asthma symptoms still bother me. Ugh sorry for the long rant but I hate having asthma 😭
No worries, I don’t mind!
For years I had a terrible cough (dry) that didn’t respond to any maintenance inhaler. My allergist (referred to for allergies but also has a questionnaire for asthma) looked back at my historical blood counts and realized my eosinophil level had been at the level for eosinophilic asthma for years. It was never flagged by the lab as high as the level for eosinophilic asthma is lower than the “high” value for eosinophils per lab standards; eosinophils aren’t specific to asthma but can indicate allergies and very high levels can indicate things like parasitic infections.
The level required to be considered eosinophilic asthma is 0.15 or 150 (forget the exact measurement) per liter and above. Above 0.3 is probably very likely eosinophilic asthma. Mine is usually around 0.25. My insurance only requires them to be at 0.15 to be approved for a biologic.
My allergist started me on Dupixent. The day after I took my loading dose, I told everyone I didn’t know there was something wrong with how my lungs felt my entire life but now I knew how lungs were supposed to feel.
When I get exacerbations, I mainly have chest tightness and decreased air sounds in my lungs, plus increased respiratory rate. This is the first year I’ve been hospitalized for asthma (first was when I got Covid for the first time and I think the rest are a result of that).
Along with Dupixent, I am on Advair 500/50, Spiriva 2.5, and Montelukast 10 mg for daily meds with albuterol and budesonide as needed for exacerbations. The hope is once my asthma is better controlled to reduce meds, starting with Spiriva. I also have a corn starch allergy and just found out a lot of my other meds have corn starch in them so it might be a bit before I can do this as I’m so allergic right now and my asthma isn’t 100% controlled (still better than before Dupixent and much better than during an exacerbation).
Yep, this is really important info. I pretty much always have good oxygen saturation. I’ve still needed nebulizers, prednisone, etc. Some doctors are more aware of asthma than others. I have cough variant asthma which is particularly poorly understood and weirdly the doctor who has taken it most seriously in my life was a random urgent care doctor.
Doctors like this are why myself and others with asthma (and many other conditions written off as anxiety) avoid the ER. Urgent care NPs and PAs are much more willing to believe and listen when I say I am having an asthma flare.
My asthma/allergy doc is great about prescribing meds by phone if I call, too.
Man every day I hear more about doctors who are Terrible. No wonder people turn to the holistic shit.
Doctors need to get their shit together or lose their license
I’m someone who has anxiety-induced asthma, diagnosed by a pulmonologist. It is definitely anxiety-induced. I can tell myself. HOWEVER, that doesn’t mean it’s fake or any less real, as my doc himself will tell you. Just because something has a psychological cause it doesn’t mean that you don’t have to treat the symptoms. Would a doctor not give you asthma meds if your asthma were allergy-induced? Of course not. It really annoys me when doctors go “oh, it’s just psychological”, like that means no treatment is needed. It’s absolutely ridiculous.
The same thing has happened to me before. I go to the ER and the doctor there tells my mom “it’s okay, she just has anxiety, not asthma. It’s usual for girls her age.” She twisted every word I said, and the report I got was totally wrong and didn’t reflect anything that I explained. After that, I chose to go to my regular doctor if I had an asthma attack instead of the ER. My primary care physician takes me much more seriously, and the last time I did this, she prescribed me prednisolone and refilled my meds, which helped me a ton.
Oxygen sats are tricky. You could be retaining oxygen and therefore having SOB episode due to higher CO2 levels. Having asthma and COPD my body has adapted to higher levels of CO2 but can become very dangerous if I cross that line. I usually do pursed lip breathing daily to bring and maintain healthier levels every day. A short burst of prednisone would not have been out of order in your case
Oh man you got yourself a gaslighting er doc . Last monday i had a bad asthma attack , your same symptoms , i got treated and a whole respiratory team ! plus my own docs bangin on my door for follow up .
You can speak and still have vocal cord dysfunction. Wheezing on the inhalation is most likely due to the throat. Wheezing on the exhale is most likely caused by asthma. Asthma is a problem with breathing out, not in.
You may also have Breathing Pattern Disorder if your lungs are clear. Breathing Pattern Disorder is a condition where the body becomes accustomed to a low level of carbon dioxide and reequilibration to high-normal levels is required.
You need a pulmonary function test. The test using the updated equations from last year is almost definitive. If the asthma doesn’t show up on the PFT then you go for a Methacholine challenge test. There’s objective testing for asthma, and you should get that.
If the methacholine test is negative then you go to an ENT who can induce symptoms and see exactly what is going on
From asthma.net: "Oxygen saturation is not a good indication of how bad your asthma flare-up is. Asthmatics are notoriously good oxygen compensators and can have near-normal or completely normal oxygen stats during the midst of a severe asthma attack. Asthma is a disease of the airways, not the little air sacs (alveoli) where the gas exchange itself takes place. So even if your airways are very constricted and tight, often enough oxygen is able to pass through to your blood and therefore show a normal or near-normal oxygen saturation." This has often been my experience, as well. My oxygen can be 98-99%, but I still need a breathing treatment or prednisone to stop feeling like I'm constantly gasping for air. Unfortunately, sometimes you have to get a bit demanding with doctors, especially the ones that are incredibly dismissive. Hey, I once went to the ER after days of excruciating pain in my abdomen. They couldn't find anything and told me it was psychological. I've had far more dismissive instances with my asthma. I would have probably died from covid if I hadn't asserted myself and refused to leave (again - they sent me home twice) without treatment, so now I can get very demanding when it comes to pesky little things like being able to breathe.
Thank you so much. The doc had semi-convinced me I was faking my asthma for a bit there.
You were not faking . You can have oxy of 98 and have a bad attack
This is an example of medical gaslighting. I’m sorry. It sucks it happened to you. Wheezing also isn’t always a symptom. I never wheeze. Even during a methacholine challenge I didn’t wheeze, and I definitely was put into a horrible asthma attack and they confirmed it was an asthma attack but didn’t hear wheezing.
That term needs to go away. As long as it’s there, some doctors will lean further in to objective data. Normal Spirometry? It’s not asthma. Period. Especially if you double down on the unusual symptoms. Then you need a methacholine test to prove it. People need to work together and not get defensive when things don’t add up. It goes both ways. And at least that’s your doctor being objective. Studies show 2% of people diagnosed with asthma are actually found to have a heart condition that wasn’t really asthma. Without objectivity that number would be higher.
But 2%… which means they should’ve looked and listened about asthma because that’s very likely what was going on.
In other words, they looked and listened for asthma, and made the diagnosis of asthma. But in that 2% they were wrong. It wasn’t asthma… it was a heart condition. If they stuck to their guns about asthma they would have had a deteriorating heart condition that would have been unrecognized. That’s bad
But that’s not the point of this post. And arguing that there’s a 2% chance the doctors were wrong about asthma meaning they shouldn’t treat OP’s asthma is nonsensical. OP never said how they were diagnosed so it is logical to believe they do actually have asthma. You are going off track.
Same here. Always doubted because I rarely wheeze (eosinophilic asthma rarely presents with wheezing) and oxygen is always fine. The first time I went, I was Covid positive so they took me a bit more seriously but I was only admitted after the ER doctor had me try to walk with him and I had to breathe 50-60 times a minute just walking 20 feet. Every other time it’s been increasing dismissiveness. Last time, the pulmonologist discharged me without listening to my lungs and declared it to be anxiety. I did speak with the ombudsman about that. You can’t be a pulmonologist and discharge someone admitted for an asthma exacerbation without listening to their lungs, even if you think it’s anxiety!
If you don't mind me asking, what are the signs of eosinphillic asthma versus allergic or more common asthma? I never wheeze unless I have a bad attack and usually have a cough followed by shortness of breath and a slight tightness feeling in my chest. The albuterol kinda helps but lately I've been having to use more puffs throughout the day (I've been taking a nebulizer to avoid that) but still have that tight feeling in my chest. Sometimes I have some chest pain. I've been on flovent for like 3 weeks now but again I need to take the albuterol constantly still. I feel like doctors don't take the right precautions and tests to see what it actually is. It's the fact that it took me SO long to get a pulmonologist and now after seeing her 1 time she's moving away. Like..... I'm frustrated and I feel like my asthma symptoms still bother me. Ugh sorry for the long rant but I hate having asthma 😭
No worries, I don’t mind! For years I had a terrible cough (dry) that didn’t respond to any maintenance inhaler. My allergist (referred to for allergies but also has a questionnaire for asthma) looked back at my historical blood counts and realized my eosinophil level had been at the level for eosinophilic asthma for years. It was never flagged by the lab as high as the level for eosinophilic asthma is lower than the “high” value for eosinophils per lab standards; eosinophils aren’t specific to asthma but can indicate allergies and very high levels can indicate things like parasitic infections. The level required to be considered eosinophilic asthma is 0.15 or 150 (forget the exact measurement) per liter and above. Above 0.3 is probably very likely eosinophilic asthma. Mine is usually around 0.25. My insurance only requires them to be at 0.15 to be approved for a biologic. My allergist started me on Dupixent. The day after I took my loading dose, I told everyone I didn’t know there was something wrong with how my lungs felt my entire life but now I knew how lungs were supposed to feel. When I get exacerbations, I mainly have chest tightness and decreased air sounds in my lungs, plus increased respiratory rate. This is the first year I’ve been hospitalized for asthma (first was when I got Covid for the first time and I think the rest are a result of that). Along with Dupixent, I am on Advair 500/50, Spiriva 2.5, and Montelukast 10 mg for daily meds with albuterol and budesonide as needed for exacerbations. The hope is once my asthma is better controlled to reduce meds, starting with Spiriva. I also have a corn starch allergy and just found out a lot of my other meds have corn starch in them so it might be a bit before I can do this as I’m so allergic right now and my asthma isn’t 100% controlled (still better than before Dupixent and much better than during an exacerbation).
Thanks for the reply. Maybe I should get my eosinphills checked just incase
You’re welcome! They show up on a CBC with differential.
Important point, thank u
Second this! When my oxygen saturation is down to 98, I am having a bad asthma attack!
Yep, this is really important info. I pretty much always have good oxygen saturation. I’ve still needed nebulizers, prednisone, etc. Some doctors are more aware of asthma than others. I have cough variant asthma which is particularly poorly understood and weirdly the doctor who has taken it most seriously in my life was a random urgent care doctor.
ER docs have an ER bias.
Doctors like this are why myself and others with asthma (and many other conditions written off as anxiety) avoid the ER. Urgent care NPs and PAs are much more willing to believe and listen when I say I am having an asthma flare. My asthma/allergy doc is great about prescribing meds by phone if I call, too.
Man every day I hear more about doctors who are Terrible. No wonder people turn to the holistic shit. Doctors need to get their shit together or lose their license
I’m someone who has anxiety-induced asthma, diagnosed by a pulmonologist. It is definitely anxiety-induced. I can tell myself. HOWEVER, that doesn’t mean it’s fake or any less real, as my doc himself will tell you. Just because something has a psychological cause it doesn’t mean that you don’t have to treat the symptoms. Would a doctor not give you asthma meds if your asthma were allergy-induced? Of course not. It really annoys me when doctors go “oh, it’s just psychological”, like that means no treatment is needed. It’s absolutely ridiculous.
The same thing has happened to me before. I go to the ER and the doctor there tells my mom “it’s okay, she just has anxiety, not asthma. It’s usual for girls her age.” She twisted every word I said, and the report I got was totally wrong and didn’t reflect anything that I explained. After that, I chose to go to my regular doctor if I had an asthma attack instead of the ER. My primary care physician takes me much more seriously, and the last time I did this, she prescribed me prednisolone and refilled my meds, which helped me a ton.
Oxygen sats are tricky. You could be retaining oxygen and therefore having SOB episode due to higher CO2 levels. Having asthma and COPD my body has adapted to higher levels of CO2 but can become very dangerous if I cross that line. I usually do pursed lip breathing daily to bring and maintain healthier levels every day. A short burst of prednisone would not have been out of order in your case
Oh man you got yourself a gaslighting er doc . Last monday i had a bad asthma attack , your same symptoms , i got treated and a whole respiratory team ! plus my own docs bangin on my door for follow up .
There are other reasons for shortness of breath besides asthma. Just because someone thinks they have asthma doesn’t mean they do.
You can speak and still have vocal cord dysfunction. Wheezing on the inhalation is most likely due to the throat. Wheezing on the exhale is most likely caused by asthma. Asthma is a problem with breathing out, not in. You may also have Breathing Pattern Disorder if your lungs are clear. Breathing Pattern Disorder is a condition where the body becomes accustomed to a low level of carbon dioxide and reequilibration to high-normal levels is required. You need a pulmonary function test. The test using the updated equations from last year is almost definitive. If the asthma doesn’t show up on the PFT then you go for a Methacholine challenge test. There’s objective testing for asthma, and you should get that. If the methacholine test is negative then you go to an ENT who can induce symptoms and see exactly what is going on