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Asthma "attack"?
Jan 27, 2012
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 I headed out for our usual bike ride (40km) 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 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.

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.

I have never smoked. I have never had asthma. I have never had ANY lung issues.

I then had a 2nd "attack" while training for an Ironman (triathlon) that I was able to get home from (hit when I was only 6 km away from home on bike) and I was completely unable to talk during that one. I took oral (not inhaled) albuterol and within 5 minutes was able to talk and walk and by 10 min I was totally better. I then got inhalers (albuterol and Advair) and all of November last year I did Advair 1 puff q.12 and never needed albuterol.

I still doubted it could be asthma but wanted to finish my triathlon so I took the Advair just in case.

AFter the IM, in December I stopped all meds (but kept training) and found myself suffering "attack" after "attack" of breathing difficulty that would resolve with albuterol. At one point I was doing albuterol 2-3 times a day every day so I went back on the Advair q.12 and then switched to Pulmicort 1 inhalatio (turbohaler) q.12. I'm doing Pulmicort Turbuhaler 100 mcg 1 inhalation q.12.

Yesterday my head felt woozy and I had a headache and when I got on the bike I got coughy and eventually had to stop and use albuterol. I did 3 puffs and was able to finish my ride with less coughing and still woozy head at a low HR (117 to 118 but finished in the low 100s) and very occassionly it felt like the veil "lifted" and my head cleared and my legs got strength but then the curtain would fall again. This seemed to happen some 3 times over the hour of the ride but I would still be incredibly short of breath after taking in water or trying to talk. I was totally unable to push the pace and my legs felt dead.

When I got home I ended up doing a Combivent neb (albuterol and ipap) and while I got super shaky I was still SUPER short of breath (just walking around) and head woozy and headachy. I found I had to sit way up for the chest tightness to decrease (orthopnea?) and about 4 to 6 hours after the Combivent neb I did 4 puffs of albuterol and then quickly the chest tightness left, the orthopnea was gone, the headache gone and the head woozy feeling gone. Today I did 4 puffs of albuterol along with the Pulmicort at my usual Pulmicort time as the chest tightness was creeping back.

So questions. Was the woozy and headache likely low o2 sats? What do you do when you have an attack and you're exercising? Should I have not finished my ride? Did I make my "attack" worse by finishing the ride (I was about 15 min into a 1:15 ride then)? I'd like to go for a run today, any reason I shouldn't? Will I make things worse if I do?

I haven't had a diagnosis as I live in rural Mexico and a pulmonologist is a 3-day trip.

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