Asthma.. Wheeze on the inhale??

[ergo343]

One of my friends (28 y/o Female) was diagnosed about a year ago with asthma. She's on the maximum dose of inhaled steroids (daily) and albuterol as needed.

About 90% of the time she walks around wheezing and can't get enough air. She won't use her albuterol as often as she needs it (so that she can breathe normally) because it makes her nauseated. Then after enough time, she gets headaches because she's hypoxic, then she decides the use her albuterol and gets nauseated, but she is able to breathe better.

Which leads me to my question: I spent part of the weekend at her house and I realized that she was wheezing most of the time on the inhale and only part of the time on the exhale. I was under the impression that with asthma the wheeze is on the exhale and if the wheeze is on the inhale it is most probably an upper airway obstruction or an allergic reaction. I didn't want to say anything because she had obviously been to doctors for her asthma who would have picked it up if there was anything to pick up. However, I have never heard of asthma presenting with a wheeze on the inhale.

Has anyone ever encountered asthma presenting with a wheeze on the inhale? Am I correct in my assumption that something else might be causing most of her symptoms?

Just looking for input.

Elkie

[Dustdevil]

Are you talking about auscultated wheezes, or audible "wheezes?"

[ergo343]

Are you talking about auscultated wheezes, or audible "wheezes?"

I knew I forgot to write something.

Audible wheezes. I didn't auscultate at all. I don't really think it is within my rights as a friend to ask if I could listen to her lungs.

[ALERT Medic]

I've treated patients with asthma who have had inspiratory and expriatory wheezing. They are usually the ones who have been out of their meds for who knows how long and are just at the point that they can't take it anymore. It's not always present but it does happen.

Sounds to me if your friend doesn't take her albuterol when she needs it, she probably doesn't talk to her doctor much either.

[hammerpcp]

It could be something like this or maybe something mentioned here. I wouldn't put so much faith in the doctors since if she is still so symptomatic chances are they have not done a very thorough job thus far. And of course there are always other medication options. It is completely useless to have a rescue medication that has such unpleasant adverse effects that the pt is completely non -compliant. This website has some right-to-the-point information. Your friend's quality of life is being severely affected and it sounds as though very few treatment options have been explored. I am sure they can do better for her. Blind faith in another human being is never a good idea. Oh, and I don't think auscultating your friends chest is inappropriate at all. I mean if you can't use your friends as guinea pigs who can you use?

[AnimalHouse]

Oh, and I don't think auscultating your friends chest is inappropriate at all. I mean if you can't use your friends as guinea pigs who can you use?

ummm ... guinea pigs perhaps? Most are sold abundantly in pet stores and they never question your reasoning for buying them. Plus, you can cardiovert a guinea pig and no ones the wiser, a human on the other hand ... :wink:

On the original topic though, I would have to agree with Hammerpcp.

[ergo343]

I've treated patients with asthma who have had inspiratory and expriatory wheezing. They are usually the ones who have been out of their meds for who knows how long and are just at the point that they can't take it anymore.

She's not out of her meds, and she does take them on a regular basis, she just doesn't take her albuterol as often as she needs to. She's wheezing audibly about 90% of the time and gets sick from the albuterol. She'll end up taking it at least once a day, but she can't breathe much more often than that.

It could be something like this

Interesting, but not this, as it is exercise induced; unless, of course, sitting at the dining room table is considered exercise (and no she isn't out of shape, she just can't breathe well)

or maybe something mentioned here.

Looked at this before posting. Wikipedia is my friend.

It is completely useless to have a rescue medication that has such unpleasant adverse effects that the pt is completely non -compliant

The issue is that she doesn't like to use her rescue inhaler all the time she is very sensitive to it and she doesn't feel that a rescue inhaler should be used on a regular basis. Even when she uses her albuterol her breathing gets bad again very quickly. It doesn't last. She uses it when she gets symptomatic from hypoxia (headache), which is often enough as it is.

I agree that there is something the doctors missed. But, she goes to her doctor regularly and it is hard not hear her breathing, so unless the doctor was deaf, I'm not so sure she could have hid it from him.

I'm concerned is all. I don't think that it's a good thing that she's not so compliant. But I also think that if there is a different underlying cause then the albuterol won't do a whole lot for her. I don't know.

and I don't think auscultating your friends chest is inappropriate at all. I mean if you can't use your friends as guinea pigs who can you use?

Married friend, at her house, with husband at home = not so appropriate; but that's just my opinion. However, unmarried friend, at my house, I can ask them to be my guinea pigs, but there is no guarantee that they will agree. It took convincing until my friends would let me take a BP on them. Lung sounds I don't think will happen. Now why don't I have little siblings to torture??

[JakeEMTP]

Married friend, at her house, with husband at home = not so appropriate; but that's just my opinion. However, unmarried friend, at my house, I can ask them to be my guinea pigs, but there is no guarantee that they will agree. It took convincing until my friends would let me take a BP on them. Lung sounds I don't think will happen. Now why don't I have little siblings to torture??

Don't be embarrassed to ask to auscultate your friend's chest for lung sounds. If it was a true 911 call, you would have to do it regardless. You might as well get used to it now.

Just a little friendly advice. Now, Where's my coffee?

[hammerpcp]

Interesting, but not this, as it is exercise induced; unless, of course, sitting at the dining room table is considered exercise (and no she isn't out of shape, she just can't breathe well)

a couple more suggestions....the first link, although it does describe an exercise induced condition this condition is not synonymous with excercisevocal cord dysfunction can be independent of exercise. Remember all that wheezes is not asthma. I would also be suspicious of allergens in her environment. Does she have cats? they are often the culprit. (personally I am VERY allergic to guinea pigs so I have to do my testing on humans). As far as her being "in or out of shape", that doesn't really mean anything in medical terms. If she is so SOB she does not have a very good functional capacity. It just isn't possible. Anyway, I would seek a second opinion if I were her.

[fiznat]

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. Still though, this is just a general common presentation of these patients. The fact of the matter is she has a serious, chronic asthma and lots of mucus in her lungs. I dont see why she couldnt wheeze in OR out, provided there is lots of mucus everywhere anyways. It is the mucus that defines asthma, not the times at which that mucus produces wheezes.

If her albuterol makes her nausious, has she considered asking the doc for a change in medication? No reason for her to suffer when there is such a plethora of bronchiodialators available for asthma patients. I'm sure there is something else out there that she can use with more comfort.

Like others have said, LISTEN TO HER LUNGS! As long as your friend is fine with it, definitely take the opportunity both as a chance to learn/experience the sound, and also to find out what her baseline is in case you are with her during a true emergency.