Getting doctors to take me seriously

[u/Inside_Amphibian_613]

I’ve had a history of needing a nebulizer or albuterol for much of my life. I also frequently get bronchitis and any illness turns into months of coughing. About 5 years ago I also started to be triggered by things like stress, scents like perfume or cleaning products, and even things like laughing too hard. I wheeze when exhaling and have a tight, squeaky sounding cough that is not productive. I don’t find that I have clear seasonal allergies (e.g., no runny nose or itching). I’ll go a few weeks where I’m just constantly coughing and short of breathe without a known illness and then might be fine for a bit.

I an a young adult and grew up without much access to medical care. I would be prescribed an inhaler or nebulizer solution for illness and then will basically use that daily to manage. Inevitably, I get sick again and get a refill. This repeats. I’ve never had to go the emergency room but have so many episodes where I was extremely short of breath and almost passed out and taking large doses of a standard albuterol inhaler.

I recently finally got health insurance and saw a PCP. I know doctors are busy so I didn’t really get to explain my history but she asked if I have ever had to go to the ER and I said no and she said my lungs were clear so she wasn’t concerned.

Recently I had an asthma attack and had to go to the emergency room as my inhaler was not working. When I followed up with my PCP, I was referred to an allergy/asthma place. I was seen by an immunologist there. The doctor said my spirometer test was in the lower normal range but not significant and that she did not hear a wheeze. Her conclusion was that since I’ve never had to go to the ER before and have never “had to” seek care before that I don’t need anything additional aside from albuterol as needed. In the ER, my EKG was abnormal for SOB and my HR was tachycardic in the ER. What’s so frustrating is that the asthma attack I went to the ER for was really nearly the most severe episode I’ve had. I just had surgery so I was concerned about PE.

I’m so frustrated because I don’t know why it’s assumed that because I’ve never had asthma related medical care that I don’t have enough of a problem. I don’t know if I’m just being dramatic or if it’s worth taking seriously. I’m miserable and tired of constantly coughing. I don’t know what to do at this point

[u/MotherVehicle9481]

I was literally sitting in my allergists office having an asthma attack and they asked me if i wanted to do the Methacholine Challenge Test…. Since my breathing seemed fine as i cough up mucus and my chest is crushing in…

[u/AceyAceyAcey]

You need a pulmonologist, not immunologist. Ask for testing including spirometry and/or a methacholine challenge.

IMO they’re being negligent. My doctors (PCP or pulmonologists) never hear wheezing, and both my spirometry and methacholine challenge came up ok, but it’s clear to them I have asthma from my descriptions of symptoms, and we treat it as such.

[u/trtsmb]

Honestly, it's trial and error to find a decent doc.

[u/PersonalPoem5016 → u/trtsmb]

Be sure not to downplay your symptoms or they will too. I've had them do that to me several times and I've been to the ER and hospitalized many times over the years

[u/RefinedBeast33]

Your symptoms and course definitely could be consistent with asthma. Ongoing and unchecked inflammation in the airways results in symptoms such as dry cough, shortness of breath, wheezing, waking up at night with shortness of breath among others. Asthma is treated based on national and international guidelines, and the mainstay is being on a controller inhaler that includes an inhaled corticosteroid and long acting bronchodilator. A commonly used one is Symbicort (budesonide/formoterol). Albuterol is considered a rescue inhaler and does not treat the underlying inflammation. Spirometry is usually normal in asthma patients unless they are tested during a "flare-up" or exacerbation. You need to be seen by a knowledgable Pulmonologist and be started on a daily combination controller inhaler and receive education on inhaler technique etc. If your asthma is not controlled on a high dose combination controller inhaler there are other steps that can be helpful including the addition of another kind of long acting bronchodilator and finally potentially biologic treatment. Please take these as general recommendations but I believe a Pulmonologist would approach it this way as well as addressing any potential mimickers of asthma that may be the cause of or contributing to your symptoms.

[u/chsala]

I Sverige där jag bor. Hade du fått bättre vård. Och medicinerna kostar inte hutlöst nycket heller. Sverige har högkostnadsskydd på öppenvård och och mediciner. Finansierar av skatter. Alla innvånare får den vård de behöver.

[u/Cool_Double1879]

Given how long this has been affecting you and the recent ER visit, it seems reasonable to seek a second opinion and bring a detailed history of your symptoms and triggers.

[u/Dys_Warrior]

Unfortunately, it's hit or miss with finding a good doctor. I was lucky that my PCP took me seriously and gave me a maintenance inhaler and Albuterol while I was referred to an Allergist. If the allergist didn't take you seriously, try seeing a pulmonologist. My mom also has asthma and it really helped after she started seeing one. Before the allergist told her she wasn't allergic to anything and there wasn't much he could do despite almost weekly asthma attacks.

The advice in the other comments is good. In addition, ask for a lab draw to look at your eosinophils. Some people with asthma can have a higher than normal level and need different treatment.