[speaker001:] What can I do for you today?
[speaker002:] Erm I came to see you a few weeks ago at night you know er It's just like I'm just filling up, you know, with mucus and stuff and coughing and I had er no sleep for about a week. I went on holiday, I thought
[speaker001:] Aha.
[speaker002:] it was hay fever.
[speaker001:] Yeah.
[speaker002:] And it and it actually cleared up, got better while I were on holiday. I've been back a week.
[speaker001:] u give you some anti histamines, did they make any difference at all?
[speaker002:] No.
[speaker001:] Oh dear. Right are you actually getting wheezy with this?
[speaker002:] Yes, very wheezy, yeah.
[speaker001:] Right. Do you find you cough when you run around?
[speaker002:] I've er I've only just I've only been coughing the last couple of days, but
[speaker001:] Yeah.
[speaker002:] I I mean I mean I've been up since half past three this morning,
[speaker001:] You wake in the early hours? I was
[speaker002:] Yeah.
[speaker001:] going to ask that as my next question.
[speaker002:] Yeah.
[speaker001:] Right let's have a listen because this sounds this sounds slightly different from last time. Certainly
[speaker002:] Yeah.
[speaker001:] sounds less like hay fever I must say.
[speaker002:] Yeah.
[speaker001:] Now er somewhere we have one of those, Right let's have a listen then. Just undo another Do you smoke?
[speaker002:] No.
[speaker001:] Good. What job do you do?
[speaker002:] Erm mechanic at place.
[speaker001:] Nice deep breath.
[speaker002:] [wheezy breathing]
[speaker001:] [thinking noise] Oops. Picture of something in... everywhere. Hmm mm. You haven't been anywhere exotic have you?
[speaker002:] No. I've only been to Devon and Cornwall, you can't really call
[speaker001:] No you're not getting much there. And you haven't been abroad in the past six months?
[speaker002:] No.
[speaker001:] Okay,
[speaker002:] Never had
[speaker001:] Right. What you do with this is take a big breath,
[speaker002:] Yeah.
[speaker001:] put it your mouth and blow out as hard and as fast as you can. It'll make you cough probably, and keep your fingers off the s off the
[speaker002:] Sorry.
[speaker001:] scale. It's okay. Right big blast.
[speaker002:] [breath]
[speaker001:] You actually put it in your mouth.
[speaker002:] Sorry.
[speaker001:] It's alright.
[speaker002:] [breath] [cough]
[speaker001:] Oh dear, is that as hard and as fast as you can manage?
[speaker002:] Well I can I can have another try if you want.
[speaker001:] as if you're blowing out your birthday cake candle.
[speaker002:] Yeah.
[speaker001:] You remember the story bit about the big black wolf who
[speaker002:] Yeah.
[speaker001:] blow the little piggies house down. Well that's what you're blasting at. That's how you blast through one of these.
[speaker002:] [breath] [cough]
[speaker001:] Yeah, yeah. I'm sorry. Well I did tell you it'd make you cough.
[speaker002:] Yeah.
[speaker001:] Yes. Hmm. It's not very good is it? It's under four hundred. And
[speaker002:] Mm.
[speaker001:] you should be probably around six fifty. Given your build and height and age.
[speaker002:] Yeah.
[speaker001:] Now the story's much more that of late onset asthma,
[speaker002:] Yeah.
[speaker001:] Now a lot of asthmatics get it when they're fairly young. But you can get it in For the first time at any age. And
[speaker002:] Mm.
[speaker001:] it may well be allergy mediated to h pollen or dust or something like that. So it may just be a seasonal thing. But I I think the diagnosis is asthma or what ever t whatever's triggered it off. And we need to treat you along those lines. Now. The drugs of choice for asthma are inhaled drugs.
[speaker002:] Yeah.
[speaker001:] Then you can use very small doses, they go straight to the lungs, and
[speaker002:] Mm.
[speaker001:] they work without any particular side effects. And you can use inhalers like this, or you can use inhalers like this.
[speaker002:] Mm.
[speaker001:] You can use inhalers like th this puffer type.
[speaker002:] Yeah.
[speaker001:] Okay. And what I suggest we do is seeing Georgina's here we send you through to see Georgina and she can, if she's got time, we can briefly run through one or two types. See which
[speaker002:] Mm.
[speaker001:] suits you best.
[speaker002:] Yeah.
[speaker001:] Er
[speaker002:] What what what I can't understand, I can be alright, at the day, and as
[speaker001:] Yeah.
[speaker002:] soon as it comes to to night time I
[speaker001:] Yeah.
[speaker002:] can feel me eyes getting sore.
[speaker001:] Yeah.
[speaker002:] And then it comes on and by the time two or three o'clock I I'm I'm a wreck, even
[speaker001:] Yeah.
[speaker002:] even if I haven't had a shave, even the bristles, everything
[speaker001:] Yeah.
[speaker002:] seems dead sensitive.
[speaker001:] Yeah, that's right. I I
[speaker002:] Is that
[speaker001:] As Well it i
[speaker002:] Yeah.
[speaker001:] Asthma tends to flare up at various times it'll it tends
[speaker002:] Yeah.
[speaker001:] to flare up with exertion,i er and it has what's called a diurnal rhythm so the body's natural rhythms affect it. Mm.
[speaker002:] And so it tends to be worse in the early hours of the morning and you can have another blip in the sort of er middle to late afternoon as well. When your sort of body's running down anyway, you know it's it's a few hours after dinner time, it's not quite time to go home from work. It's a natural time to get tired and you can have a blip ten as well. Mhm.
[speaker001:] Er and things like sort of er midday and a late evening er usually fine, and then you have y quite a lot of asthmatics say they wake up in the night, somewhere between two to five. And
[speaker002:] Mm.
[speaker001:] it's very very common. What I think we'll do to start off with is to just put you on one inhaler and see how well you respond and if you only need it ev every now and again we don't need to do anything else. Some asthmatics need to be some On treatment on a in a regular preventative basis.
[speaker002:] Mhm.
[speaker001:] In the same way we was giving people blood pressure tablets to take every day. Whether
[speaker002:] Mm.
[speaker001:] they feel well or not. I think to start off with we'll just give you something to relive the symptoms
[speaker002:] Yeah.
[speaker001:] and see what you need, so er
[speaker002:] I mean it's been r been really bad as i You know I you know as er I don't know what to do with myself, you know
[speaker001:] Yeah.
[speaker002:] it Course [LAUGHTER] no sleep at night [].
[speaker001:] [LAUGHTER]
[speaker002:] And walking about in
[speaker001:] Right you've only got a wheeze there's no evidence of
[speaker002:] Yeah.
[speaker001:] an f an infection, at all there. There's no crackles and it's expanding well and it peaks three eight two which is okay but it's quite down on what it should be. So you're going either Ventalin or Briconil And we're going ask Georgina to see if she's free. Okay?
[speaker002:] Right, thank you.
[speaker001:] Er and then we'll see what device cos the I mean there's there's a couple more devices apart from those, and you know different people are suited to different ones. There's no point in me giving you type A when type B's better for you.
[speaker002:] Yeah.
[speaker001:] So we'll ask her to run through and see what's what. Okay? Follow me.
[speaker002:] Right. [tape change]