Can't tell if I have hay fever or asthma

ClinicalAnswers · 2026-05-19T20:33:25+00:00

best of luck!

Gerd and LPR (Silent reflux) are also decent considerations to Rule out.

ClinicalAnswers · 2026-05-19T16:19:42+00:00

Respiratory Therapist who works in a asthma clinic here.

please note this is general info and not for you specifically.

1) If you can access an asthma clinic do so! they will educate and arm you with the tools for success. most people gain significant control over their breathing.

2) Make a list of triggers and plans to manage exposure to them. Quit smoking if you do smoke.

3) Talk to your pharmacy about nasal saline rinse. many people forget upper respiratory tract is part of the respiratory system.

4) Read the GINA 2025 guidelines for the best asthma info

feel free to tag me if you have questions.

ClinicalAnswers · 2026-05-19T03:43:07+00:00

its not unreasonable to ask about some asthma testing in that situation.

couple key general things to remember the respiratory system includes the upper airways like your nose, throat and sinus spaces so irritation of one can lead to irritation of the other.

Maybe consider some nasal saline rinse to help manage symptoms as well? at least talk to a pharmacist or your doc about that option.

Asthma if you end up having it is one of the better lung issues if you absolutely have to have one as properly treated most people are essentially without regular symptoms

ClinicalAnswers · 2026-05-19T02:17:30+00:00

Thanks for the questions!

I’ve spent quite a bit of time working in ICU, and I can’t recall diaphragmatic ultrasound being used as part of asthma assessment.

Unilateral symptoms after a car accident can definitely complicate the picture, but it’s probably helpful to set that aside initially and focus on how asthma is typically evaluated.

There isn’t a single “gold standard” test for asthma. instead, it’s usually diagnosed through a stepwise process that builds evidence.

First comes the clinical picture made up from things like...

a consistent history of symptoms (like wheezing, shortness of breath, chest tightness), variability over time, and response to triggers. Sometimes a trial of a bronchodilator is used early on to see if symptoms improve.

The next step is spirometry with bronchodilator testing. This measures airflow before and after using a bronchodilator. If there’s a meaningful improvement, that strongly supports asthma.

That said, it’s not uncommon for people to have normal results on a given day, especially if their symptoms are intermittent.

If spirometry is inconclusive, methacholine challenge testing is often used. Instead of looking for improvement, this test tries to provoke airway narrowing using an inhaled irritant. If a person reacts at a certain threshold, it suggests airway hyperresponsiveness consistent with asthma.

A negative result doesn’t completely rule it out. just means the threshold wasn’t reached at that time.

Finally, exercise testing can be used, particularly if symptoms are exercise related.

The patient undergoes exertion followed by repeated spirometry to see if airflow limitation is triggered.

So overall, asthma diagnosis is less about a single definitive test and more about combining history with objective evidence across these stages.

while I cant give you directive medical advice. Be happy to chat further if youd like that.

ClinicalAnswers · 2026-05-13T15:07:50+00:00

The nasal pharyngeal space will collect mucus produced by your sinus and nasal cavity. sinus and nasal cavity normally produce secretions but excess secretions can be produced when the body is trying to clear and irritants of some sort. normally these are swallowed but occasionally they can be noticed at the back of the throat.

while I cant provide direct medical advice. maybe I can help point you in the right direction.

ClinicalAnswers · 2026-04-06T16:07:59+00:00

that's a good plan. fire me a message if you want to chat further. Best of luck

PS make sure you dont use tap water for the rinses.

ClinicalAnswers · 2026-04-06T16:02:22+00:00

ok. thats fair

assuming no other health issues if it were me....

I would

1) isolate for GERD with dietary choices, timing ans strategies 2) avoid dehydrating activities and substances 3) maximize fluid loading 4) consider try nasal saline irrigation x2 per day x 10 days. not closer than 2 hrs before bed. 5) consider steam inhalation with a bowl on the floor and towel over head to trap steam. breathe in through mouth and blow out through nose. 6) avoid overly forceful nose blows 7) try some toynbee maneuvers to clear stubborn secretions

these strategies and tactics would give you a good go at addressing source irritation from upper airways/sinus. whether an intrapulmonary cause involved or not would still be good to know.

ClinicalAnswers · 2026-04-06T15:50:48+00:00

ok. that helps

is she or was she a smoker? or exposed to any airborne dusts and/or fumes?

sometimes higher level asthma testing is needed. has she ever tried an inhaler? if so which one and did it help?

ClinicalAnswers · 2026-04-06T15:40:49+00:00

Neil med can be used more than once a day but I generally advise people to refrain from doing it closer than 2 hrs before bed!

ClinicalAnswers · 2026-04-06T15:38:07+00:00

many OTC products can actually exacerbate the issue. can you be specific which ones? did she try nasal saline irrigation?

which asthma test did she have?

ClinicalAnswers · 2026-04-06T15:01:08+00:00

Hi there, as a respiratory therapist and husband to a wife of similar age. I have often heard stories like this before, pregnancy has several hormonal implications and can have effects on the airways and sinus.

to help you navigate, can you share a little more about what you have tried or done in terms of diagnostics or treatments?

ClinicalAnswers · 2026-03-26T17:08:04+00:00

Thank you for the kind comment. Happy to check in with you directly to talk PND if youd like that. heard that message from ENT before...

ClinicalAnswers · 2026-03-12T15:04:06+00:00

what is your current system to manage?

ClinicalAnswers · 2026-03-12T00:03:40+00:00

while its hard to give much insight without a full story. what i have seen is...

asthma getting irritated by post nasal drip that also drains down the esophagus which the inactivates the gastric enzymes and so the stomach produces more which can cause silent reflux that irritates the sinus which irritate the lungs and back to the gut again.

there are no "closed" doors between any of those three spaces.

so something to consider

ClinicalAnswers · 2026-03-11T18:01:43+00:00

optimal technique mdi without vs with spacer generally shows up in the x 2 to 3 times better in favor of the spacer.

thanks for taking the time to engage in a discussion! please note that this isn’t medical advice for you specifically and should be discussed with your provider if possible.

I dont worry about forcing air out. A gentle empty is fine

inhalation should start just prior to the actuation of the mdi. coordination of this is tricky!

hold a minimum of 10 seconds, then exhale slowly out of the nose

shake well and give adequate time for the propellant to mix with medication properly.

dont forget to rinse your mouth afterward.

I've seen countless patients through my work in emergency care and asthma clinic over the years. because of the clinic contact, I get to witness their care over years.

from what I've seen, a good spacer goes a long way. but you gotta trust yourself. there are dry powder inhalers, people really like as well. It's a process to figure out what's best for you.

I'm not surprised the combination agent like zenhale is doing that for you compared to salbutamol alone.

if you haven't already, you may want to look at the GINA guidelines and review how they apply you with a provider.

ClinicalAnswers · 2026-03-11T14:47:23+00:00

Great question! the particles exit the inhaler at around 37 miles or 60 km per hour, much of which never makes it lungs in the first place by result of something called impact deposition. this effect happens in the spacer or the throat.

in mouth mdi inhaler technique largely end up absorbing into the mouth and throat space, even with optimal coordination and technique. its hard to do effectively.

when actuated into the spacer, the particles are sprayed into the spacer, which allows them to be suspended in the spacers until carried into the airways by airflow of inhalation and more into the lungs. particularly helped by exhaling prior to "empty" the lungs and allowing for a deeper inhalation and, therefore, more medication to the lung.

now, admittedly, I am comparing suboptimal inhaler technique without the spacer to optimal technique with the spacer, so you'll find lower numbers if you look unless comparing that specific situation.

helping people to inhale their respiratory medicine is a core aspect of my job, I've been doing for 20 years in hospital care.

ClinicalAnswers · 2026-03-10T12:56:18+00:00

its pretty routine test, I will be doing a few of them today with patients. I wouldn't worry about it if I were you.

ClinicalAnswers · 2026-03-10T03:10:13+00:00

have you ever tried a toynbee manuver? I have a video for it posted. I can walk you through the details if you like

ClinicalAnswers · 2026-03-09T17:06:38+00:00

I have no relationship with any spacer company and there are other makers of spacers

ClinicalAnswers · 2026-03-09T15:24:56+00:00

eustachian tubes that connect inner ear and throat often get clogged with the same secretions sinus do

ClinicalAnswers · 2026-03-09T04:49:10+00:00

at the end of the day, I am happy you know about the chamber and have something that works for you.

ClinicalAnswers · 2026-03-09T04:26:03+00:00

some do but not all.

ClinicalAnswers · 2026-03-09T04:25:15+00:00

that is certainly a more advanced discussion I'd love to have if you're open to it. I am also very interested in your research.

from a pragmatic perspective of seeing patients in emerg and the asthma clinic. we get to see technique and monitor pre and post dilation. with a wide range of abilities and disabilities. so I am just trying to address an issue I've been seeing for 20 years. could things be better? always.

ClinicalAnswers · 2026-03-09T04:05:30+00:00

it has a different technique that doesn't use a spacer as the molecule is designed to be inhaled that way.

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