oral steriods - recovery pattern

I am currently on my 9th day of 30mg pred plus 250 serevent and ventolin- am feeling lots better though about 70 short of my usual peak flow rate I intend taking pred until back to normal reading (reducing slowlyish) I got a bit stir craazy and have been out walking slowly locally for a few separate half hours I felt okish but a bit dizzyish and not 100% breathing wise. Am I doing any harm by pushing it before I am really better or even off the oral pred?

Thanks - it is a brilliant site I have had so much help and information over these last 10 days SandiX

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Hi Sandi,

I hope you have guidance or a plan from your doctor about when to stop the oral steroids and how to reduce - I'm sure you're an old hand at it after having asthma for so long, but it does pay just to check that you are not trying to reduce too quickly. It is such an individual thing, of course - a reduction regimen that works well for one person might be a complete disaster for another.

In terms of pushing it regarding physcial exercise - I can totally relate to the 'stir crazy' feeling, and it is difficult at this time of year when it is so cold outside. I would suggest that you plan your walks for the warmest time of day (whenever that is - is there one?) and obviously cover your mouth with a scarf or similar - the usual drill. Obviously (I'm sure I don't even need to say this really!) make sure you take your salbutamol with you and perhaps have a puff before going out to help prevent any exercise- or cold-induced bronchospasm.

I think only you can know if you're pushing yourself too far - it sounds like you are listening to your body and have a good awareness of the symptoms you are getting. I would say that if you are only getting mild symptoms that recover fairly rapidly once you are back home, then you should be alright - but if your symptoms are more severe, you feel really unwell with it, or you are taking hours to feel back to normal once you get home, you might want to take it a little more slowly. Perhaps you could try more frequent 15 minute walks rather than half hour walks?

Other than that, congratulations on your improvement and I hope things continue to go in the right direction!

Take care

Em

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Hi again Emily I have typed a rather long reply but I think I gave it a new heading - I may have sent it personally to you. I think it is time for me to go to bed. Can you let me know if you have not got my reply about reducing my steroids and my recovery pattern. I will type it again. Thanks and goodnight.

Sandi X

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Hi sandi,

I didn't get your message as a PM, and I can't find it under a different heading - feel free to get in touch again in the morning if I can be of any help, though!

Sleep well,

Em

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Hi Emily, sorry not to get around to re-posting again until now. I hope I didn't concern you with my haphazard steroid reduction plan. It isn't that way at all really, as you say i've had asthma for ever and am quite organised with it.

Many thanks for the tips - I already do the scarf thing thoough it does make my glasses mist up something awful. I find its best to leave the house aroung 10-10.30 and to be back by 12 ish for the best of the days weather as a rule. Just need to re-read Emilys post a minuite. ok back now your posts are so full of info which is great. I am not so good about taking a puff of salbutamol before I go out - usually I don't need to but yes I think I do right now.

my reduction plan - as discussed with my GP over the telephone last week is to continue with 30mg pred until my peak flow is back up to my predicted normal - still 40 short today. Then I will reduce by 1 tablet for 2 days at a time. I think I will end up with 2 weeks worth of 30mg. I am currently on day 12. My GP asked me to ring him and let him know how I am doing this week - I will phone him tomorrow for confirmation that things are improving ok. I would like my peak flow to have come back up quicker (wouldn't we all like that) but still I must be patient and be very grateful that such medications are in existence as they weren't for my grandfather who died at 45 from a heart attack. As a result of poorly treated asthma. Sorry about that bit not meant to be depressing but I don't like taking pred but it is better than the alternative. I feel a bit lame cos I know that a lot of other members have to take a lot more stuff than I do and we have to just accept it and make the best of our situations.

Right back to it - actually my GP is a no psychological stuff sort of bloke and says that there is no pharmocological evidence that reducing pred is any different to stopping it suddenly once peak flow is up to normal. I don't think this is the case and I always have reduced it slowly. He is going to let me reduce slowly however, he just has to let me know he doesn't think its necessary.

With regard to the exercise thanks loads Emily that was really helpful - yes I am sensible but I think I do get a bit panicky now when I first go out and about again when my asthma has been rough. Yes any symptoms I get which are tightness do pass off when I slow down, stop to browse in a shop and certainly once I get home they pass off straight away although I was then feeling tired.

I had my first trip into town today. After the first unsure 20 mins or so, which I think is when my long acting ventolin (severent) was just getting into action I felt fine and did a bit of the dreaded xmas shopping. My husband saves so much more when I am unwell, no shopping trips, no gym fee no yoga fee - and a quieter - less chatty wife. Perhaps he is putting little viruses over my food?! just joking.

Emily have you thought of doing a column in the Asthma magazine - I think you would be great at it - you probably wouldn't want to - would you have time? You seem to do so much researching and I gather moderating for this forum.

Thanks youre brilliant and have helped me loads through these past 2 weeks.

Love Sandi X

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Hi sandi,

Don't worry, I wasn't too concerned with your steroid reduction plan - you did sound like you knew what you were doing, but I just wanted to check to be on the safe side! I know doctors vary vastly in what they think is a good reduction plan, and patients certainly vary vastly in the way they respond to reduction! I'm sure you already know this, but I guess we have to think about two different issues when we are reducing. The first is the effect on the asthma - will it flare when the steroids are taken away? The second thing of concern is of course that if you have been on steroids for a while (not a lot of evidence on the exact length of time, but most doctors say something between 10 days and 3 weeks) there is a possibility of the body's own natural steroid production by the adrenal glands having been suppressed. The body doesn't tend to bother making hormones if it doesn't need to! If this has happened, reduction, especially once we get to the lower doses (<10mg) has to be slower to give the adrenals a chance to 'wake up' - otherwise all sorts of unpleasant and potentially dangerous things can happen as a consequence of too little steroid in the body.

I think most of us who have had courses of steroids for a while know our own bodies, both in terms of flaring of asthma on reducing and in terms of adrenal suppression. I know that when I was first given steroids for asthma, I could have a 7 - 10 day course and stop, with no problems, but as my asthma got worse and my lungs were more twitchy, even the shortest course would require a bit of tailing off to avoid an asthma flare. It could have been psychological, of course - asthma is of course hugely affected by state of mind, and anticipating a flare, once it's happened once, is often enough to precipitate one in some people! These days, I'm on pred all the time, but when I do reduce it I do it extremely slowly.

I'm really glad you have managed to get into town and do a bit of shopping - given how exhausting Christmas shopping is at the best of times, that's probably as good a marker as any that things are improving! I know it's never fast enough - I am as impatient as the best of them! - but at least things are going in the right direction. You are right that we are lucky to have these drugs these days - much as we might curse pred, and much as it can cause some awful side effects, it is a life-saving drug. I guess for a lot of us it's our best friend and our worst enemy.

Thank you very much, sandi, for your kind words about my writing. I am looking at various forms of medical/scientific journalism and writing as a job I can do from home now that I can't work, so, who knows, maybe one day I will end up writing for the Asthma magazine! It would certainly be something that I'd enjoy.

In the mean time, I'm very glad that I've been able to help you over the last couple of weeks, and I hope that I can be of more help in the future. Having been in a busy career previously, which was obviously very much focussed on trying to help people, I do get a great deal of personal satisfaction out of being able to continue to help people in some small way on AUK

Take care

Em

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WORKING AND ASTHMAetc.

Hi Emily - some of this message I typed last night seems to have disappeared - prob too long! you would be great in the medical journalism field. Can us ordinary bods access the BritishThoracic journals?

Working is a bit of a difficult area for me. I tried to go back to work after having my children - my youngest was 7 and I felt I could do something part time. I trained late on ie., 24-27 as an Occupational Therapist not too successful as I seemed to pick up all the bugs while working in hospital.

My original job was as a shorthand typist/secretary - pre electric typewriters for my first job! I missed loads of school with my asthma and I felt this was the only opportunity open to me. I loved my first job in a Solicitors office in town. The pay was low and when my boss left I decided to change companies to earn more money.

Around 3 years later I was VERY BORED and had kept doing more and more shorthand exams then some catch-up o levels and eventually 2 A levels at evening class after work. I then took a leap - left work and went to college to do OT.

Anyhow when I went to the job centre in 1998 myself and the interviewer couldn't come up with any suitable jobs - some of the problems were related to my eczema. I cannot tolerate earphones and plastic chairs are a no no.

Anyhow I applied for incapacity benefit and because of a lack of stamps ended up with Severe Disability Allowance.

When I have a couple of months feeling well I feel guilty for not working and then I am ill and think that no employer would want me. I always hate phoning in sick - I felt so useless and you let people down, especially as an OT when people are relying on you. When one of the team is away there is more work for the rest of the team.

Moan, moan I know - on the other hand I am more in control of my asthma by not having to go to work. Perhaps working from home is the idea. Don't know. Need to go to bed actually.

I had flirted with the idea of going to the gym tomorrow - to see my friends really, but have just about decided not to but to do some home gym instead. Hoovering, changing beds - catching up jobs. Plus an errand which will involve one of my walks.

Bye now, hope its not snowy for you tomorrow.

SandiX