Being referred to a Consultant - what should I expect?

Hi

I've got moderate asthma, currently taking symbicort and accolate. My asthma gets worse over the summer months and once this summer and twice last summer, I was put on a course of steroids when my asthma flared up. I'm a lot better once the Autumn comes along, although I still get a bit of exercise induced asthma when I run.

Just back from a routine check-up with my GP. She has asked me to keep a peak-flow diary as she is trying to establish what is the cause. Peak flow wasn't overly illuminating and she's a bit concerned about the three episodes requiring steroids, as well as the continuing exercise induced stuff.

Can anyone give me an idea what a Consultant is likely to do? My GP said I had pretty much exhausted the treatments available at primary care level. I'm guessing I'll have to have another chest x-ray, but are there any other standard investigations I'll have to undergo? Finally, I'm keen to know if the next range of drugs (described by my GP as 'dirty') are effective? Or is there something else I might be offered, that doesn't come with nasty side effects?

Thanks for your help and advice.

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Any further tests that a consultant does are likely to be based on a history that he takes from you or the referral that he receives from your GP. Spirometry and a chest x ray are probably the two standard investigations that most people undergo.

As for the next category of drugs being dirty I would disagree. Have you tried montelukast which may be one of the next drugs to try - that has one of the better side effect profiles of the next group of asthma drugs, and is supposed to be good for allergy induced asthma. Your GP may be referring to ""theophylline"" as a dirty drug which may be something else that a consultant may wish to try if it is appropriate. Some doctors are reluctant to use this drug as in some patients it can have a poor side effect profile and requires blood tests to begin with to ensure the levels of the drug are within a therapeutic range. I know that some people are unable to tolerate it, but for others it is a wonder drug.

There is also the option for ""in-class"" subsitutions, so for example the consultant may suggest changing your seretide to symbicort. They are both combination inhalers but contain different drugs. Some people find one far more effective than the other.

I hope that your consultant manages to get your asthma under better control, and I wouldn't worry too much about the other drugs being ""dirty"" as for most asthmatics there is a combination of drugs that works for them, without giving them intolerable side effects.

Emma

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Hi Emma

Thanks for your advice. I've tried montelukast and it gave me terrible headaches and the seretide made me worse. I guess it's onto theheophylline.

T

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Always expect more questions than answers.

Keep a PF diary and be prepared to try new things and probably asked to do some lung function tests. Remember the new consultant will not know you from Adam so try to a patient patient IYSWIM

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I think it's very unhelpful for your gp to refer to drugs as 'dirty'. All drugs are thoroughly tested for adverse effects and you should have confidence that your consultant will not prescribe anything which is inappropriate for you. He/she is a specialist in the field after all, whereas the gp is not. Also, if you find the side effects of a particular drug unacceptable, you can always try something else. Write down all your questions before you go, and if possible take someone with you to help you remember what the consultant says. Good luck!

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a consultant referral is nothing to worry about and many of us on here do see one. Your consultant will investigate your asthma thoroughly and really look in to what causes it, how bad it is and in some cases, whether it is asthma at all (I say this not to be unkind, but to bring to light that yes there are millions of asthma cases in the UK, but sometimes there are other conditions that have similar symptoms and thus do not respond to asthma treatments).

They will do a variety of tests, including a spirometry where they will look in to how well your lungs work.

Hope this helps

Wendy