Asthma Review with the asthma nurse

[yaf_user681_6778]

I went to see the asthma nurse today for my annual review, after asking all the usual questions about how my asthma was and what medication i was on.

My currant medication is:

Salbutamol Breath - Actuated Inhaler, Seretide 250 Inhaler 2 puffs twice a day, Montelukast Sodium Tablets 10mg, Loratadine Tablets 10mg, Mometasone Furoate Nasal Spray, Sodium Cromoglicate Eye Drops. When my peak flow is below 300 I start 40mg of Prednislone.

I had to do my peak flow which was 380, my best peak flow is 450 so a little bit below my best. She also checked my inhaler technique which she said was good. She asked if I had been in hospital just lately which I have not been in hospital for years. I am really scared of hospitals and I would not want to go there if I had a choice.

I told her that sometimes I wake up during the night needing my inhaler and sometimes I need to take it during the day. I also told her that I have been coughing up clear phelm over the last few weeks and that I was feeling quite tried.

I told her that I needed to take my prednislone about 2 weeks ago and asked her to ask the doctor for some more to keep at home. She said she would get some ordered from the asthma doctor and she would ask him to do an asthma management plan for me as I do not currently have one. The asthma nurse said my asthma was unpredictable and I may need to be seen by the asthma doctor as I am on quite high steroids at the moment.

This afternoon I had a phone call from the asthma nurse who said please could I make an appointment to see the asthma doctor in the next to weeks as he wanted to see how my asthma was and he may alter some of my medication as my medication is not properly under control. I have book an appointment for the 26th April at 5.10pm.

I am going to keep a peak flow dairy over the next couple of weeks to take with me when I go.

What is an Asthma management Plan? I do not know what the next step is for me? I don't know what the doctor is thinking of changing with my medication? I am nervous about my next visit!

Sorry for the long post.

Thanking you in advance for your ideas.

Rachel

[yaf_user681_6778]

Hello to everyone,

Hope all is well with you all!!!

I'm off for my third asthma review this year I have had one in April, May and now I am off to see the the asthma doctor tomorrow as he has asked to see me again.

I have had 2 doses of pred since my last appointment with the doctor due to my asthma been in zone 3 last course last week.

I am really hoping this will be my last review until next year as I am getting a bit bored of going every few months.

The asthma nurse did say my asthma is unpredictable so this was the reason for all these reviews but my medications have never been change at any of my reviews this year.

My peak flow chart is still up and down and i am having to take my reliever quite often most days.

So I don't know maybe the doctor may want to change my medication I don't know what else he may do!

Rachel

Thank you for all your support.

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Let us know how you get on at your review. Not sure you'll get away with not seeing them again this year though. I've been poorly controlled for a while now and seen someone at least once every four weeks. It's not always what we want to do but it's something that we need to do when uncontrolled. I'm very gratefull for all the help and support I get from my asthma nurses/doctors.

[yaf_user681_6778]

Hi to all,

Went to see the asthma docotor yesterday at my surgery for a 2 months review.

He asked me how my asthma was and how many doses of my reliever I am needing. I told most days I am needing 2 puffs sometimes up to 6 puffs most days. I said I have had to courses of pred since my last visit and that I was still on sereide 250 two puffs morning/evening. Peak flow chart is still full of the peaks and fulls.

He said my asthma was not as well contolled as he would like it. So he said he may want to put me on symbicort but I have had dry powered inhalers before but didnot get on with them. He did say about an other combation inhaler begin with letter f but he said this one has quite a lot of side affects or he said the other option is to keep me on oral steroids full time not to keen on at idea. He did not change any of my meds this visit as I said I would like to stick with seretide for a while longer as one of my tiggers is the weather.

So I have to go back in another two months for another review.

Do anyone on here take symbicort and has it improved things?

Sorry for the long post thanks for reading.

Rachel

[Hidden]

I've been uncontrolled for a while, so am changing to symbicort from seretide to see if that improves things. Have to go for some lung function tests first though in a couple weeks. Seretide improved things a lot for me so I'm a bit nervous about changing, but as i can't go on as i am now i think the symbicort is worth a go. I'll let you know how it goes. Reading through some of the other threads about symbicort it seems to have worked wonders for some but not for others.

I would have thought that if doctor is thinking of maintainance pred then he should be refering you to a cons.

Hope all goes well and you improve soon

[yaf_user681_30355]

I really like Symbicort, it doesn't solve all of my asthma symptoms but makes a huge difference. Are you also on an add on? I am on Uniphyllin and also find a huge difference taking that.

[Hidden]

Symbicort seems to be working for me too...well sort of, and I am on quite a lot of it! But it's definitely the best I've had so far; took about 3.5 weeks to kick in. I've been on the components of Seretide ie Clenil (higher dose) and Serevent and have to say they didn't do much, so when cons offered me the choice of Seretide or Symbicort I went for the Symbicort.

Like Lou said though - works for some and not others, but might be worth a try if the Seretide isn't doing the job completely. Did the dr not discuss an add-on therapy like montelukast, or are you already on one? Would have thought that was worth a go as well!

[yaf_user681_6778]

Hi,

Thank you for all your replies.

Here is a list of my current medication as I am not just not on meds for asthma.

Salbutamol Breath- Actuated Inhaler -2 puffs as required

Fluticasone and Salmeterol Cfc- Free Inhaler 250 - two puffs twice a day

I take this inhaler with a spacer

Montelukast Sodium Tablets 10mg

One to be taken daily

Prednisolone when needed

Epilim Chrono M/R Tablets 500mg

One to be taken at night

Epilim Chrono M/R Tablets 200mg

One to be taken each morning

Fexofenadine HCL 120mg tablets

one to be taken in the morning

Azelastine 0.05% Eye Drops

Put one drop three times a day

]I went to see the asthma nurse at my surgery on the 10th April for my annual review. she asked my about my asthma and me to do a peak flow it was 380 so below my personal best. She asked if I had an asthma action plan, which I don't. She also asked me if I needed any steroids to keep at home and if I did she would speak to the asthma doctor. Later that afternoon the nurse rung and said for me to make an appointment with the doctor in 2 weeks. She said that my asthma was very unpredicable at the moment and asked if I had been in hospital just lately.

I booked to go and see the asthma doctor on 26th April to go through an action plan and to pick up a prescription for some more prednisolone to keep at home for if needed. He listened to my chest and asked my to do my peak flow. I show him my asthma diary that I have been keeping at home. He said my asthma was not fully under controlled so he wants to see me in 2 - 3 months to see how I am getting on.

My action plan:

Zone 1

If you are feeling well and your peak reading is above 380 you should take: 2 puffs of your sere tide inhaler twice a day 1 micrograms of montelukast tablets once a day. Take your blue, reliever inhaler (salbutamol) for unexpected coughing, wheezing or breathlessness.

Zone 2

Zone 3

If you are becoming increasingly breathless and having to use your blue reliever inhaler every 4 to 6 hours or more often or peak flow is between 220 and 380, you should take: 6 prednisolone tablets (5mg strength) immediately and every morning until your symptoms are better and your peak flow is above 380 for two days, then take 3 tablets every morning for the same number of days that it took you to get better and then stop the tablets. Let your doctor or nurse know within 24 to 36 hours that you have started a course of tablets. Also take 2 puffs of your seretide inhaler twice per day.

Zone 4

It is a medical emergency if your symptoms continue to get worse and your peak flow reading have fallen below 220. Get help immediately by telephoning your doctor or calling for an ambulance by dialling 999 or 911. You should take 8 prednisolone (steroid) tablets immediately (5mg strength). Under these circumstances it's fine to use you reliever inhaler every 5 - 10 minutes until you receive medical attention.

I am really nervous about taking my reliever in front of people i don't like people asking me if I am ok and so I try to take it away from people which is not always possible, as I work in a college with students with severe learning difficulties. So my job can be quite challenging at times.

I really hope that I never get to zone 4 as I have a real fear of hospitals.

I am going back to the doctors again on again at the end of August for another review so I am going to ask to try out symbicort as this seems to be quite good for many. I am just wondering how many courses of pred I will need in the meantime.

Thank you for reading my lone post.

Rachel

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Hi Rachel

Just read you took 2 puffs twice a day of 250 seretide, only my asthma nurse told me there was no benefit to taking more than one puff twice a day of seretide 250 accuhaler although I had been taking two twice per day as I was sure that that was what my doctor had advised me!!

Have you heard of this?

Ems.

[yaf_user681_6778]

Hi Ems,

My doctor has prescribed me two puffs of the seretide 250 twice a day but is looking at changing my inhaler to symbicort at my next asthma review at the end of August, as I have had to have quit a few courses of pred this year.

Rachel

[Hidden]

hmmm that's confusing me Rachel - I know it's difficult to tell properly but I thought Seretide, at least the steroid element fluticasone, was more potent than budesonide which is in Symbicort (there was another thread so I looked it up as I seemed to have it backwards). Symbicort is sort of working ok for me but not all the way yet and I'd been wondering if Seretide might be an improvement.

Or is it just a case of what works for different people and they think Symbicort might be better for you?

[Hidden]

At one point I was put on seretide 250 four puffs twice daily by my consultant. So wondering if your asthma nurse is limited in what doses she is allowed to prescribe. Personally I would go along with what your doctor has told you.