Worsening moderate asthma

Hello,

Just wondering how many people are in a similiar state to me? Asthma's gradually been getting worse under control for a few months at a time then yurgh since diagnosis in 2007. I've not been in hospital or A & E and luckily ok in work but often bad/v.tired evenings/mornings. I have regular GP appointments. I am now step 4 to 5 on the stepwise management from the British Thoracic Society (see here brit-thoracic.org.uk/Clinic... or the BNF bnf.org/bnf/bnf/57/119630.htm) Never had prednisolone before but now on a weeks trial of 30 mg. Peak flow best should be 450 but recently best 350 worst & lowest ever 220. I know this isn't severe by any means but wondering if many people are similar and if many people with severe/brittle asthma have been through this kind of progression? Thanks

P.S. meant to say chest doesn't like this muggy weather and hayfever/sinusitis/postnasal gunge drip worse

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Hey TJ

I've had asthma since I was about 15, and have gone from mild to moderate in that time. I went through a patch where I was constantly symptomatic, was constantly in my doctors and I honestly never thought I'd get my asthma under control. I moved to England at the end of January, and since then I've managed to get my asthma more under control. It took a good doctor and some support from friends to help me through the rough patch.

Have you had a referral to a consultant? You might find it will give you some more options and they will look into other things. I think RBH (Royal Bromptom Hospital) is your closest, and they are also one of the most recognised centers in the world for asthma treatment.

Hope you get some help soon, I know how hard it seems at the time, but you can get help!

Vicky x

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I have had moderate asthma and it suddenly got worst and they thought it had gone brittle, and now they are not sure they just think it was really badly controlled, although now it is controlled and i dont need pred, i still have to use a neb which does put it very near the top of that scale thing you use. When it get really bad i have to have IV. But what i am trying to stay is do not worry about becoming brittle just yet, concentrate on getting your asthma controlled with out ever amount of medication it takes. You are an asthmatic currently that is out of control or very litlle control would be my guess (note only guess going on my own situation). Be postive and do what you can to gain control. Hope it goes well and any question feel free to pm

plumie

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Hi TJ,

just wanted to come and say that just cause your asthma is worsoning at this moment, it could just be a virus, or a small blip. It really doesnt have to mean that your asthma is getting severe. But also then aswell please don't ignore the warning signs of anything getting worse and see your doctor. You do sound worried about it becoming severe, cause it doesn't have to be. please take care and i hope the pred helps.

nutty

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Hi TJ,

I'm sorry to hear that you've had such a rough time recently, it sounds like a real struggle, especially with it making you so tired and then having to go to work. I know it can be really hard to balance the demands of work and life if you are constantly exhausted by asthma symptoms, not sleeping at night and so on.

It sounds from what you say (referencing the BTS guidelines and so on) that you are on the ball and that you probably have a GP who is on the ball too. This is your biggest asset in managing your asthma. The important thing is to be proactive and ready to try new treatments, which obviously you are. Sometimes it can take a while to work out which particular treatment suits you and works for you (because after about step 3, the BTS guidelines are by no means clear about what to try first, due to lack of evidence) but the vast majority of people do eventually find a combination of medication which works for them. It can be a frustrating few months while you and your GP work it out, but you will get there. 95 - 97% of people with asthma can be controlled with the right combination of medication, and there is no reason to think that you will not fall into this group.

You ask if many of us with severe or brittle asthma have been through this sort of progression. I would imagine most of us have experienced at least some degree of gradual deterioration, rather than a sudden fall into brittle asthma. Myself, I developed asthma age 14, was never particularly well controlled, had my first hospital admission age 15, first ICU admission age 19.

I wonder why you are asking about brittle asthma, though? Are you concerned that you may be developing it? Is there anything particular about your asthma that makes you feel like this? If there is, it's probably worth discussing with your doctor, as she/he will want to know of any major concerns that you have. The important thing to remember is that brittle asthma is very rare, and whilst most of us who have brittle asthma will have experienced the kind of deterioration that you are talking about, most people who experience that kind of deterioration will not end up having brittle asthma. This message board does naturally draw a disproportionate number of people with severe or brittle asthma, so it's easy to get a false idea of how common it is, from reading here. As I said, the vast majority of people don't have brittle asthma and can be controlled.

If you are not having any luck with the pred and other medications prescribed by your GP, do push for referral to a respiratory consultant. The Brompton has been mentioned, and they are excellent. They will do a full work-up to make sure it is asthma and not something else, and will also get you seen by an ENT consultant for the sinusitis/post-nasal drip side of things.

Incidentally, are you on montelukast or zafirlukast? They are especially good for folks with a significant rhinitis/sinusitis component. Nasal steroids are also helpful and nasal sinus washouts make a big difference to some folks - search on here for a how-to guide.

Hope this helps, do ask if anything is not clear,

Take care

Em H

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Thanks all

for your replies. I was just curious really how many people are in a similar situation with middling asthma. Am having regular GP appointments ( defo. know which are the better/more confidence inspiring GPs at my practice) trying different things latest of which is upping to a short course of prednisolone having tried everything below.

I'm not really worried about severe or brittle asthma. I haven't felt like I needed to go to A&E/hospital yet or ever I hope. Not feeling a great deal better after 4 days of 7 on the pred. tablets so will defo. go back to GP and ask for referral if I have to - they said I'm almost on the top dose of inhalers/tablets I can be.

Anyone know if there's any asthma specialists in the Bristol area ( I know otherwise it's London or Birmingham)? Have been doing nasal rinse for a while due to hayfever/sinusitus and steam helps too.

I think I'm wondering about worsening due to personal experience and professional curiousty with my AHP/medical hat on (hence the BNF etc references).

Perhaps someone here knows if there is any statistics on mild/moderate/severe/brittle asthmatics?!

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TJ, as far as I know there are no accurate statistics on mild, moderate, severe and brittle asthma, because there are no clear definitions as to what qualifies asthma as mild, moderate etc. Someone could be on Step 4 of the BTS guidelines and be quite well controlled, and someone else could be on Step 2 and be poorly controlled - who is worse?

The AUK document _Living on a Knife Edge_ says that 2.1 million adults have severe asthma symptoms, and that about half a million of those have genuinely bad asthma despite maximal medication. The rest of them are probably not on maximal medication for whatever reason and probably could be well controlled given the right combination of drugs.

Em H