When to start pred/ theophylline

I was shocked to read the Asthma UK action plan the other day (I've never had my own). It classes the red zone as, amongst others, using a reliever more than every 4 hours. The treatment for this is to start taking pred.

Would this be true for most people - the pred bit?

Ermm, I would be on pred a lot! I have discussed feeling a bit uncontrolled with my doc recently, but he's reluctant to start me on a theophylline because of side effects, and I think he doesn't think I need it - which he may well be right about. I'm on Seretide (Fluticasone/Salmeterol) and Montelukast. Having thought about his answer for a few weeks, I think he's right for a few reasons - and I dont think I'm bad enough (yet).

I occasionally have days without using ventolin, but certainly use it most days. I probably average 6-12 puffs a day, but can easily get to 20 or 30 without worrying, if it's keeping me walking and talking. That's only a couple of nebs. I only worry if its not working at all, i.e. in a sudden attack.

I thought pred was a last resort - infact to quote a doctor, 'it's only used as a last ditch attempt to save your life', and then reels off side effects.

I'm pretty active, have a reasonable level of fitness, and have a high threshold for worrying, so I think this can sometimes deceive my doctor about how bad I feel.

So, two questions. 1. What criteria would make a moderately bad asthmatic with a history of sudden attacks start taking pred? 2. Are the side effects of theophylline really bad? (Bearing in mind I avoid coffee with lots of ventolin, because it makes me shaky and feel weird.)

PS I really, really hate pred.

x

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Hi C

If you want ( all asthmatics should really have one) an action plan you should make an appointment to see your asthma nurse and get them to fill one out for you because each action plan is different and tailored to each individual based on their original peak flows and they will work it all out from there. But get one done because they are ( well to me) invaluable and helps so much.

20-30 puffs a day is a lot and you should really see your GP or nurse if you are using that much..

Every time had an asthma attack my GP would put me on a short course of pred, but unfortunately I have not been off the pred since May, and the side effects are only to worry about in long term use not short term.

I am theophylline ( well aminophylline) and the side effects from what I have are just a rapid heart beat and palpitations, but not all the time...

Sorry I really have not been of any help, but if you really are worried and need some info I would go and see a doctor or an asthma nurse.

Take care x

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Hi C

Whilst were all different, theo24 or similar are only given in extream cases. If you use your ventolin every 4 hours, is that every day? I'd question the current medication. Do you use peak flow meter, that's usually a better way of working out how you are, unless your symptoms are really clear, and well known.

I've only been given prednisolone for 1 week when I had a chest infection, so doctors don't like giving it, but it's not the last resort and fine for short rescue dosages. Prednisolone would be given long before theophylline .

Before being given theophylline or prednisolone long term, I would try singulair or accolate first, much lower side effects, and these work by blocking the bodies ability to produce leukotrienes, the bodies immune chemical that causes asthma.

try this link emc.medicines.org.uk/ type in (NAME OF MED) in the search box in the top right, you'll get a list of medications, pick a link with a yellow SPC box beside it if you can. This is all the information that is available for the drug, and is what the doctors see. The blue PIL link is whats made available to the general public, usually with the medications.

Hope this may help

Chris

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You should see your doctor.

Theophylline is good if it works for you, but if the dose is too high (toxic) the side effects are awful (been there done that).

Let us know how you get on.

Emma

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Hi C,

The ideal of asthma control should be mininmal or no use of your reliever, with complete freedom from asthma symptoms as far as possible.

16-20 puffs as average is too much, you should really be seeing your doctor for further medication - we look at increasing preventer therapy if someone is using their reliever inhaler once every day, let alone four or five times!

Hope you get better control of your symptoms soon.

CathBear

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What about new inhalers?

I think it would be a good idea to have your regular medication reviewed, as a couple of people have said, pred is for emergency use and GPs try to avoid putting you on it long term.

I had 2 visits to hospital after severe attacks in November. During my 2nd stay, the consultant checked my inhalers - Beclometasone and Serevent and said ""oh, someone's still prescribing that old stuff"" and switched me onto Symbicort, which is a combined steroid and beta 2 agonist. (Same ingredients as Bec and Serevent, but in one package and a different style of inhaler where you inhale dry powder rather than use an aerosol). Seems to work a lot better for me and is cheaper as you're getting 2 for 1!

Good luck!