When to start steroids?

Symptoms have been getting worse over last few days, not coping with heat, wheezy when I walk around an need lots more ventolin if I have to go outside.

I have prednisolone at home, just wondering what the usual criteria is for starting it?

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You should really have a written asthma plan agreed by your GP or asthma nurse or your consultant if you have one, and this should say when you start steroids - it will vary for each person depending on what's 'normal' for you. I'm guessing you don't have one - do make sure they give you one asap after this.

Sorry not to be more specific - it's just that there isn't really a 'usual criteria', we're all individual and YAMV (your asthma may vary)! How do you feel compared to the last time you ended up taking pred? That's probably the best thing to go by.

Can you ring your GP/asthma nurse in the morning? If you're really struggling tonight then I'd start them anyway and then confirm with the GP tomorrow - if they don't want you on them then one day of treatment won't do you any harm, where as delaying might cause you more problems.

hth,

Cx

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I have no written plan, the agreement is I only use nebuliser once a a rescue treatment before getting help. I have long history of blue light admissions. Recently been diagnosed with secondary adrenal insufficiency from taking steroid and am now hydrocortisone dependent. This has changed things with my asthma, symptoms increasing very slowly, hence my query when to start on prednisolone. Frightened the asthma will trigger an adrenal crisis, which is a life threatening emergency. Going to start the prednisolone and see GP tomorrow. Thanks for helping me think it through.

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Ah, the joys of adrenal insufficiency + asthma. Yup. I know that one

Once I started on HC I found that my asthma changed - as you say, my last bad bout came on much more slowly and also I had less sticky cough than previously. So tbh I failed to recognise it as asthma as it didn't feel 'normal' for me.

I've been a lot more stable since being on HC. Personally I no longer use pred at all - I double or triple or go on to injected HC (depending on how unwell I am). But luckily so far my asthma has only kicked off when I'm going into adrenal crisis - though I haven't had a cold or flu or chest infection yet to stress-test that! In my case I think the adrenal crisis (due to minor gastric upset stopping the HC being absorbed) kicks off the asthma, but at least you should have an emergency kit, so if you do go into crisis you can get that 100mg of IV/IM HC on board instantly - much quicker than pred!

Good luck - pred + GP tomorrow does sound like a safe plan. As Soph rightly says in your other thread, if in doubt always take the steroids - you can't OD and bad things can happen if you hold back.

I saw my asthma nurse and updated my written plan to reflect the new situation as soon as I'd been dx'd with the adrenal stuff in March - I guess different consultants have different policies but ours is aiming for 100% of patients having a proper Asthma-UK style written, zoned plan.

Cx

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Update.

Good GP appointment. Back on 4 hourly nebs at home and prednisolone . Now been told to stress dose during asthma attacks at double my dose o HC then inject early if it isn't helping and call the Paramedics. Feel I've got things straight in my head now and know what to do when. GP told me today I know as much about asthma as he does........ Lets hope not, I need him to be the grown up! Feeling a little bit better so hoping that continues. Nighty Bless everyone, got sleep to catch up on.

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So glad you got helpful advice!