Possibly extra things to try...?

Hello lovely coughing people!

So... after over a year of brilliant control (mostly), the hurricane and pollen and haymaking have thrown that out the window.

Sudden onset but constant coughing / tightness since 6am Sunday. I am lucky to have rescue antibiotics, steroids and nebs at home, so I started all that yesterday.

Just seen my GP - she's upped the steroids (I was on hydro equivalent to 25mg of pred, now up to 30mg pred equivalent - as IM injections). She says that unless I have a great night, she wants to see or speak to me (so, that'll be see me as on the phone I always sound worse than I am) tomorrow. I'm trying to think of any fast acting 'next steps' we can give a shot rather than wind up in the hospital...

I can currently walk, can just about speak in sentences (if I talk fast) and we agreed that I've definitely been worse in the past, but I probably can't tolerate this for very long as if I also have an acute attack on top then we'll be in epi-pen land.

My GP can also call my consultant, and can also ring the CF team. (I don't have CF but I have a CF-like phenotype so they've offered advice).

I'm on:

Hydrocortisone 120mg - as 30mg every 6 hours. (Equivalent to 30mg pred)

Seretide 250/25, 2 puffs twice daily (upped from my usual once daily)

Tiotropium 18mcg / day

Montelukast 20 mg (doubled from usual 10mg)

Hydroxyzine HCL - 20mg / night

Salbutamol nebs - 5mg every 4 hours

Salbutamol inhaler via spacer PRN

Doxycycline 100mg / day (no sign of infection but this stops me from developing one)

I also take insulin... that's part of the difficulty of whacking the steroids up. And I have adrenaline (epi-pens) for very severe attacks.

I've sometimes had ipratropium nebs in hospital, and I met someone in hospital with asthma similar to mine who uses adrenaline nebs and finds them really useful. My GP and I also mentioned maybe using more saline nebs to help with the copious quantities of phlegm!

Hopefully I'll have a good night and all will be heading in the right direction - but if I don't, I'd like to go tomorrow with a list of stuff worth trying so that I don't get packed off to hospital just to have a treatment that I could have at home!

Thanks in advance for any suggestions...

Cx

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Hi!

Reading ur list of medications I got uniphyllin 300mg sometimes 1 sometimes up to 2 depending on thelevels in blood. It was the gp who started me on them but I am in the same shoes as you. Completely out of control and got referred to Bromton for the trouble. Only thing is how did you get a neb? To me all the drs refuse including the cons and resp drs ?. They say if I got a neb at home wont even make it to the hospital in an attack?. But thats not the case, as its always a n e who tell me to wait either with the green card the usual 4 h when I got almost to a point of dying (but was in hospital!) and the many times when the dr sent me home with a silent chest ! Ended up in itu afterwards but I was in hospital but the drs still refused to prescribe the meds for a nebuliser so how did u convince them?

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Yas, it's very difficult for an asthmatic to be given home nebs and personally I agree with them. The general consensus is that if your inhalers aren't working then you need more than inhalers you need to be monitored. This isn't so that they can automatically scale up treatment , but so that you are in a place to be monitored of anything goes wrong. If you're that out of control then you need to be in.

I have home nebs, but the reason for this is that I live 20 miles away from my local hospital and 30 miles away from where my team are based. In the middle of the countryside, where it takes a long time for help to arrive. Also because of how fast the asthma sets off. I don't use my bronchodilator nebs all the time (though I also have steroid nebs which are twice a day) however and I have a very strict action plan. I also have an epi pen.

I'd hold off pushing for home nebs tbh. Wait until they're suggested to you, trust your cons. If you have been to ICU they will be taking you seriously - it's more they are being safe than dismissive!

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Hi Yas, I agree with Laura - one of the reasons I have home nebs is because I live in the middle of nowhere, and it takes at least 30 minutes for a first responder, usually more like 45 for an ambulance, and can be hours at night.

At the time when I first got them, they were intended to be a ""use until the ambulance arrives"" and also a temporary measure while I waited for a specialist referral. I bought the nebuliser myself and my GP prescribes the nebules.

The recent flare-up I had was pollen/weather related and has - thankfully - subsided. I've only used my neb a handful of times since my asthma started to be better controlled after they picked up and treated my adrenal insufficiency / Addison's around 18 months ago.

We added in Carbocisteine and my GP actually gave me permission to do hourly nebs, as that is what I would get if I was in hospital - I've already spent 2 months of the last 18 in hospital and she appreciated that I was really keen to not be admitted, and she was going to check me again 48 hours later.

I hope they manage to get you sorted soon Yas. It's very tricky - asthma is not 'one thing' but many different conditions and problems that happen to present in a fairly similar way - so it can take a long time to find the right combination of treatments for you.

Cx

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I also agree. Home nebs increase, not decrease risk of things going wrong for people overall, because they lull folk into thinking they are safe and then they don't seek help until it's too late. I also have home nebs, but I don't just have asthma and things can go wrong rapidly without warning. They are also part of my general management rather than just for emergency use. Your consultants are being sensible and with good reason.