Advice needed - how can I regain control?

[Choristermum]

Hi - Hoping that some of you may be able give me some useful advice.

Had a horrible cold/cough back in August which set off Asthma symptoms. I thought I had it under control with extra Ventolin and upped my Seretide 250 to 2 puffs twice a day. Things seemed to improve after 3 weeks of coughing and being tight chested and out of breath.

I had 2 weeks of feeling fine and then came down with a severe chest infection, requiring Clarithromicin 500mg and 30mg of Prednisolone for 5 days. After 2 weeks off work, my peak flow remained low and I was still having lots of symptoms. A chest x-ray was clear and my GP put me on to Montelukast tablets and kept the Seretide up at the higher dose.

I saw the Asthma nurse 2 weeks later and was pleased to report that things were a bit better but still not back to normal. She swapped my inhaler to Flutiform 250 (2 puffs twice a day) and after about a week I was feeling much more like my old self. I even had 3 days on the trot without having to take my Ventolin at all!

Early last week I felt as if I was getting a cold and mentioned this to the Asthma nurse when I saw her. My peak flow was starting to drop a little and symptoms were increasing. She said to keep an eye on things - that I was already on the maximum dose of Flutiform and that I should just take more Ventolin and get in touch if things got worse.

Of course they did. I came down with a stinking cold on Friday and this morning went to see GP with a nasty chest infection again. Now have the Clariththromicin 500mg and Prednisolone tablets again. Have to go back to be seen by the doctor later - have never known a GP who wanted to see me twice in one day! - to see whether I need to be sent to the hospital.

Don't know whether I've just had a run of bad luck that has lasted almost 4 months or something else going on.

Am now thoroughly fed up and would be grateful for any advice. Sorry to have gone on!

[Hidden]

Hi the only thing you really can do is try to avoid catching colds and germs in the first place. Make sure your relations and friends know to avoid you when they have colds etc. You can buy something called First Defence in the chemist which you spray up your nose etc. before you go out. I don't use it but others swear by it.

The other thing is a common sense one - if you are with people who are infected then try not to touch your eyes, mouth or nose and wash your hands frequently. Follow the nurse rule of 1 metre away. Finally would your doctor give you a rescue pack to keep at home in case of an exacerbation. I have one which comprises of ab's and steroids. When I use one lot I just order some more. Not all doctors will do it but some do. x

[Choristermum in reply to Hidden]

Thanks - will look out for 'First Defence'. The only problem with staying away from germs is that I am a primary school teacher!

Will definitely be asking for a rescue pack though - these things always seem to start at the weekends.

[Hidden in reply to Choristermum]

Ah not easy! Kids always seem to have something don't they. x

[AnnieAnnieAnnie]

Hello there..sorry to hear you're struggling.

I assume you're on the higher dose of f 250/10 flutiform?

Speak to your nurse if GP about MART with a fostair inhaler or SMART with a symbicort inhaler where you take regular morning and evening preventer but is also used as a reliever. This can work really well and you can titrate the dose up and down as needed.

if you're having one chest infection after another it may be worth sending a sputum sample for culture.

Hope this helps

[Choristermum in reply to AnnieAnnieAnnie]

Thank you!

[S4r4L0u153]

As a temporary measure, I am allowed to up Flutiform 250 to 2 puffs, 3 times a day until the exacerbation is under control. I used to be told I could only have 2 puffs, twice a day as it was on the max dosage, but that advice was changed for me back in Aptil and I'm allowed to increase it further. Maybe you would be allowed to increase the Flutiform temporarily. X

[Choristermum in reply to S4r4L0u153]

Thank you. I have been told not to up the dose as it is the maximum - just to up my Ventolin to 10 puffs each time.

[risabel59]

Hi there,

This happens to a lot of people with asthma including myself. One thing you might like to consider is a chronic sinus infection which is constantly flaring up your asthma. Or you say you work with children, so you are going to be in contact with viruses all the time. One of my consultants told me that my asthma would improve when the kids were no longer bringing home bugs from school. It's pretty much proved to be the case. Do you have a proper Asthma plan with a step up regime, if you are thinking that you are beginning to get any cold symptoms or even if those close to you have them you should step up your steroid inhaler, you can always step down again quickly. The important thing is to try to get ahead of the curve.

[Choristermum in reply to risabel59]

Thanks - my main problem is that I have no step up plan other than more Ventolin because I'm already on the maximum dose of my inhalers.

[risabel59 in reply to Choristermum]

Its very hard for G/P's to prescribe outside the recommended doses for certain drugs, They generally have to refer you to a specialist. However, I see that you are using a combination inhaler. Do you have an add on steroid inhaler? You can't up the dose of your combination inhaler as it is dangerous to take more than a certain amount of the LABA content (i.e. Formoterol) but that doesn't mean you couldn't use more steroid inhaler, i.e. Flixotide.

So there are various set stages that the G/Ps use for grading asthma so if not controlled going to another level. These are agreed by the British Thoracic Society.

Stage 1

use of Ventolin

Stage 2

Ventolin & an inhaled Corticosteroid

Stage 3

Ventolin, Inhaled Corticosteroid & Long Acting bronchodilator (LABA) ( which is where you are)

Stage 4

Referral to specialist &

All of the above, + additional add on's of any or all of the following Montelukasts , Theophillin, LAMA inhaler, (spiriva) Long term antibiotics, Sinus investigation and Acid reflux investigation

Stage 5

All of the above, + daily steroid tablets

It seems you are at Stage 3, and struggling to have control of your asthma.

You should have a written asthma plan and a peak flow meter with clear instructions what to do when.

I am mostly at stage 4. but my asthma is brittle. I have a very complicated written asthma plan of when to do what. Ie when to call the doctor, When to take steroid tablets, When to use my nebuliser, and when to go straight to hospital. A lot of this is based on my peak flow meter.

If you have a smart phone you can get an amazing peak flow meter made by an Italian company called MIR. Its called Smartone. I started using it in September and its made keeping my peak flow diary much easier.

A peak flow diary and record of symptoms is a fantastic weapon to use to get the right treatment.

I know this is a long Reply, but I really hope it helps.

R

[Choristermum in reply to risabel59]

Thank you - very helpful. My GP has said he is going to refer me to a specialist as things have been so unsettled for too long. Hopefully that will mean more flexibility and control of symptoms.

[Choristermum]

Thanks - I think you have hit the nail on the head. I have no flexibility with anything other than the Ventolin because I am apparently taking the maximum dose.

When I'm over this flair up I think I will go back to dr and see if I can have another inhaler/steroid tablets at home so I can take action at the first sign.

[dmbrkmn]

Hello, ive been a sufferer for as long as i can remember im 34 and i was diagnosed when i was 6. At the moment the weather is a bit to cold to go out side and do it, but what i highly recommend is riding a bike I've had such a success with it i highly reconmend it for controlling asthma. I dont know what the body does but when i ride my im ok for a few days ( i have to have a break as i take my wife to work and need the car so i only ride for 3 days a week).

[Choristermum in reply to dmbrkmn]

Sounds a great form of exercise. Will perhaps give it a go when I feel better and the weather is warmer!

[runnerwithasthma2559]

Dear Choristermum,

Right now it sounds like your asthma is giving you a big problem. I was at that point once myself. I can relate to your suffering. Now I'm feeling much better. Asthma symptoms can sometimes be lessened. Two things really helped me. One, I moved out of a polluted urban area to a rural mountain area with much cleaner air. Two, I began doing breathing exercises. One such exercise is the Peaceful Warrior Workout (PeacefulWarrior.com) At some point you could talk to your doctor about doing this workout. It takes 5 minutes a day and is not very strenuous. There is a lot more to my story. I wrote a book about it, "Running with Asthma: An Asthmatic Runner's Memoir."

Wishing you better breathing,

John Terry McConnell

[Choristermum in reply to runnerwithasthma2559]

Thanks - think I will have a read of your book. Am now back on more antibiotics - this infection is certainly stubborn! I don't live in a place where pollution is an issue but I've got to the stage where I will try anything.

[runnerwithasthma2559]

Hello Choristermum,

It is my strong hope that you find something that works for you. You deserve to feel good and breathe freely. You can reach me a [e-mail]

Yours,

John Terry McConnell