Should I be asking my doctor for long term low dose prednisolone, I have asthma, re-occurant nasel polyps & bronchitus

[Bill61]

Hi I am a 56 year old non smoking male and suffer from asthma, nasel polyps ( removed twice) bronchitis. I am trying to find a regime to keep the symptoms stable. I have seen how a short course of 40mg per day of pred makes a sig change. Though hated the sleeping disorder. My current regime is:

Med: symbicort, montelukast, fexofenadrine, pirinase,

Other: nasel rinse, lots of water, stopped alcohol, stopped dairy, regular moderate exercise.

Just had the last surgery last week, hit by upper respiratory track infection . Back on co amoxiclav to clear it out. Now havw had antibiotics 4 times this year.

I am running out of ideas and option and would really appreciate advice from those more experienced than me.

Thanks Bill

[hypercat54]

Hi I know that doctors tend to only give long term steroids as a last resort. There is a reason why they are known as the 'devils pills'. Long term use can lead to big weight gain, paper thin skin and other problems. Best to be avoided long term if possible. x

[Bill61]

Thanks for advice, appreciated.

[Josephone]

Hi I have similar symptoms as you do with three operations to remove nasal polyps. I'm now on a new medication called mepolizumab which apparently is helping asthma condition. It's an injection u have every month. I need to take it for a year to see if it works on me I need another six months to go. You may wish to discuss it with your consultant. Hope that's helpful.

[Bill61 in reply to Josephone]

Hi Thankyou so much for taking the time to respond. I shall certainly add your suggestion to the next discussion with the consultant. Merry Christmas Bill

[Matman]

Hi

I have operable sinus infection, nasal polyps and eosinophilic asthma. I take pred and believe it is a good solution if used sensibly.

I would try to avoid a daily regime but do use it in short courses. For some people that may be five days, for others maybe seven to fourteen days. If taking for more than five days I prefer to then reduce by five mg a day rather than come off abruptly.

Where I’m concerned, each Short Course Burst of pred can often bring relief for some time after the course has finished. During the ‘feeling better’ periods, I exercise more and try to build on my fitness.

The weight gain issue is not a given, providing you’re the type who can stick to a firm dietary regime. I’ve had two courses of pred in the last 3 Months and have lost three kilo via ruthless dieting (if you struggle with serious dieting, you might gain extra weight while on pred). Example, I have two pieces of toast for breakfast, then nothing but tea / coffee / fluids (no sugar) until evening dinner time, when I have a reasonable but not greedy meal.

As far as Biological Treatments (drugs ending in MAB) are concerned, these monoclonal antibody treatments are not guaranteed to work and typically require you to have taken four courses of pred in a twelve month period to even qualify for them (and you may still not qualify for numerous reasons including NHS financial ones). A number of people on MABs are simultaneously taking Pred at around 4mg per day. Personally, it seems questionable to me whether the MABs or Pred is helping them most.

An issue with pred is that, once you feel so much better after taking it, if you’re weak willed (or very poorly) you will convince yourself you need another course sooner than you could perhaps manage to keep off it for.

Pred does have side effects, but seriously studying it online, keeping up-to-date once a month on news about it, and ensuring your GP runs tests regularly for issues, can help you avoid at least some of them.

All Meds carry risks, including MABs, and it goes without saying that whatever meds you take you also need to embrace a good diet, be as active as feasible, get plenty of sleep / rest etc.

At the end of the day, I’m a quality of life not a quantity of life person and my thoughts (above) derive from that philosophy (and from getting the quantity / quality balance right).

I’m not medically qualified and this is not advice, just my personal opinion. Chat to your GP frankly and / or ask for a Consultants referral to help you decide what’s right for you.

[Bill61]

Hi Mat, thanks for the fantastic, comprehensive response. You have given me lots to think about.

I had a 5 day course of pred in September along with 2 weeks of clarithromycin.

At my next consultation I was told the disappearance of my polyps was incredible.

2 months later they were back.

So last week was my second op.

Just wondered, do you have any issue with sleep disturbance while on pred?

Thanks for any help Bill

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