Asthma Plan

The Asthma plan provided by Asthma UK says amber is increase preventer to....

Why are severe asthma clinic consultants and nurses now saying this is no longer valid advice? Why are they saying preventer should not be increased for excerbations? Why are they saying preventers do not help during excerbations? I would like to know where the research is for this and when it was completed and by whom?

It feels wrong to not increase my preventer during an excerbation. I am not the only one either before anyone suggests it.

[EmmaF91 Community Ambassador]

Hi

I think it depends on what dose your preventer is as there is a ‘maximum’ effective dose for inhaled steroids and increasing doesn’t actually give any benefit. When I was on fostair 200 the max effectiveness was 4 puffs a day, any more wouldn’t do anything... this came up in convo with asthma UK a few years ago cause at the time my maintenance was dose was 2x2 but I was also meant to use it as a reliever (MART regime) but ended up needing my ventolin on top. If I was on less maintenance then upping my dose would have helped. I think this is now being implemented into asthma plan regimes by the docs/nurses.

It also depends what you mean by exacerbation - for acute you’d need your ventolin +/- pred and for chronic you’d be looking at med regime change (increasing dose of maintenance or changing steroid base or adding different meds). Personally other than when I was wrongly put on the MART regime, I’ve never been told to up my preventer in times of exacerbation, even when I spiralled into severe/difficult asthma.

Here’s some research about the max absorption dose for most people (a small % of severe can absorb more as stated in the conclusion).

thorax.bmj.com/content/thor...

Hope that explains things a bit, but if not you’re probably better off asking the doc/nurse whose changed your plan as to why they’re changing it.

[Hidden in reply to EmmaF91]

I think personally I am on the verge of giving up with my whole medical team at the hospital. I have booked to go and see my general practitioner on monday as I tend to get more sense from him.

[EmmaF91 Community Ambassador in reply to Hidden]

Sounds like a plan... always worth talking to people who know you, listen and explain things properly! Good luck

[DianaW]

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[Hidden]

I’m from USA and don’t know what the term “preventer” means. If the preventer is long term Med with a LABA in it, they’re right. It can make you sicker and can’t manage a sudden flare.

We have “rescue inhalers. “ They have albuterol in them, which can open up the airway and ease the asthma some. For me, Duoneb, which is albuterol and a second medication, also fast acting, works better. I have to use a nebulizer for that.

[EmmaF91 Community Ambassador in reply to Hidden]

Yes we use preventer to cover any long term steroid inhaler (ICS inhalers), which may or may not have a LABA in it (combined inhaler). Your rescue inhaler we call reliever which typically are salbutamol based.

Over here home nebulisers are usually frowned upon, with only the worst asthmatics getting them - most consultants don’t like us having them cause of the risk of not seeking further help if needed. Mine comes with the rules 1 neb and see my GP (family doc), 2 nebs and go to hosp. I guess things work differently here cause we don’t typically have health insurance (and no one uses it for emergency care)

[Hidden in reply to Hidden]

From what I saw online, in the UK A preventer is inhaled steroids only. Here the next step is a “rescue inhaler,”’which contains albuterol. It is markedly more effective when used with a spacer. The spacer helps more of the medication get to your lungs.

They usually try people on just steroids first, but that’s only for very mild asthma here. Most people here also have a rescue inhaler.

If you’re prescribed one, protect it from the heat. Don’t put it in the glove compartment or anywhere that it can get hot. It will ruin it. Also, don’t keep it more than a year. They go bad.

[Yatzy]

My GP told me that increasing preventers was no longer considered helpful in response to an exacerbation, because it isn’t considered a rapid enough response to inflamed lungs following research.

Oral steroids such as prednisolone are much faster acting. The aim is to prevent/reduce possible scarring of the lungs, which if it happens, is irreversible.

Makes sense to me, even though I hate taking prednisolone .....it seems to do the trick for me.

[Hidden in reply to Yatzy]

It seems that is the new guidance. It just feels weird. And I wonder when the asthma UK asthma plan will catch up and amber just have put in prednisone?

[Yatzy in reply to Hidden]

Yes, disappointing if our asthma experts are in disagreement.

Just rechecked asthma uk action plan, and revised 2018. My GP changed his advice to me in 2016, I think.

Really need a question to asthma uk, though not sure how to do it...I’ll look for an email contact address. Really needs settling.

I’m going with my trusted GP for now.