Referral to respiratory?

[Rainy_x]

Over the last 6 months my asthma has become uncontrollable. I'm currently on fostair 200, salamol reliever, antihistamines, steroids and montelukast. I'm taking my reliever 6-10 time every 30-60 minutes day and night. I'm back at my GPS Tuesday and they said if it's not improved with this latest course of steroids they will refer me to respiratory. I'm just wondering what will happen here and what the next course of treatment will be? I've had 3 major attacks ending in resus and icy stays since October and I'm now honestly worried that this is how I'm going to die!

[EmmaF91 Community Ambassador]

If you’re taking your reliever that often then it suggests you need hospital treatment as 10 puffs should last more than 4 hours. In a&e they can give you treatment at this level (if you explain the maintence issue not the reversibility issue). If you’ve had an ICU stay in hospital you should already be under the resp/asthma team so check your notes and see if you have any contact numbers for them and give them a call explaining the issue.

A local hosp team can prescribe you more drugs just as spiriva (a LABA inhaler similar to atrovent nebs), and things like theophylline/aminophylline tablets, maintenance steroids, carbocisteine (if you have issues with mucus etc) and can change antihistamine if you’re not on ‘the best’ and have a little scope to increase past GP dosage. They can also look into seeing if you are eligible for biological injections if none of this helps to control you and will then refer you on to a specialist hospital for investigations as to what is going on. They will probably want you to do a LFT/spiro if you haven’t done one to ‘confirm’ your diagnosis (I wasn’t officially diagnosed until I had inhalers for 10 years and 1-2 years of severe issues cause old GP never referred unless he couldn’t help it 🙄)

It’s nothin to be worried about just expect to have to do a lot of talking/explain about what’s going on

Hope that helps (and I really do suggest a&e to calm down this flare!)

Just remember once controlled asthma is easy so long as you take you meds and get help when you need it. When uncontrolled it’s irritating but you just need to keep seeking help... the more you do the more they realise the issue and the quicker they get you sorted/referred (GP referrals can take up to 3 months so check old paperwork and see if you have a contact cause with asthma after ICU you should do). The more you take issues to a&e the more evidence of issues and more likely to be admitted/referee to hosp AN/con (you don’t need to be at resus/icu level for hosp... 10 puffs not lasting 4 hours/resolving issue/PF is enough!)

Good luck x

[Js706]

I agree with Emma that it sounds like you need something like a&e to help settle this flare!

Also because when you use ventolin very often for a while (like it sounds like you have) your body can start to build up tolerance to it so it isn’t as effective a reliever - so you may well need more medication to relieve your symptoms at the moment!

[Tugun in reply to Js706]

Hi Js706,

I have heard that your body can build up tolerance to ventolin but for me, it hasn't. I have taken it every day for 40 years and when I have an infection, I have to take it much more frequently. I have never built up a resistance to it. When the infection is over I go back to my normal dose. However I do use a ventolin rotahaler which is ventolin in a rotacap or capsule which the rotahaler opens and I breathe in the powder. It turned out I was allergic to the propellant in the CFC free inhaler. It gave me asthma. Maybe it's the propellant that causes the problems in frequent use.

Legally in Australia the company GSK have to provide an alternative to the CFC free inhaler for those who have difficulty with the propellant. As the rotahaler is not freely available I need to order it from my chemist. Some chemists and doctors don't realise that it is still available as it was a very early alternative to the pressurized inhaler.

[EmmaF91 Community Ambassador in reply to Tugun]

Hi

No it is genuinely the over use, however you only usually build up a tolerance if you’re consistently overdosing on salbutamol (say taking 10-20+ every day for months). I use both MDI and dpi inhalers and generally have to take 4 puffs to get the response I used to get at 2 puffs (or 2 sucks in place of 1 of DPI). I also have home nebs... when I first start having to take them they work really well, last really long and I tend to get the shakes etc, but after using 1 a day for a week I tend to get less side effects, and they last less and less time. Once I’ve got through the flare and stop the nebbing the next time I get it out it works as previous (same with the vent but I rarely get a chance to go through with that 😅)

Due to this potential tolerance, in the UK the doctors don’t usually resprive using the reliever as maintenance therapy (whoever some older docs/asthmatics are on it cause it’s what they’ve always done). Hope that helps explain things.

[Tugun]

Hi Rainy_x,

I'm surprised you haven't already been sent to a respiratory specialist. What did the doctors in the hospital say? Do you have a lung infection or what do you think is the reason for this continuous flare up. Did something happen (such as the flu or exposure to an allergic substance) that precipitated this in October?

[DanceQueen]

i have a referral to repiratory as i have out of control breathing and cough

.......one of my posts

I have been breathless now for 8 weeks since i had a chest infection that was treated with anti biotics and steroids.I spent a short time in hospital and was told to return home and i would eventually recover...when my inhalers were changed the cough dissappeared.....oh joy....well for the last 5 days i still remain breathless on exertion and the cough has returned with avengance.....i have a doctors appointment in a weeks time.....But has anyone any ideas for me in the meantime....i wake in the morning dreading how the day will go......PLEASE.......i am 70 years.......I have asthma.high blood pressure[well controlled]osteoporis,arthritis,migraine,vertigo etc etc........oh shoot me now hahahahahahaha...i am utterly disparing now i feel so low and depressed........

so im afraid im no help but your not alone

hugs

[Rainy_x]

Hi all! Thanks for all the response. Shortly after posting this I had my 10 puffs and it did nothing! I ended up having to call an ambulance and was taken straight to resus in quitea bad way. I've had treatment and now stable again and able to breathe 😁 doesnt it feel good to breathe normally again when you haven't in so long! Another week of steroids and a fast track refferal to respiratory in place.

[Echoblue in reply to Rainy_x]

So glad things have settled and you have fast track referral in place. Wishing you a speedy recovery from this latest bout.

[EmmaF91 Community Ambassador in reply to Rainy_x]

Glad you’ve been seen at that things are calmer for you now. Hope you get seen quickly in the resp clinic and that you stay stable until then. If not you know what to do 😉 x

[twinkly29]

Glad you've been seen, are feeling better and have a referral in place. I'm also surprised they've not had you under a specialist before now. Hopefully you'll be seen in the near future and stay stable until then.

[SwishUK]

I was also on fostair 200, salamol, citirozen, steroids and monekulast. I had 2 asthma attacks in May a week apart. They found I had an infection but not in my chest so wasn’t spotted on a routine check (after the first attack), by the GP. It was only spotted when they done bloods the second time and said I had an infection somewhere. Is it possible that you have an infection?