Puzzled - stepping up preventer medicine when symptoms come on so quickly

[pen5377]

I was diagnosed at age 60 close to 6 years ago after a series of winter illnesses left me breathless and with a constant cough. My asthma was well controlled after a number of weeks on Clenil Modulite. Then a GP suggested I step down to 1 puff twice a day from 2. All was well until I got a chest infection; I was given antibiotics and salmeterol, went back to 2 puffs, and saw some improvement within a week. So whenever I got a cold that set off my symptoms I’d use salmeterol for 4-6 weeks, keeping up the extra puffs of Clenil for a bit longer, before stepping down.

Just recently my chest tightened a few days after I got a scratchy sore throat. But I didn’t improve, so went to GP after 2 weeks. Was told I had chest infection, given antibiotics and told to use ventolin 6 puffs at a time 3 times a day as well as using it 2 puffs a time as needed. Six days later chest felt clearer, but cough no better - I can only sleep at night almost upright. Back to see another GP today who has changed preventer to Seretide. She said it can take up to 6 weeks for increased doses of preventer medicines to have effect - so how do you know when to step up, when symptoms come on so quickly? When I’m free of viral or bacterial infections I have no symptoms at all.

I have a review booked in just under 3 weeks with the asthma nurse, and I’ll try to get a written asthma plan. By the way peak flow does not seem to decline too much - down from 440 in summer to 340 now, so GP won’t give steroids. My other concern is that my age may start making these more severe episodes of coughing more frequent. Any suggestions of questions I should ask the asthma nurse very welcome!

[Hidden]

If you noticed an improvement with Clenil after a week then you should notice an improvement with Seretide in a similar time frame as they both contain corticosteroid (although Seretide activates beta-2 receptors also).

Im not sure where the 6 week figure comes from (there may well be some clinical data behind it) but for me, like you, Clenil would start working after a week.

[pen5377 in reply to Hidden]

Thank you. I guess my problem is that this time around I had seen only continuing decline after a three weeks of upping the Clenil, which is the reason the GP has switched we to Seretide, as she says the steroid in that - Fluticasone propionate is stronger. Plus, having started with a sore throat, then picking up a chest infection and now I think I have a cold developing - poor old chest is having to deal with one trigger after another. The six weeks is the time she reckons it takes to get full benefit from the steroid. Meanwhile, thank goodness for Ventolin and an adjustable bed, though I crave being able to lie down for proper rest!