Just returned from Annual asthma review- slightly confused.!!
I am an Elite Master competitive swimmer 59 yrs and clock some 36km per week.
I've been informed that my usage of Salamol and Clenil apparently are being looked at. !!!
My explanation regarding the necessity to use them prior to training in the pool due to chemicals and my lack of attacks- ZERO and my peak flow output 800, did not have any bearing on the response.
So i asked the nurse, are you telling me that you will be cutting down my inhalers- I did not get a clear response.!!
I'm super fit- I need/ use them in order to prevent issues and i'm being informed that the supply will be reduced. Apparently I need to cut down.
Unbelievable.
Anybody else had similar experience.??
Written by
stealthman
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Hi stealthman, I’m certainly envious of a peak flow of 800.
I have not had a similar experience but generally if your asthma has been stable for a fairly lengthy period then they do look at reducing the amount of medication you take, based upon the principle that it’s better for your health. Clearly if you were not stable on a reduced dose they would have to revert back.
I take 3 puffs in the morning and 3 puffs in the evening of a combined inhaler and spoke to an asthma nurse recently who said that if my asthma remains stable then the principle would be to go down to 2 puffs twice a day, then one puff twice a day. I do not think I will ever get down to the 1 puff but I’m fine with the principle.
I would much prefer not to take any medication at all but some I have no choice and have to take them.
I had EIA when I was a teen. Super sporty (gymnastics trampolining karate etc about 20-24hrs sport per week). Because I was needing too much ventolin as I was training so much they actually escalated my meds until I got to only needing 2 puffs pre training.(current guidelines are if you need more than 3x2 doses a week you are uncontrolled so they should be escalating maintenance meds as well as trying to reduce reliever usage)
If your using the blue a lot it will flag the system cause that’s a sign of poor control. If you do get issues/have pumps stopped for some reason I’d suggest seeing your GP and explaining that you’re EIA so have issues when training especially when chlorine’s involved. GPs can bypass the system but you have to see them and not the AN.
I feel like in general this guideline (improve control to reduce salb use) has been poorly understood by medics and so it’s being poorly implemented (restrict salb access) and asthmatics as getting scared cause they can’t access the drugs they need.
As I said see the doc. Explain the situation. And tell them that Rn what you do works for you but say you’re happy to try increasing maintenance treatment in an effort to reduce reliever use if that’s what they want to try.
Ps if they quibble about your high best PF throw Bradley wiggins or any other sporty asthmatic in their face as examples cause ‘excessive’ sport will increase best! personally my best is 630... I’m predicted 440... I’m no where near as sporty as i was as a teen (and never did a PF back then) and i have severe/brittle atopic/eosinophilic asthma now and can still hit 630 on a good day
I completely agree with Denboy & Emma. I would say that you ensure that you have a follow up appointment made if your meds are reduced. Any changes should be monitored closely.
There's definitely been a rewrite of the guidance on Salamol (Ventolin). One consultant wanted me stop it altogether leaving me to depend on the long acting bronchidilator, even in an emergency. I resisted quite assertively and she relented. I gave it a go and had a miserable summer.
So back up appointments made, say four weeks, you could try a new regime but with the knowledge you can then provide proof to the health care professional if it doesn't work and assert a better treatment plan.
Hi Thankyou for replying: it’s great to hear from people who have to actually deal with this on a day to day basis. I will definitely be looking and reviewing- then revisit my doc to put my case .
Your comment on Ventolin is interesting as I saw a respiratory consultation last week who suggested the same, that I use my combined inhaler as both preventative and reliever.
Before I give it a try I’m going to discuss this with my asthma nurse when I see her in 2 weeks time and see what she says.
I’m willing to give it a go but I will also keep my Ventolin inhaler to hand just in case.
I resisted as having increased the combo inhaler already my asthma had got worse. Personally, and it just be my asthma, but too much of the long acting bronchidilator seems to exacerbate my asthma.
I got no where with the consultant, apart from her allowing me to keep the Ventolin for emergencies only. But my asthma nurse has listened to my concerns about the combo inhaler. As she's asthmatic she understands, thank goodness.
I believe the new thinking is that Ventolin creates a dependancy so by not using it the asthma settles down. The fact that the long acting bronchidilators are also relievers just raises more questions for me; why are they any better, especially in higher doses?
The frustration with asthma is that you can 20 people in a room all with different symptoms and medication, so very difficult to understand what the best route is to take.
I find that my long acting bronchidilator takes affect quite quickly, although you would expect it to because as you say it’s also a reliever, so willing to give it a try, nothing to lose by it.
Apart from the 2 courses of Prednisone in my nightmare month of November last year my asthma has remained relatively stable so far. I can understand anyone with unstable asthma not wanting to drop the Ventolin.
I currently take 3 puffs in the morning and 3 puffs in the evening which is quite a high dose, dropping this to 2 puffs twice a day plus using it as and when necessary may reduce my daily dose overall. All questions for my asthma nurse when I next see her.
I totally agree with you. It's a minefield so I've learned to be a bit more assertive as the process of questionnaire and breathing tests aren't enough to review what's going on with me.
Sounds good advice - the medications are not there to enhance, but level things out and … as always …. the body changes, circumstances change, so there is a need to keep meds under review - but always in a discussion, not according to some edict of course - like economies.
I agree and in turn I have been trying to cut down on use but have then had to fall back to reactive use due to my inability to cope. the great thing that has come out of this is that the responses and indeed yours have given me the boost to go back to see GP and discuss this again. Thankyou for the boost.
It’s not dangerous to use them. If you had exercise induced asthma it’s dangerous for you to not use it before exercise.
I SUSPECT this is at least partly triggered by your very high peak flow when the asthma isn’t kicking up. Doctors who look only at the numbers can be confused by athletes.
I have very high peak flow even at 74 from swimming. Do it intensely while you’re a growing and you’ll just have big lungs with bigger capacity.
I don’t know if you have an appeal process but I’d find out.
I don’t have great asthma, usually infections all the way through the year.
I’ve been told at one point that I was only allowed 2 ventolin inhalers a year (I used a whole inhaler in one month, this month). They only allow my combi inhaler once every two months but my inhaler only lasts a month... it’s ridiculous. Literally had this conversation with my doctor on Friday.
Ventolin I’m sure you can buy online, I remember a newspaper article about 2 years ago where one of the big supermarkets was going to sell them in their pharmacies.
I take 6 puffs a day from my combined inhaler which holds 120 doses, so I get a new one every 20 days.
If they only allow you one inhaler every 2 months that works out to be something like 2 puffs a day. If you need more and your doctor won’t budge then you need to speak with the practice manager and find out what the process is to elevate this matter.
At the end of the day your health comes first and it may put your doctors nose out of joint, but so what.
Hi, I get the impression they are looking at all inhalers, I find my ventolin has been reduced, I have been told inhalers are bad for your heart, and you should only take an inhaler in an absolute emergency.
I have had a few emergencies lately when I needed to use ventolin, although I put it on my last prescription I notice it was not included with my most recent prescription when I collected from the chemist, I was told it had been crossed off.
It would be good if we could be offered an alternative as there are times when you need that extra.
I think it would be marvellous if there were more GP's, asthma nurses who actually have the disease. The missing bit of the equation seems to be patient experience. The patient knows their own body better than any medic. There are so many triggers for us asthmatics, that logically I think it is impossible to have fully controlled asthma. There will always be times when we need our rescue inhaler. We can be absolutely fine for the majority of time, but some trigger can tip our bodies into abysmal chaos at the blink of an eye. Is it time for a review of these damaging and dangerous guidelines ?
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