I am in my late 60s and have had asthma pretty well all my life. For almost all of that time it has been pretty well controlled. I have always maintained a good level of physical fitness and ran marathons, played football well into my 40s. I still walk and play golf (no buggy!!) on a regular basis. I use Fostair 100 twice a day and Montelukast in the evening. When sedentary and going about my daily business, I am fine. I don't have attacks as such but when my control isn't so good, as at present, any exertion - gentle walking, household chores - make my breathing laboured and uncomfortable. I am allowed a permanent repeat prescription of prednisolone (5days at 30 mg) for when things do dip, but am reluctant to use this too often - i.e. more than twice a year. When I do use it, it sorts it out pretty well. So, my question is - am I being too cautious about its use? Try as I might, I never get a really clear answer from nurse or doctor - who give me the impression that its kind of my fault for not controlling things using my inhaler.
Thanks in advance for any thoughts.
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Boom1875
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It is common for people to take steroids in the yellow zone which on PF is about 70-80% to 50% but you can also go by symptoms.
When you lose your control do you find yourself reaching for your ventolin more? If you are and it helps then that’s usually a hint that you may need your steroids. If you need to use your steroids more frequently then your team will possibly escalate your preventer medications. Pred usage is a big indicator to the docs that you’re having issues and so they usually ‘pay attention’ to that more than over use of ventolin.
Ideal asthma control is less than 3 doses of ventolin for a week and little/no pred courses. If you know what triggers these episodes then it’s worth mentioning that also (ie is it during hayfever season, or when you do a proper dusting etc... as antihistamines might help etc etc)
If you’re not controlled you’re not controlled (and having a plan should stop you feeling like they are patient blaming cause you are just following plan). If you need escalation you need escalation (tho usually it’s worth informing them when you have used pred and why you used it)
I totally agree with EmmaF91. If you are following what you have been told it is not your fault and the Dr/Asthma nurse should not be blaming you.
There are a wide range of triggers for asthma symptom flare ups. Knowing your triggers helps in order to avoid or minimise them. However, you can't avoid all triggers its not always possible.
Triggers can be :
- stress or emotion (i.e. laughing can cause some people to start coughing fit and trigger an attack)
- exercise
- cold weather
- hot weather
- food
- pollens
- perfumes, aerosol deoderants
- cleaning products
-scented candles
- mold and damp
- infections
- dust and dust mites
This is just a few triggers and the most common ones.
You may find if you have been on the same inhalers for a long time they are becoming ineffective and need changing.
I have discovered a pattern and realisation for me that if I start to get frequent infections (not just respiratory/ increase in any kind of infections) then this is usually a sign for me to change my inhalers.
Inhalers for me definitely work for at least 2/3 years.
I was on Seretide for over 10 years, the last 3 years I started getting too many frequent infections. I had forgotten about this and it took a very serious infection and trip to A&E and seeing Hospital Asthma Nurse to get inhaler changed.
Sometimes GP and surgery Asthma nurses see you so often they seem to forget that if you have been well controlled for years that if it starts to become less controlled they don't automatically consider its time to change inhaler - so ask them about changing your inhaler as if you are still taking it the same ways as before it can be that the inhaler no longer has the same effect it once had for you!
If you need to take the prednisolone then take it but as you rightly say you don't ideally want to rely on it and if you are having to take them more often then this is another sign your GP needs to change your inhaler. (NOTE it can take 3 - 6 months before see a major change)
Hope both my and Emma's view have helped, go back to GP and ask about inhaler change. Highlight you are taking it as prescribed but you are not getting the relief and having to take the prednisolone more so maybe its time to change the inhaler.
How long have you been taking Fostair 100? If it is more than 3 years this could be the problem.
That's a really interesting point about changing the inhaler - and seems to make a good deal of sense. I have been taking Fostair for much more than three years and, yes, I do feel that it's not having the proper effect that it used to have. Thanks for the hint and the response - much appreciated.
Here are seven things your doctor might do if your current treatment plan isn’t keeping your asthma symptoms under control.
1. Adjust or change your medication
Treatment for asthma generally consists of quick-relief (or rescue) inhalers, taken when your symptoms flare up, and long-term controller medications, which are taken daily to help reduce inflammation and prevent symptoms. If you’re already taking these medications but still having shortness of breath, wheezing, and coughing, a first step may be to make sure you’re using them correctly. “Some of the inhaled medications can be difficult for patients to use correctly, so doctors often spend time teaching patients how to get the most out of their medications,” explains Dr. Levy.
Your doctor may also increase the dose of your current medications. “In all but the most severe asthma patients, this usually provides relief,” says Levy.
The next step is to try an add-on medication or explore other treatment options altogether. “Asthma therapies come in a wide array of options,” says Levy. “They are formulated as inhalers, nebulized solutions, pills, and injections. For the most severe asthma, there are even therapies that target the bronchial smooth muscle — they are administered directly through the airway by a specialized bronchoscopy procedure called thermoplasty. Patients can explore these different treatment options with their healthcare provider.”
If your doctor changes your medication dose or prescribes a new treatment, you should schedule a follow-up appointment to discuss how the treatment is working, according to Asthma UK. Together, you can continue monitoring your condition to optimize the treatment plan for your needs.
2. Test for airflow obstruction and inflammation
A variety of tests can help your doctor tailor your treatment to your specific asthma. For example, your doctor might ask you to breathe into a machine for a lung function test known as spirometry. You might then be asked to repeat the test, possibly after taking a puff from an inhaler, so that your doctor can compare results and check whether the inhaler helped improve your airflow.
Additional tests look for signs consistent with inflammation, in particular allergic inflammation, says Levy. These tests might include a peripheral blood eosinophil count, serum immunoglobulin E (IgE) level, and exhaled nitric oxide level.
3. Determine if you have a more severe form of asthma
If your asthma is uncontrolled or partially controlled despite taking high-dose inhaled steroids plus a second controller medication, or taking oral corticosteroids, you may have severe asthma, according to guidelines from the American Thoracic Society and European Respiratory Society. Severe asthma doesn’t respond to standard treatments, but there may be other options for you.
For instance, nearly half of people with severe asthma have high levels of eosinophils in their lungs and blood, according to the NHLBI. These white blood cells can build up and cause inflammation and swelling in your airways, and today, medications called biologics can be prescribed to target those eosinophils. To diagnose eosinophilic asthma, your doctor will perform a blood test, a sputum induction test, or a bronchial biopsy to measure your level of eosinophils.
4. Identify hidden triggers
Does your asthma get worse in certain situations? Many people have triggers — often allergies. To figure out your triggers and where they’re lurking, your doctor might ask detailed questions, help you recognize patterns, and even order a blood test. If we identify asthma triggers, we can develop strategies to help you avoid those triggers, says Levy. “This can be challenging and is a bit like detective work,” he says.
Here’s how you can help: Keep an asthma diary that tracks your symptoms, where you were and what you were doing when you experienced an asthma attack, and any factors that may have triggered it.
5. Diagnose conditions that make asthma worse
Sometimes the problem isn’t just your asthma; something else may be aggravating your symptoms. For example, chronic sinusitis with post-nasal drip, gastroesophageal reflux disease, and obesity can all aggravate asthma or make it more difficult to control, says Levy.
6. Provide tips for healthy habits
While lifestyle changes won’t cure asthma, people tend to manage their symptoms better when they eat a healthy, well-balanced diet, exercise regularly, and sleep well, says Levy. Stress-reduction techniques like mindfulness, meditation, and deep breathing can also be beneficial: Stress and anxiety can lead to shortness of breath, too, so keep them in check to better manage asthma.
7. Help you develop an emergency plan
Asthma attacks can sometimes become emergencies, and during severe symptoms you may not be able to speak up and ask for help. Be prepared: “It’s very important for patients with severe asthma to develop plans for seeking urgent help from friends and family members, which might include assisting with a home treatment or transporting you for an emergency evaluation and treatment,” says Levy.
Your emergency plan should also include a list of all your medications, allergies to medications, healthcare providers’ names and contact information, and your preferred urgent care center or hospital, says Levy. Make it digital to easily share with family, friends, or coworkers. “I also suggest that patients with severe asthma keep an updated record of their most recent pulmonary function tests and blood test results to share with providers who may be unfamiliar with their history,” he says.
Wow. Thanks for such a detailed and well-informed response. Hugely appreciated. Looking at the responses so far, I'm instinctively thinking that a change of preventer inhaler may be the first step to looking at this.
Put a weather app on your phone and daily see if there is a connection between say high pollen /grass/mould count and your symptoms The University of Worcester display a detailed allergy report All best Marilyn
I had been on Fostair 200 but recently put on Fostair 100 but 8 puffs a day which gives the same steroid preventer dose As the 200 but double long acting reliever, it’s really helped me to stay away from the prednisolone - there are lots of options it seems with Fostair and I didn’t realise there were. Would definitely recommend speaking to an Asthma UK asthma nurse to help with how to play it with GP/nurse/specialist. I have an air purifier which seems to help me, there are tips for minimising pollen exposure on the Asthma UK website if it‘a pollen that affects you - you could go on a prescribed antihistamine if it is. I have also experienced similar where they seem frustrated with you that it’s not working and you are still poorly which is just silly as that is the nature of asthma, definitely not your fault.
I am 58 and developed asthma when I was 50 which was a precursor to EGPA. when that struck I was seriously ill and was on 1000mg of prednisilone! 3 years later I am still on 5mg every day. I can’t come off it yet as mY body does not make its own steroids yet. I am jogging, playing tennis and golf and feel great. I think much of this is due to the pred. I don’t think you should feel guilty or be made to feel guilty for taking pred a couple of times a year. If I was you I would continue to take it when you require it.
Wow - how unprofessional they don't give you a clear asthma plan. You should use a Peak Flow monitor daily and record it - in a notebook or App- If you record 3-5 days at a level of 600% of target (you should know your target - can be found on a graph easily found on the internet ) then start prednisalone.
I agree a plan is needed but Boom1875 should probably work out the details with their GP or asthma nurse, as a plan works best when personalised.
Peak flow alone may not be the best approach for them to base a plan on (as Emma says symptoms can also be used, or a combination). Ideally the best rather than their target peak flow should be used, if known (as a lifelong asthmatic Boom1875 probably has a good idea of theirs but it can be worked out).
It may be similar to target anyway, but some people have personal bests which are quite different from their target, which is just an average value for their age/height/gender and a starting point.
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