Asthma control post covid - are my expectations unrealistic?

[Glty]

I had covid in march. My previously well controlled asthma isn't anymore.

I am currently on fostair 2 X 200 am and pm, braltus, montelukast, cetirazine, dymista and ventolin. I've had 4 short courses of pred since April and am now on a one month reducing course.

I was referred to the local hospital but have an unfortunately high max peak flow and aced the lung function tests (on a good day) though they didn't check reversibility. I was discharged shortly afterwards but 2 weeks later I was back on steroids 🤦🏻‍♀️. I've been referred back but no clinics are running right now. Thankfully my GP is great but doesn't have many options other than pred which thankfully does work well for calming things back down. I've tried uniphylin but was struggling with side effects whilst still on a sub-therapeutic dose so we switched to braltus.

My bloods showed no allergies, and no eosinophils but elevated CRP so inflammation going on somewhere.

My main trigger before covid was resp illnesses (also irritants, smoke, chemicals, candles, exercise/exertion and cold air but usually in combo or when I'm not doing well). Now I seem to struggle if I get a stuffy nose without even needing a full on cold.

My main question is whether, if I was well controlled, would I still expect every sniffle to cause a major flare?

Also is my expectation of control (being able to go more than a few days without ventolin or symptoms and not being afraid to catch a cold) unreasonable given the severity of my asthma now?

Thanks!

[Glty]

Not sure if this got a bit buried with all the other posts yesterday - I'd really appreciate some input though, if anyone has any words of wisdom...

[twinkly29]

Hi, have you tried the AUK post covid hub for advice/support? They might at least be able to tell you that what you're experiencing is very common in post covid patients.

It could well be that it's not actually your asthma that's the issue but post covid symptoms - maybe why the asthma meds aren't helping much? But the AUK nurses will have much more experience in this and will I'm sure have heard from many in your situation.

I hope proper post covid care becomes a thing where different elements are really looked into because asthma treatments don't really seem to help yet quite obviously many people need support in some way, whether it's respiratory physio or something else.

[Glty in reply to twinkly29]

Thank you, I have spoken to asthma UK, they were really helpful but it was a few months ago, so I'll call them again.

What I probably didn't make clear is that my max peak flow is high (620) but every few weeks I start getting big variations from morning to evening (drops of 15-20%) also slightly symptomatic as the day goes on, which over a few days sees me declining to the bottom of the yellow zone. I do respond well to ventolin, though often need more than 2 puffs at a time. My GP doesn't want to have to keep giving me pred but it does help, though I continue with the variability for 4-6 weeks afterwards but without the deterioration.

I do have long covid but it does seem like asthma is the main cause of my breathing issues and my GP agrees. I did have multiple things going on over the summer and had breathlessness and tight chest that didn't come with peak flow drops or respond to ventolin but sorting out a slight anaemia really helped that sort of breathlessness but didn't fix everything 🤷🏻‍♀️.

Thanks for the link below, I'll definitely check it out.

[twinkly29 in reply to Glty]

Arghh being referred and then discharged is really annoying - easier said than done but you need a consultant who listens to the whole/ongoing situation not just taking a one off reading of something. Glad your GP is supportive but very frustrating. It may be he'll have to keep giving the steroids as repeated courses of steroids might highlight to a consultant if you have to be re-referred (which I suspect you might) that there are ongoing issues.

Have you tried something like Spiriva? Or maybe that's what Braltus is?

[Glty in reply to twinkly29]

Yes, braltus is spiriva which is helping a little.

In hindsight I was probably a bit too optimistic about how I was when they decided to discharge me, I was alot better than I had been, but I don't think they heard anything I said after that. I also ran out of energy to argue with the consultant too. They were insisting that my peak flow was too high and I was overmedicated 🤦🏻‍♀️ and needed to reduce my fostair - I'm sure that would have worked out well (sarcasm). GP and asthma UK agreed that perhaps one week of being well, wasn't long enough to decide to reduce my meds.

Mostly I'm just frustrated with the variability, and being stuck in limbo, but I guess it's time to adjust my expectations until the NHS can deal with non-emergencies again.

[Plantobsessed]

I also had covid back in March and have been struggling increasingly with asthma symptoms. I’ve been on long and short courses of pred and yesterday it got so bad I ended up in A&E on a nebuliser. But like you my peak flows are good and doctors often seem quite baffled.

Today I was lucky enough to have a post covid consultancy at the hospital. They said that technically my asthma is under control, but I was still seriously short of breathe. They sent me to see a physio who within minutes gave me some tips which significantly improved my breathing. They gave me information about breathing pattern disorder and whilst I was sceptical that it would be fixed with some exercises, I can honestly say that in just one afternoon I feel heaps better. I know it’s not fixed but I now understand that I can also control the breathing with exercises and don’t need to rely so much on extreme medications.

I’m not saying yours is necessarily the same but it might be worth enquiring about a physio. I wish I found this information out earlier!

[twinkly29 in reply to Plantobsessed]

It sounds awful to say it but I'm glad you ended up in a&e as you seem to have had a really good moment with the post covid person and the physio - just some light on your situation must help but hopefully the physio will too.

This site was recommended to me by a respiratory physio (a few years ago so not for covid per se) which may or may not be useful (and may or may not be similar to what was suggested to you so may be of no use) but is free to join and it remembers where you've got to in the steps....

lifeguidehealth.org/player/...