What's the next step?

[Universalreader]

I am usually a very well controlled asthmatic - take sirdupla 125/25 two puffs twice a day and rarely if ever need to use my salbutamol inhaler. Most of my asthma attacks have been able to be managed at home.. as I often get some warning symptoms of having to use my inhaler more.

This time, i've had two to three weeks of slowly increasing symptoms, now I'm waking up wheezy and tight chested in the night, and having to use my blue inhaler during the day. I am still able to exercise though, but when I finish I often find i'm tight chested and wheezy in the evenings.

Prior to the sirdupla (which works well for me) I used to double my ICS dose in this situation - but I'm not sure what to do this time? Plus my GP surgery has no appointments, only online e-consult (which I've done!) - i dont want to leave it so long I need oral steroids, although it does feel like that point is coming....

What else could i ask for instead of oral steroids to help reduce the inflammation and get the symptoms under control?

[EmmaF91 Community Ambassador]

Hi

If you call them and tell them you need an urgent appt as you’re asthma is kicking off you should get an on the day appt. Asthma/breathing issues/chest pains should always be prioritised by the receptionist so you need to say ‘my asthmas really bad and need to speak to someone urgently’

It does sound like you do need a short course of steroids to calm things down.

Long term the GP may increase/change your reliever or he may prescribe an add on like montelukast- you can read about them here; healthunlocked.com/asthmauk...

Hope this helps and you feel better soon

[Universalreader in reply to EmmaF91]

thank you.... hoping to avoid the dreaded pred but having been wheezy and tight all morning I think its on the cards...

[twinkly29 in reply to Universalreader]

To be honest nothing else is going to work quickly. If they decided to change preventer medication longer term then that would take 6-8 weeks to kick in - which is ok for ongoing care but not ideal for acute flares

[Universalreader in reply to EmmaF91]

I think I knew this was coming, thanks everyone - just got a call back and a prescription for steroids. Should have pushed a bit harder for the same day appt rather than waiting for e-consult as been short of breath and with a tight chest all day. This is the first time I've had a really obvious loud wheeze rather than coughing!

[Universalreader in reply to EmmaF91]

Thanks for your help. I'm now finished the 5 days, felt back to normal on pred but now starting to get short of breath more easily again....grrr. I'm keen to speak to the asthma nurse with an idea of what I might like to do - she always asks, but I'm never sure what to say!! I have had had tiotropium (sp?) and montelukast suggested before as additions to manage an increase in symptoms - are these preferable to increasing inhaled steroid doses? I'm a bit scared of ending up on a very high ICS dose...but I'm finding it very frustrating having such a twitchy and sensitive chest as even cold air is triggering me now!

[Lysistrata Administrator Community Ambassador in reply to Universalreader]

Hi just jumping on sorry, though sure Emma can add more! I just looked up your Sirdupla dose on this site and it already appears you are on high dose ICS: rightbreathe.com/medicines/...

So you would probably need to be looking at adding something else in at this point according to guidelines if you're not controlled on that dose, since there's only so far you can go with ICS-LABA and keep getting an effect. And it does sound like you're not controlled if you go back to having symptoms as soon as you're off the pred and are twitchy. Either montelukast or tiotropium (usual brand name Spiriva) is possible, so you could discuss with the asthma nurse which one might be best. Emma's link above should also be helpful. healthunlocked.com/asthmauk...

It might also be worth having a chat to the AUK nurses before you talk to your nurse, so you have a better idea about the options and what to consider when looking at add-ons. You can reach them on 0300 2225800 M-F 9-5 or on WhatsApp - 07378 606728

Hope this helps!

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better to have the 5 day course of prednisolone sooner rather than later, and get on top of it.