Pregnancy and montelukast

[TabKit]

Hi everyone, would love to know your thoughts on this. Originally getting pregnant and discussing this with one of my GPs, they were fine with me carrying on with normal medication (seritide 125 2x2 and montelukast). However I then spoke to another GP at the practice who is more specialist in asthma who said if possible stop the montelukast. The thing is my peak flow is good (530-550) but since I've stopped the M, im more often at 530 rather than 550 which when I'm fine I'm always at. I know it's tiny but I do seem to notice it.

Also doing exercise leaves me wiped out, and I'm coughing more than normal. I moved house and did a bunch of cleaning which made me cough loads and need to use my reliever, and the GP said that could have been triggered even if I was talking M,so I should keep off it. Fine, but yesterday I did a 2 hour cycle ride (on an electric bike so not even strenuous!) and today I'm completely wiped out. But this goes to the crux of the issue which is that being wiped out never seems to be taken seriously as an asthma symptom if you don't have other serious symptoms... just a slight cough and I'm breathing fine but I get that thing where your breath feels dusty and taking a deep breath makes me cough pathetically.

It reminds me that I posted here before about exercise and still needing to take my blue puffer for it, and Emma replied to say that it meant my asthma wasn't actually totally controlled, but that GPs don't all know this. Mine definitely don't.

What do you think, is being wiped out for the whole next day after exercise due to the asthma, or being pregnant, or something else? I really don't think it's due to being unfit as I cycle a lot, walk a lot, and do yoga from time to time. And i had this from time to time when not pregnant.

Should I fight to start taking montelukast again?

Does anyone else get this wiped out feeling and think it's asthma?

Sorry this was so long and very gratefully if anyone has any thoughts,

T

[Bevvy]

Lots of different things going on here but not sure you need to restart montelukast on what you have said here.Reduction in peak flow is quite low and still numbers that you have previously.

If you have moved house and doing lots of cleaning am not surprised you are coughing more and continue to do so. Will take time to get new home to level of cleanliness that you want.

Tiredness is quite normal in early stages of pregnancy. No need to suppose this is due to asthma.

Obviously only you and your doctor can make final decision. But remember what ever decisions you make you can always change your mind.....

All the best.

[TabKit in reply to Bevvy]

Thanks Bevvy, it's true things are happening which are likely to trigger asthma anyway... and with pregnancy on top it's an extra thing to add into the mix. it's just a nagging feeling that doesn't feel right... and coming on this forum tends to mean my asthma feels off even if I can't describe it! Thanks so much for your reply

[Lysistrata Administrator Community Ambassador]

Just to add a different perspective here: yes, all this may not be asthma, but it also may be, even if your peak flow hasn't really dropped. Not everyone's does, and it's important to take symptoms into account not just peak flow.

When you feel well, how are you with cleaning? I think too many people just put up with symptoms on doing certain activities and assume it's normal. I don't think coughing loads when cleaning is normal or just something you need to ignore.

I've never been pregnant, though I know it can be tiring. However, it sounds like what you describe may not be all pregnancy or necessarily related, if you got it when you weren't pregnant doing similar things. When I got rediagnosed with asthma part of my symptoms were the cough and feeling wiped out; montelukast made a big difference then. I've stopped and started it a few times since then and while the difference isn't as major compared to my other meds, it really does seem to help my exercise tolerance and tiredness.

I insist on staying on it now, despite being told 'it shouldn't help you/it's not effective' etc. It is for me, and it makes a difference to my quality of life. It seems like this might be the case for you too, though obviously I'm not a medic and just going off my own experience.

If montelukast is ok during pregnancy, then I might ask if you can restart and see if it helps? This does seem like your asthma might be flaring a bit off it, whatever your peak flow is doing, and I believe apart from the fact that you deserve good control for yourself, it's also considered best for the baby if the mother's asthma is as well controlled as possible.

It would probably be worth having a chat with the AUK nurses too, who will know more than I do about this and probably more than your GPs do, and have time to discuss it. They're on 0300 2225800 M-F 9-5 or WhatsApp - 07378 606728.

[TabKit in reply to Lysistrata]

Hi Lysistrata, thanks so much for your reply. Yes it's that it seems my asthma has been building since I stopped the montelukast, that's why I feel l want to take it again, but my GP is reluctant and thinks the triggers are enough reason alone. So if I was to start again I'd have to fight for it.I certainly could get this when using montelukast, but in the last year/ half year I was really feeling very well so it's a bit sudden.

So interesting that taking montelukast stopped you feeling wiped out, and that that was a key symptom for you too. I feel it's often not mentioned as a symptom.

Weird that the doctors say it won't help. Why do they say that? Do they give any reasons?

Super grateful for your thoughts. I'll definitely give the asthma UK nurses a call, good plan.

Take good care

TK

[Lysistrata Administrator Community Ambassador in reply to TabKit]

I'm sure it is the triggers causing it in the moment, but if you had better asthma control you would probably be less twitchy and responsive to triggers.

You can't avoid them entirely of course, but I (and others) find there are 'major' triggers which set us off regardless (mine are eg people smoking, weather changes, mango and lavender etc) and 'minor' ones which don't do that much unless we are already doing less well (mine are exercise, laughing and others). This is very anecdotal of course and I don't know if there is formal research into it, but at the same time if you are frequently symptomatic for whatever reason, then you're not really controlled, whatever your peak flow is.

You might find it helpful to take the Asthma Control Test and see how you score - if you're coming out as poorly controlled you can show your GP the score and discuss it as one potential factor and at least a sign you aren't well controlled - but definitely also chat to the AUK nurses. (One link to the ACT here: rethinkyournormal.gsk.com/t....

I do feel that the wiped out thing gets dismissed and ignored re asthma. It may still be something else, and worth looking at other causes too. However, having had the same problem which montelukast helped, and the timing of your problems, makes me think it could be at least partly contributing.

Montelukast was the first med that really helped me and my GP at the time was fine with that. However, I now have a consultant who has definite ideas about medications and doesn't seem to accept they can be good for some people and not others. He says that montelukast is pretty useless anyway (I think it's more that it works well for some and not at all for others, and in a trial that makes it look like a weak effect).

And even if it did work I don't have allergic asthma (true) so it won't help. He doesn't want to hear about how it does help - plus it also seems to help exercise-induced asthma. Although exercise isn't a major trigger for me, montelukast does stop that exhaustion I can get and helps my exercise tolerance. Luckily the asthma nurse said it was fine to try again and they weren't worried as it doesn't have major side effects.

Good luck and hope you get somewhere with the GP!

[TabKit in reply to Lysistrata]

Thanks for the extra thoughts again hugely appreciate you taking the time. Interesting about the major and minor triggers, I know what you mean but hadn't thought about it in those terms, helpful to think of it like that! I think my main ones are windy conditions, fumes like paint/ smoke/ gas. If I'm well controlled exercise is fine (tho need blue puffer if it's strenuous) but if not I'm wiped out. Never heard of mango before!

Will do the test and call the nurses.

Definitely up til moving house and stopping montelukast I was doing so much better.

Take good care!

[Poobah]

I think the problem for GPs is the lack of testing and data of meds on a pregnant group. You may have picked up on the chat about the latest vaccines and their safety/efficacy for this specific group. Any testing would take place at a later stage or not at all. With many meds at the testing stage, healthy young men are the most likely ones things are tested on, so there's usually little or insufficient data with regards gender, build, weight, existing conditions etc.

If you're an 8 stone female would you be taking the same dose of med as a 16 stone man, twice your age? Yes, probably, as dosing guidelines aren't usually refined for such criteria. And bring pregnancy into the mix and avoidance is the safest recommendation a doctor can give.

If you're experiencing fatigue your doctor may want to check your various VitB levels.

[TabKit in reply to Poobah]

Hi Poobah. Thanks so much for your thoughts. So true! Not just for pregnancy but I've read about this in general for women and medication and as you said weight differences etc. Sigh. This mass data testing as they are doing with covid and Zoe, I wish they could do with asthma as well!

Take very good care,

T