Third lot of prednisolone this year, advice

[Cushionluver]

Hello All

So finished my second lot of prednisolone 40mg/5 days 11 April. They were effective cough didn’t completely go but a lot more bearable. Last weekend cough got worse saw loving GP on wednesday he said chest clear no wheeze advised steam inhalation and gargling. He thought Fostair caused dry throat. Since then nitemare constantly coughing, retching night and day. Unable to talk for long periods without coughing, sometimes clear phlegm. Feels like throat irritated day and night. Affecting work, sleep and play. Gave in and rang out of hours GP this morning to ask for prednisolone she says sounds like acid reflux. Already taking 20mg omeprazole daily, she advises to take it twice a day and Gaviscon before bed. She prescribed the prednisolone reluctantly. Then at pharmacy where I had a coughing fit a fellow asthma sufferer told me I should only have max steroids twice a year.

Have you guys heard of this? I know there are side effects with steroids but I can’t function and that seems to be the only thing that works. I’ve been using my reliever 3/4 times day so surely something isn’t right? Thoughts?

Thanks in advance.

[twinkly29]

That's utterly ridiculous to say that about steroids. It's like saying only take your blue inhaler twice a week. If someone needs it, they need it.

However...

- if someone is needing repeated courses of pred then their other meds need to be reviewed

- other conditions also need to be ruled out or treated, eg acid reflux (it may be that an alternative to omeprazole would be an option if the gaviscon doesn't help?)

- steam inhalation could be making it worse as a lot of people can't tolerate steam

What is your peak flow like at the moment compared to your best? And before and 15 mins after taking reliever inhaler?

What meds are you on?

[Cushionluver in reply to twinkly29]

Hi Twinkly29I’m now on fostair 100/6 two puffs twice a day. Ventolin as and when needed. I was on clenil 100 before. I also take fenfexadine 180mg once a day, montelukast 10mg at night, mometasone 50 mcg nasal spray once a day and sertraline 100mg at night for depression. Just developed eczema to complete the trio they’re trying to work out what’s causing that just had patch testing done and minor reaction to cobalt. PF340 after its 400. But the best I’ve ever had after ventolin was 500

[twinkly29 in reply to Cushionluver]

Ok that answers one of my questions about antihistamines! I think I'd persevere with trying reflux stuff (adding or switching to find right ones for you) as it sounds like it's triggering your asthma (as your pf is dropping).

[Cushionluver in reply to twinkly29]

Yes I’m gonna pursue that as I’ve had it before and was successfully treated after a scope. But hospital advised much larger dose than GP.

[Dogruff]

I ended up admitted to hospital for a few hours this week for tests As I was starting to cough more at the end of my steroid taper. Turned out it was most likely reflux which was made worse by steroids and doxycycline coupled with post nasal drip from the sinus infection I developed towards the end of the 4 week course of pred. Since the infection cleared, stopped the pred and doxy and started sleeping upright and eating smaller meals I’ve had less coughing and wheezing.

The only difference I noticed between what I had this week and a typical asthma flair was I felt like there was something slightly different but couldn’t pinpoint what exactly.

[Cushionluver in reply to Dogruff]

Hi Dogruff glad to hear things are improving for you. What are you taking for the reflux?

[Dogruff in reply to Cushionluver]

I’ve been on Lansoprasole 30mg. I was changed from omerapzole a few weeks ago. I also use gaviscon or rennies. Rennies are handy for the handbag but I prefer gaviscon. I’m hoping now that my asthma has improved that I can start getting more active and lose the excess weight steroids and lockdown gave me.

[Cushionluver in reply to Dogruff]

Thanks and good luck

[mintypol]

Are you taking vitamin B12? Omeprazole can cause vitamin B12 deficiency .

[Cushionluver in reply to mintypol]

No, didn’t know that. Thanks for the tip.

[Cushionluver in reply to mintypol]

I’m an idiot I replied to myself lol. Thanks for that tip I didn’t know that!

[Sparkywoo]

Four lots of steroids last year which my consultant is not happy about and will now consider Xolair or similar to avoid this. I now have developed diverticular disease, probably as a result of all the steroids. He took me off the fexafenadine as I said I had a dry throat which I felt kept making me cough and has put me on Avamys nasal spray instead. I feel much more stable

[Cushionluver in reply to Sparkywoo]

That’s interesting about the fexafenadine. Will chat to my doctor about this I’m still seeing various GPs about my asthma.

[Poobah]

Looking at the side effects of Sertraline I'm wondering if this maybe a factor. Heartburn and dry mouth are 2 of the side effects listed. I was on Amitryptiline which also is very drying and I ended up with problematic reflux as well. I know that I was eventually advised to keep very well hydrated and to eat plenty of fruit & veg. I was living on Gaviscon as a result andmy GP was happy with that as the aim was to wean me off Amitryptiline. I think most SSRIs have similar side effects. A chat with your doctor and pharmacist may identify something with fewer reflux side effects.

[Cushionluver in reply to Poobah]

My friend mentioned that. The sertraline has really helped me and seems to be one of the less nasty antidepressants. It’s such a balance having to work all this out. Will speak to the GP. Thanks