Post steroud wean or Ipratropium side effects? - nausea, dizziness, fatigue

[Ghoulette]

Hi everyone, me again ☺

So I'm back home after spending 2 weeks in hospital in April for steroid wean. I'm now off the preds.

All went relatively OK. I only had 1 full on attack, after which they added in Ipratropium nebs along with my salbutamol nebs four times a day, which seemed to help (I'm already on fostair 200/6 and spiriva respimat). They have discharged me on these too. I know that Ipratropium is a similar drug to my spiriva, and the asthma nurse said I shouldn't need both but it's not impossible to be on both. But, I tried not taking my spiriva for 2 mornings, but by the third morning, I felt really rough and my chest felt really heavy. Hubby said my breathing was a bit noisy and I was really pale. So I have gone back to having my spiriva in a morning too.

They have switched me onto hydrocortisone tablets at the physiological dose (10mg am, 5mg midday then 5mg evening all with meals). I am on this for a few weeks then will have synacthen test to check if adrenals have shut down.

I just still feel generally a bit crappy. I'm tired a lot and find I am sometimes sleeping in the day (I was doing this whilst in hospital for the last few days as well). I still get sob on exertion, feel nauseous, sometimes get an upset stomach and have dizzy spells. I also have tachycardia (I have 24hr heart monitor booked for this month).

I'm just wondering, is this normal after weaning off preds and switching to hydrocortisone? I'm aware of the risk of AI and the signs of adrenal crisis, but I just want to make sure that what I'm experiencing is just normal post wean, post hospital fatigue and to be expected. Or could it be due to the added nebules (I take ipratropium and salbutamol 3-4 times daily)

Any advice gratefully received.

Many thanks,

Michelle x

[twinkly29]

I am on both spiriva and ipratropium nebs and don't have those symptoms. Well the fatigue yes but that's just me.

They sound like steroid withdrawal symptoms to me so it's possible that your body needs more than it's getting. Have you told your GP how you feel? It might be worth mentioning that you are concerned about adrenal function given you have these ongoing symptoms and can they do the tests sooner.

It shouldn't be post hosp fatigue still as you've been home a while now (ie not a few days). And you're not still weaning, you've been on the same dose a while. So my inclination would be your body not coping with the low dose you're on.

[Ghoulette in reply to twinkly29]

Thank you Twinkly. I'm kind of leaning towards adrenals. Tbf, the fatigue isn't new, it's just not getting better iykwim 😏. I'll try and speak to someone. I might give endocrinology a ring to see when the synacthen test is planned for (I've received a copy of the referral letter that respiratory sent to them).

Thank you xx

[twinkly29 in reply to Ghoulette]

Good idea. If you tell them you have symptoms you're concerned about maybe they'll get on with it!