Call asthma doctor? She doesn’t help much. Long term prednisone.

[Shadowcat04]

It seems like the fall often bothers my asthma. I was hospitalized in fall 2019 for 6 days for severe asthma exacerbation. Then COVID started. I’ve been on oral prednisone since fall 2019. I’m on daily 25 mg. My doctor is trying to lower the pred. She says it’s not doing anything now my body is just used to it. But, whenever I lower it or have forgotten, my asthma gets bad and I feel terrible. Anyway, I did lower it to 23 one day this week and I’ve taken a little less than 25 every day this week.

And, perhaps coincidentally, I’ve been having some trouble breathing this week. I’ve needed my inhaler at least once daily and often twice. My breathing is tight and I’m coughing (a main asthma symptom for me). Twice now I’ve had to get up at night for my inhaler. I’m also exhausted. When I do an activity (laundry for example) I am quickly out of breath. I also take dulera 200 inhaler, spiriva, montelukast, xyzal. When I’ve checked my peak flow meter it has been between 275 and 325. My usual medium low is 375, my regular is 450.

Thoughts? should I keep using my home treatments? Call in? Urgent care? Online doc? I feel like my pulmo has given up because I haven’t been able to lower the pred. I appreciate any feedback.

Beth

[Bevvy]

Ok I think you in USA? Certainly it sounds to me that you need to be seeing a doctor ASAP. You may well have an infection and your results currently are not good. You should even consider ER. I don’t know time difference so uncertain if you can contact your regular doctors. If not I think ER needed.However re long term steroids- if is known that autumn is particularly dangerous time for you (it is for me as well so understand what you are saying) it seems ludicrous to me to try to reduce steroids during your worse period of the year.

Finally please remember we are not doctors here and so limited what can/should advise. Just from what you are saying sounds like you are in “red” area and need at very least to be checked out by doctors.

[peege]

Hi, I'm wondering if an air purifier in your home may help.As Bevvy says, best get checked out in case it's an infection, it deffo sounds as though your asthma isn't controlled for some reason Shadowcat04.

Regarding cutting down on a medication, a few years ago I wanted to stop a daily tablet, I tried by taking half a tablet per day for two weeks then stopping it. I felt absolutely dreadful & had to take it again. I rethought and decided to cut down over 3 months very gradually by using a pill cutter. It worked.......only a suggestion for later on when it's safe to reduce your pred. Personally, autumn (fall) & early winter are the worst asthma time for me. All that damp and mould spores about.

Good luck, Peege

[Poobah]

There are options available to your asthma doctor to try a different combination inhaler to Dulera 200. I swapped from Symbicort to Fostair and found the change really beneficial. Everyone is different though and trying to find the best inhaler for you will be a matter of trial and error. As to why we get on better with one LABA inhaler to another - who knows?! But if you do change inhalers, give it a good 8 weeks to ensure the change in steroids have time to have an effect.

There's also the option of long term, low dose Azithromycin instead of Prednisolone for the treatment of severe asthma. I respond much better to Azithromycin than to steroids and tolerate it much better. A four month course sorted out long term inflammation so well that I didn't need another course for 3 years.

Biologics are also another option and are approved by the FDA for the treatment of asthma.

Also check out this website in case you fall into the AERD category. Their resources on foods to avoid are spot on. samterssociety.org/

A discussion with your asthma doctor about your phenotype is important in understanding your asthma and how to treat it. I'm still learning after decades and so are doctors - we're learning from new research all the time.