In need of advice

[Bob987]

Hi, I had a bad asthma flare on Monday. GP put me on prednisolone. 4 days later and still struggling, coughing fits every 20mins, chest tightness and finding breathing tiring. Had 8 puffs of Fostair and 9 puffs of ventolin today and still struggling. GP told me to go to A&E as I needed a nebuliser. No nebuliser given as I wasn't wheezing and "all asthmatics wheeze!" (I never wheeze, I cough!) Sats normal (they always are) and chest sounds clear but they've given antibiotics anyway as they didn't not believe me when I said I was struggling with my asthma. What do I do now? Any advice would be greatly appreciated.

[IChoose]

Wow! First of all, what triggered the flare? Did you come down with covid, flu, etc? It's usually a virus with me. Or exposure to an animal indoors or a severe pollen outside. And of course, chemicals including disinfectants.

I don't do well on prednisone, medrol, etc. I do much better controlled with inhalers. I will give you what I stabilized on in 2017 (after lots of medrol drama - shots and pills):

Maximum Strength Mucinex 1200 guaifenesen only 2× daily

1 hour later 2× daily duo neb ( albuterol + ipratropium) via nebulizer followed with 2 puffs qvar 80.

10 mg monteleukast at bedtime.

I don't wheeze either, my lungs always sound clear unless I have an infection. I have had a home nebulizer most of my life. I use the devilbiss pulmoaide.

When I get sick I always need antibiotics. It was my asthma regimine +zpak that saved my life when I had covid this year, but I have not been the same since.

I had a hard time with the covid vaccine as well.

For a few years I was on theophylline 100 mg 2× daily but we stopped that last year when I had a dangerous interaction with an antibiotic. It did not seem to be a problem at all stopping theophylline and i think my blood pressure is better as a result. Theophylline reacts with a lot of things.

That's all I can give you. It's clear you've been triggered. Now you need to stabilize. I'm so sorry if you're getting lousy care. If you can, and you need to, switch doctors. Otherwise, lots of office visits until you're stable.

And remember, decrease stress.

In my experience, you need an allergist or pulmonologist. An allergist who is a real pro and is also a great internist is really what's needed. The PCP, GPs in my opinion know absolutely nothing about asthma. If you see an allergist and get skin tested that could show up what's causing the flair.

This is all I can think of

[Bob987 in reply to IChoose]

Thanks for your reply. It was the cold weather that triggered this flare. It normally gets worse every winter but never this bad. I spoke to my asthma nurse the morning after and she told me to get to the GP surgery asap. Was on a nebuliser within a minute of walking through the door. On another course of steroids, advised to max out both inhalers for the next few days and have also been put on montelukast. They're checking in with me every couple of days for the next couple of weeks and have given me a note for a&e in case I have to visit again.

Asthma nurses are worth their weight in gold!

[ReedB]

Hi,With everything you've said I would be contacting your gp again ASAP. Usually after three days of prednisolone at 40mgs a day asthma starts to calm down so it's a little worrying you're stil struggling so much.

I never present with a wheeze either (sometimes a tiny one if I have an infection) and Sat's only drop if I'm on the brink. Sadly, its pot luck if doctors t A and E provide the right treatment when they meet asthmatics that aren't wheezing. If you're taking that much fostair and ventolin in a short space of time then don't be put off calling for an ambulance.

Some tricks I've discovered when I'm struggling:

Making sure I take inhalers at the right time. Including ventolin. Don't wait til you're struggling. Ten blue through a spacer every 4 hours is similar to using a nebuliser.

Hot water bottles! I find the heat on my chest/back soothing and relaxing. As well as sucking sweets. Along with breathing exercises.

If cough medicine works then maybe worth a try just not all day long... If its an allergic response then an antihistamine may help?

Sorry if this all seems obvious but maybe something may help.

[hilary39 in reply to ReedB]

I agree with all this advice and am wondering too if you can get in to see your GP again

[Bob987 in reply to ReedB]

Thanks for your reply. Saw my asthma nurse the following morning and she spent over an hour with me. Things are starting to improve.Thanks for the tip about the hot water bottle. I find that sitting in a really steamy shower helps but it's not always possible so going to give the hot water bottle a try next time.

[Sparkywoo]

Bob that’s appalling. In this day and age why are people still judged as not having asthma if they’re not wheezing. Like yourself and the other two people who have replied I never wheeze no matter how bad my asthma is.

Call your GP ASAP.

[twinkly29]

Agree with ReedB that you need to go back if the inhalers aren't helping. Definitely difficult to contemplate with a response like you had but needs must.

Taking a "summary" can help (though doesn't always) - ie list of symptoms that you get (and specifically that you don't wheeze!), any known triggers, etc.

It could be that you have a virus and the repeated coughing fits are actually the virus not asthma - which the antibiotics won't help with of course. If the steroids aren't helping after day 4 I wonder if the coughing is more viral than asthma as steroids should be helping by now if it's an asthma thing (assuming they normally work for you). Sometimes they only begin to kick in after a few days and so a longer course is needed, but it's odd they've not helped at all. Have you tested for Covid? There are so any viruses "out there" (not just 'oh it's not covid so must be flu' as so many assume!) but it would be sensible to rule out covid - for isolation purposes not because of potential problems - in my experience covid is much less likely to mess with asthma than other viruses do!

I would call your GP again today to let them know what happened though.

[Bob987 in reply to twinkly29]

Thanks for your reply. I had 3 Covid tests in 3 days, all negative but not everyone's convinced! Saw my asthma nurse who immediately declared my cough an asthma cough and put me straight on a nebuliser and adjusted my meds. Thanks for the tip about having a summary - it'll hopefully save a lot of time and stress if I end up in a&e again!

[twinkly29 in reply to Bob987]

So many things about that are similar to covid - no surprise really as covid is a virus lol. Also it's a type of coronavirus which (shockingly!!) causes symptoms like other coronaviruses 🤣 But yes 🙄 to people being adamant it's still covid when you've repeatedly been cleared. I suspect if it was covid it wouldn't be affecting your asthma!

Glad the nurse did the appropriate thing - hope things are more settled now?

[IChoose in reply to twinkly29]

Uhh ... Not so fast re covid.

Last August I presented in Emergency Room with what my ER doctor told me was very likely a mild strain of covid. He said I likely would test negative, which I did. I asked him as they had taken chest X ray could it be asthma attack. He said no, it's covid. I was given zpak by my asthma doctor and then cipro and I was finally recovered in November. I highly recommend zpak of they are not sure.

After that I started a zinc, vitamin d, vitamin c regimine per one of my doctors offices.

I got the full whammy horror covid in January and was positive until June 3. I have not been the same.

All my best to everyone!

[twinkly29 in reply to IChoose]

Ah well I did mean for people who are double vaccinated which is most people in the UK. In any case, most people with asthma are no more likely to be affected by covid and haven't had the severe complications from it that was originally feared - that's been known since the summer of last year. Of course there will always be exceptions but this is generally the case. Much "covid breathing symptoms" are not related to asthma at all. Again always some exceptions but most issues respond brilliantly to respiratory physio even if that takes time.

Now, most double vaccinated people here (asthmatics or not) are unwell with all sorts of viruses - and those who are particularly unwell often do not have covid. Good sign the vaccines are working though as they are preventing serious illness.

Of course 9/10 months ago or longer this would have been different because people had not been vaccinated. Although I roll my eyes at a doctor who is adamant something is covid despite a negative test - they can't possibly know that and it probably wasn't - if it had been then you wouldn't in all likelihood have it again after just a couple of months.

[ChrissieMons]

Insist on seeing a consultant. You can’t go on like this as the worry about not getting better is making you worse. Your GP said you need a nebuliser, so see if you can have one at home. Maybe they’re right and it isn’t asthma, so see an expert and find out what’s really wrong.

[Bevvy]

I don’t understand why gp cant give you a nebuliser at the practice. When I have been bad (before having nebuliser at home) and gone to gp he put me in a room and gave me nebuliser. Have only had at hospital if been so unwell needed an ambulance.Certainly as others are saying you need to contact gp urgently. IF unable to get anywhere with gp phone 111. They can send paramedics who can also treat you with a nebuliser.

[ribblevalley]

Im glad you say you dont wheeze as I don't either nor do I cough. However they wont give you a nebuliser unless you wheeze apparently?? They have told me to take my ventolin through a spacer 10 x in 10 minutes - this has the same effect as a nebuliser they say.