Chest infection/asthma exacerbation and tapering steroids

[Leigh2305]

Hello, so I started an asthma exacerbation about 11 days ago. Started my pred then started with a chest infection. Had a neb at a and e Thursday as peak flow wouldn’t change from 60%. All my obs were fine. Slight improvement yesterday

When sent home from a and e I was told to taper my steroids as I was on day 8 of 40mg. So today is day 2 of taper 30mg. 20mg tomorrow for 2 days and 10mg for 2 days and given another week of antibiotics.

Thursday I had my respiratory appointment where I was finally able to have an add on inhaler. And due to awful cramps they swapped my fostair. So I now take relvar and spiriva.

The issues I’m having is I now have a really dry cough, my rescue inhaler clears the coughing fit after about 6-8 puffs. Some coughing in between. My peak flow is around 70% going to 80% occasionally. I’m checking a lot.

It’s currently 70%, which is 500 as when well my peak flows 720 so when attending a and e without a wheeze unless they hear a crackle they send me home even when I’m really breathless.

I only got a neb Thursday as I held my chest while talking to the doctor because at that moment the tightness was increasing whilst he was telling me I can go home with a taper dose of steroids. The nebs helped loads I could get a full breath

If I phone 111 they will tell me to go to a and e due to asthma symptoms. Unless my o2 drops or im loudly wheezing when I’m there they will tell me to carry on with antibiotics and if same doctor on duty to taper

Plus in a and e because I have a cough I’m segregated of to the covid section as I was on Thursday. I don’t want to sit with covid people when I already have a chest infection and asthma exacerbation. I was sat opposite a lass who either had covid or flu that worries me about going to a and e now

Do you taper steroids when you’re still in an exacerbation?

[twinkly29]

The changing of your inhalers right now (as in swap from Fostair) is part of the issue I think. Doing so stops the steroid that was built up in your system and of course the new one takes about 8 weeks to build up. So them doing this now when you're recovering from something is just going to add to issues - it's possible that the exacerbation is being managed but then meds change is now causing extra issues. So 😫 to them really!

Some people sometimes need pred anyway to see them through this change. So reducing it now would be silly, in my opinion.

If you know you'll be able to discuss with a GP or AN on Monday, I would personally keep at whatever pred you're on until you've done that, explain the issues as you have here and ask what they think about adjusting the taper (ie slowing it down) given you've got/had the exacerbation and they've changed your preventer meds which need to build up (not suggesting you'll need the taper for that long but continuing to drop every couple of days right now while your body is under-treated with oral steroids isn't ideal. So maybe they'd do say 5 days on each amount (random number plucked there!)

If you're not sure about GP contact, you could just keep on what you're on now and then phone and say urgent asthma issues and hope...

Another option might be to keep doing the taper and cross your fingers but use vent every 4 hours as required - it's ok to do that given you're having understandable issues post exacerbation and with treatment change. And you're clearly monitoring things and know when it's not right to stay home - but do go to a&e if you need to. Maybe write down what's gone on so far in case you need to as it gives them a background?

[Leigh2305 in reply to twinkly29]

Thanks. I wondered if some could be due to swapping my fostair for a different inhaler. Whilst the lack of cramps is definitely a welcome bonus. Even with the increase in ventolin they aren’t as bad as they have been during flare ups on the fostair.

Hopefully once they’ve taken effect then I won’t have as many flare ups as this is the worst I’ve had for a quite a while. I thought I would be back at work on Monday but I’m thinking maybe not now

[twinkly29 in reply to Leigh2305]

See how things go but might not be a go-er! But....better to avoid a big dip on top of things already recovering. Increasing potassium (through diet) can help well with cramps left over or caused by the extra vent and oral steroids needed at the moment.

Hope things stay settled enough for you and that the new meds kick in quicker than average!