Asthma worsening once stop taking preds

[Casey_87]

Hey

So I am 34y/o and have been diagnosed with asthma since 2018 as an adult. For the past few years my asthma has been controlled with fostair. Since November 2021 after catching a cold and not been able to shake it off I went to see my gp as my asthma became uncontrolled, in January I had a 5 day course of preds which worked and I felt great again then 3 weeks after the course I started with the same symptoms and have just finished my 2nd course of preds, yet again they worked and I feel better. My GP has said that if become unwell again in 3-4 (next review) weeks then I will be referred to a consultant for further input.

Has anyone else had the same thing happen? And if so what has been put in place to help with your asthma.

Thank you 😊

[Poobah]

Your GP is following the Stepwise Asthma Management plan and if your asthma can't be controlled with primary treatment then a referral to a specialist is the next step.

The referral should lead to tests and therefore a better understanding of your asthma type (phenotype) and following that, a variety of meds can be tried and monitored for efficacy. Unfortunately, sometimes finding the right combination of meds is down to trial and error. But the consultant will have wider prescription options than your GP.

The aim is always to achieve control of the asthma with the least amount of medication, mainly as all meds come with side effects and over prescribing oral steroids is the least favourable option for the patient. Over prescribing any medication is never beneficial, so moderate amounts of a combination of meds can be better and achieve more regular control.

You probably already know that all asthma is not the same and can be, at times, as unique as the patient. The tests and blood tests should provide one piece of the jigsaw, while your personal experiences will provide other bits of the jigsaw. Overall, that helps with prescribing choices. But it's always important to review new meds after 8 to 10 weeks, to discuss progress or lack of progress and to consider changing doseage or changing meds.

To get the most out of your hospital appointment be prepared with a clear idea of your asthma patterns, potential triggers, when it's worse (time of day, week, season, exercising etc). And try and leave with a plan - in that what to do if things worsen between appointments. Unfortunately, hospital appointments can sometimes be 6 months apart so you don't want to have to wait until your next appointment if things aren't going well. Say if you're happy with an interim telephone consultation, between appointments, once test results are available, in order to discuss possible medication changes.

And if you're triaged by an asthma nurse before you see the consultant, ask if you can get the clinic contact details for use between appointments. I've found the nurses are very helpful and they can be approached (email, telephone) if you need info or help between hospital appointments.

All the best.

[Hidden]

My last couple of asthma attacks (I too use fostair) I found 5 days of prednisolone just didn't entirely do the trick so my GP prescribed a weaning off process over 3-4 weeks and that worked well.

[Keisha192001]

Mine has been the same. I was controlled on 1 puff morning and night of fostair until I got ill at the end of September and then I had antibiotics and 2 back to back steroid courses and still uncontrolled now even on 4 puffs morning and night. I started montelukast a couple weeks ago and we’re waiting to see if it improves my asthma before changing inhalers or referring on

[Casey_87 in reply to Keisha192001]

I’m the same I was on 2 puffs morning and night and since I caught a cold my asthma has gone awol. Iv been on montelukast for 3 weeks it’s helped at night along with the preds, but then 3-4 weeks later I’m back to square 1 of not been able to breathe. Have a review today and then In 4 weeks. If go back to been unwell within 4 weeks then they are referring me.

[Bob987]

Mine was the same back in October. I was put on pred for 5 days, and a week or two later needed another course of pred. This went on for a couple of months and the hospital put me on montelukast and Spiriva which didn't have much of an effect. In the end, my GP put me on a 5 week course of pred with a lower dose each week. This worked and I've been pred and symptom free for 6 weeks.