Managing asthma while reducing steroids

[Celie1]

Hi, hope you’re all ok.

I’ve been lucky that I’ve been steroid free for about 5months and my asthma’s been fairly under control, which for me means taking ventolin maybe 2 or 3 days a week and sometimes several times during ‘that’ day.

I recently caught a cold and I’ve been really congested with sinus and chest infection 😩 , lost my sense of smell and taste too (not COVID), so doc gave me a week’s supply of antibiotics (on top of the Azithromycin I take 3 times a week).

The doctor also gave me 5 days of pred. I explained that it usually takes at least 2 courses plus a weaning off to get the asthma symptoms back on track (not that I want to take the horrible things! He wanted to do things his way, so today is the last day, although he has given me a wean off, reducing by 10mg every 3 days. Last time it was reduced this way I had to go to A & E and ended up back on the full dose!

I’m still waking at 4.00 a.m. to try and clear my tubes and it usually takes about an hour or more before I stop coughing. Also short of breath just doing regular moving around, not too bad though. When I start the ‘wean’ to 6 I’m sort of expecting the shortness of breath to get worse, so I thought maybe if I just take ventolin every 4 hours until I’ve finished the wean that it might help with the adjustment. What do you think?! 😬😬

I have this dread of having to take more pred and more and then do the whole weaning over weeks as I’ve done before.

Thanks for any advice - 👍I’ve probably asked all of this before! 🤦🏻‍♀️

[Karenjaninaz]

I have been on prednisone for polymyalgia rheumatica 6 years and asthma steroid inhalers. It’s important to taper slower; the body needs time for the adrenal glands to “wake up” and produce their own cortisol. Even with my slow, endocrinologist approve, taper my asthma needs more Ventolin than usual - but once I stabilize on that dose breathing is better and I taper further. I is normal to feel rather unwell tapering after a hefty steroid treatment. Consult your doctor and perhaps ask to lower slowly. An endocrinologist will certainly agree.

[Celie1 in reply to Karenjaninaz]

Hi,

Thank you for your reply. Hope you are well just now.

I tried to tell him I usually need a longer course, certainly more than 5 days and about the taper. Unfortunately, he is the kind of doctor who likes to go ‘by the book’ and I can understand his caution, but a look at my medical notes would have given him information relevant to me and my symptoms.🤷🏻‍♀️ I think some doctors just lump all the asthmatics together and treat them the same!

It wasn’t until I got home and read the box I realised the tapering was over a shorter time, the same as last time when I ended up becoming very short of breath and needing to go to A and E. I think he did tell me what the taper would be, but I didn’t listen properly, as I wasn’t feeling too well. I remember trying to tell him it didn’t work last time and even mentioning the hospital.

Anyway, if I feel that the ventolin isn’t helping, I’ll get back in touch with the doctor. Thank you 😊

[Karenjaninaz]

When I took 40mgm prednisone for 5 days, for a cold, I had no problem going to my baseline taper( for another disorder).

. As long as one keeps the high dose under 10 days, coming off prednisone should be OK but, with asthma, it can be a lifesaver.

The cough tends to hang around longer for us. Interestingly, I had Covid in September, and my O2 did drop so I was given the monoclonal antibodies- a Godsend.

[Celie1 in reply to Karenjaninaz]

Thanks for your reply.

I’ve had prednisolone lots of times, but unfortunately have problems weaning off, even from a short course. Hopefully it will be ok this time.

Glad the antibodies worked for your COVID symptoms.

[Trazj]

The rule is to aim to never have to take ventolin by taking just enough preventer ie steroid inhaler etc to keep symptoms at bay.

[Karenjaninaz in reply to Trazj]

In my case, with my current taper for a non asthma issue, I need ventolin when I normally don’t. It’s a transition period I must go through. I have been on prednisone for 6 years and my adrenals have to wake up. My asthma “grumbles” during that time. (Retired nurse-anesthetist here).

[Celie1 in reply to Trazj]

Hi

Thanks for your reply.

Yes, that sounds ideal, if you’re lucky enough to have asthma that responds well to meds. Unfortunately I’m on all the meds available and still need to use ventolin a few times most weeks.

[Hidden]

I always hate the wean too. If using the blue inhaler gives you confidence then I don’t see why not. Did you discuss this idea with the doctor? It might be worth having this conversation. Remind the doctor about Personalised care and working to get you best quality of life rather than quantity. There is two free courses on personalised care in nhs on future learn if you are interested in learning more.

I start a wean on Wednesday but first I am being reviewed tomorrow Tuesday by my asthma nurse. Is that another option speak to an asthma nurse first?

[Celie1 in reply to Hidden]

Hi,

Thanks for your reply.

A few years ago, a doctor advised me to do this during my asthma flare up. It worked ok then, until I stopped the regular doses of ventolin I had been taking during the course of prednisolone and then the asthma flared up again. Probably because I still had an infection. It’s always difficult to know what’s going on internally isn’t it 🤔.

It’s not that easy to get doctor’s appointments or nurse ones for that matter, to discuss how I’m feeling about the way the reduction is handled. I did say at time of the appointment what had happened previously with this kind of reduction, and that didn’t alter his thinking. Also it’s difficult to be assertive and to think of the things you might want to say when you’re feeling unwell and short of breath. My next nurse appointment isn’t for a few months now, it was organised straight after the last one.

Personalised care is interesting, I might look into that, thank you for highlighting this.