Has anyone any advice how to get back down to my normal dose of inhaled steroid after a short prednisolone course and chest infection please? Story: I’m maintained on 1 or 2 puffs once a day of Alvesco 80, PF max 380 and very occasional use of Ventolin. I caught a cold virus about 12 days ago and despite maxing my Alvesco to 8 puffs a day and Ventolin 8 puffs my PF dropped to 290. Saw GP who found early chest infection so prescribed antibiotics (which finished on Christmas Day, chest seems fine now) and 40mg prednisolone for 5 days which I started a bit later and last dose was morning of Boxing Day. On the prednisolone my PF stopped bouncing along the 310-320 (my amber/red borderline) and rapidly rose to 340-350 and stayed steady. GP told me to start stepping down the Alvesco immediately I stopped the prednisolone so yesterday (27th) I cut it to 6 puffs of both inhalers. This morning I woke early and breathless with PF back down at 310 again. Ventolin brought it up to 340 , much better than it was helping before the antibiotics and prednisolone, but I’m wondering if I’ve reduced the Alvesco too soon and can find nothing on the internet relating to what I’ve recently been on, and the Asthma helpline is closed until new year. I know everyone’s asthma is unique to themselves but I’m hoping someone here has been in a similar situation and received advice that might help tide me over the next few days, please?
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What to do after prednisolone rescue ended?
I think you should contact gp surgery tomorrow or phone 111 for advice. I regularly need more than one course of antibiotics and steroids and it sounds like you need some more steroids. From the amount of steroids you have been on you can just stop the tablets as you have done but it sounds like you might need an extra dose.
Thanks Bevvy. There’s masses of info out there about stepping up but nothing about what to expect after stepping off the cliff when the meds are finished , and really bad timing with the Christmas and New Year breaks meaning the GPs must be at breaking point. I will speak to someone tomorrow.
I am on two doses of alvesco 160 a day, and fostair 100 mart so up to 6 doses a day.
I understood the max dosage for my alvesco was 320 a day, hence the fostair 100.
I agree with Bevvy that you need to talk to your GP tomorrow. After the new year I would have a chat with the asthma UK helpline 0300 2225800, to have a chat re your medication generally. Then maybe ask your gp for a medicine review.
Thanks Homely2, it’s nice to hear from someone else on Alvesco, I’m pleased with it. I was getting side effects from Fostair and Qvar and the Alvesco was an option suggested after I saw a Respiratory Consultant. When I had a flare and saw the GP last week it was initially to check what Alvesco dose I should go up to, because my written asthma plan was for my previous Qvar. GP checked the NICE BNF guidelines and they say “increased if necessary up to 320 mcg twice daily, for severe asthma” which I presume means a flare.
I was feeling better this morning and PF was 340 but I took your advice and spoke to a GP today, with the weekend and bank holiday coming up they’ve given me a rescue pack of 30mcg prednisolone to use if I’m struggling again or keep if not. I will definitely speak to the Asthma U.K. Helpline next week and get some longer term advice.
I'm on alvesco 160 too,2 puffs x2 day,plus fostair etc x
It is great to have the insurance of some pred.
I personally find the alvesco much more effective than the fostair when my asthma has been out of control for a while. The fostair mart regime is great when I am generally in control, but at present the alvesco is very much needed.
I understand dosages on fostair quite well, but my understanding is much less re alvesco. It is interesting how your GP varies the dose.
I am seeing my consultant on 8 January so will talk to the helpline before then, so I can have some positive ideas of my own for the appointment.
Alvesco doesn’t seem to be prescribed very often in the U.K., possibly because it’s slightly more expensive, but everything I read about it (and I avoid commercial sites) is good. 18 months ago my main problem was throat and voice issues, my surgery could only offer Fostair or Qvar inhalers so I had to be referred to hospital. I’d read about alternatives and spoken to the Asthma helpline (they suggested Relvar) and I was keen on Alvesco because the active steroid doesn’t start to work until it reaches the lungs. It’s been a journey. Although the throat issues were long term and started on Qvar, continued on the Fostair I was switched to in 2017, and still there when I went back on Qvar, GP rightly wanted them investigated first. I always do all the rinsing, gargle, teeth cleaning and yogurt. So I had a throat camera investigation (fine), and a chest x-Ray. That found a wider gap than the norm between two bones in the thoracic area so I had a CT under the 2WW list (alarming but thankfully fine). I was diagnosed asthmatic as a young child, probably before 1960, and never had any respiratory tests beyond PF so I was pleased to get Spirometry and FEV done. My asthma treatment up to 1980 was ephedrine tablets. Anyway, back to the Alvesco. I just asked the consultant whether it might be suitable for me, he agreed I could give it a try and wrote to my GP. The dosage plan was to start on 1 puff of 160 at night (Qvar equivalent dose) and I could try going down to 1 puff of 80 if I was controlled. Discussion was only around which strength of puff, we settled on 160 which he said could easily be increased morning or night if needed, I think he said 2 puffs each time. GP has prescribed the 80. I only started Alvesco in August, dropped down success and it worked well on the 80 without any increase when I had a mild runny-nose type cold a couple of months ago. This latest virus started with a sore throat and fierce cough so I’d already started to step up the Alvesco dose before my PF plummeted and I contacted GP. I’ve been discharged from Respiratory. GP didn’t consider trying any additional inhaler, it was all about how much Alvesco I could take and the chest infection. I am thinking maybe I should stick at the 160 if it might avoid me needing Pred. Interestingly while I was looking around the web I found a research paper trialing a very high dose of Alvesco as an alternative to Pred for some cases, with good results. More trials would be needed and I don’t know if similar trials have been done on the other inhaled steroids but to me it looks promising and seems in line with your experience of Alvesco working for you when you really need it. That’s all I know about the dosage. Good luck with your Consultant appointment, and keep well!
I am on the alvesco as an alternative to long term pred. My GP asthma nurse has been saying I should be on long term steroids, my hospital asthma nurse instead suggested alvesco to the consultant.
The consultant went with the hospital asthma nurse luckily.
I would try a Himalayan salt inhaler & get Himalayan salt lamp(s). I detest the way steroids are dished out. The only inhaler I use is the duoresp spiromax which works well for me & don't have to use it much but it works as a preventative inhaler as well as a rescue inhaler. Hence I have no need for the blue ventolin inhaler.
Even if salt inhalation works for you, there's no good evidence that it works for asthma more generally, and it can trigger asthma symptoms for some people, as from the ALUK page: asthmaandlung.org.uk/sympto...
There are very few good quality studies into salt therapy. A recent review of the research found only one reliable scientific trial. Inhaling salt can also irritate your airways, which can cause coughing and trigger asthma attacks. Currently, most experts do not recommend salt therapy for people with asthma.
There's also no evidence that salt lamps help with asthma symptoms.
Could you please avoid recommending unproven remedies which may be harmful to some people with asthma? healthunlocked.com/asthmalu...
I'm glad that you do well currently on just the Duoresp as needed and don't need a blue inhaler, but that's not the case for others with asthma, who may need additional asthma treatments, including with steroids. Merryroundabout should be contacting her doctor if she's finding her asthma isn't controlled, rather than trying things at home which could make her asthma worse.
Salt therapy is an accepted treatment in other countries. there are 'salt caves' where people with all sorts of lung conditions visit. Basically big lumps of salt in a room. She asked for advice. Steroids are disgusting & just mask the symptoms with side effects to go with it.
As I've already posted, there isn't currently good evidence for its use in asthma, and it may trigger asthma for some people. The fact that it may be an accepted treatment in some places and that some people use it does not change either of those facts.
Steroids do have side effects yes, but also do more than mask symptoms, as they reduce certain kinds of inflammation which are very common in asthma and which are dangerous if not treated. Newer non-steroid treatments are in development and can help reduce steroid use, but as yet there isn't anything that can completely replace them effectively.
Some people have to use sometimes quite high levels of steroids as well as other treatments, and deal with the side effects as best they can. And sometimes there is no option other than a short course of oral steroids to treat an acute flare and stop it getting much worse. Generally everyone would prefer not to have to do this, but some people don't currently have a better way to manage their asthma, or are having attacks which need effective treatment. This is for them and their medical team to decide.
Users are allowed to ask for and give advice within the rules of the community. Those rules *don't* allow members to advise someone else to use unproven home remedies in place of standard licensed treatment for asthma, and make inaccurate statements about those licensed treatments.
What you want is for Uk doctors to only reply to people. Just seems wrong to only do that when all they ever do is prescribe steroids &/or antibiotics. I was going to advise using turmeric milk but I suppose that's 'un proven' to.
If you could point to solid, properly conducted scientific evidence in humans that turmeric milk helps asthma, and suggest that another user discusses it with a licensed healthcare professional who is aware of that evidence, and of the side effects of turmeric and its interactions with any other medication or natural remedies - then you could suggest asking about it. (That goes for anything else too, on any post on this forum).
It's not just anti-home remedies either. People are also not allowed here to say 'take X inhaler, it's great for me' or 'this is my personal regimen I use for asthma, do this' ('I had similar, ask your doctor if X is an option for you' is different and generally ok). People are not all the same and neither is their asthma, but taking home remedies with no good evidence in place of licensed asthma treatment can be really dangerous - asthma kills.
Sometimes steroids and/or antibiotics may be needed - even if they are also prescribed unnecessarily at times. This forum is for peer-to-peer support - advising specific remedies or giving medical advice, particularly unproven home remedies, and particularly in place of getting proper medical advice, is not the purpose of the forum.
Even healthcare professionals are not allowed to give direct personal medical advice in a forum like this - they could get in a lot of trouble.
I don't want to divert from Merryroundabout's question and I've explained the position of this forum on the topic - so can we draw a line here and avoid getting into a natural remedy vs mainstream medicine debate, please? Merryroundabout has said above she plans to go back to her doctor, but others read these posts so I wanted to make it clear.
I'll always agree asthma is different for different people. But if me or anyone says 'this worked for me' then I thought that is the sort of reply people wanted. So sorry, so it seems when someone asks for advice then it appears the only accepted reply is go docs, A&E or ring 111.
It's how you responded is the problem in my view not your ideas. Your judgement that steroids are 'dished out'says a lot about your particular insight and infers that if we are prescribed steroids, maybe we don't require them.A dangerous comment in my view.
After 4 sessions in a salt cave some years ago under medical supervision my lungs were so irritated so badly that I was coughing up fresh blood and ended up in A&E.
This is my real experience.
So alternatives or complimentary additional don't suit everyone.
Peer support Forums are for support not disparaging comments about meds being dished out and then counter arguments with a Moderator.
It derails the real conversation.
Think before you respond again.
Please.
Apologies for what I put. If you met me you'd find I'm easy going. I put a new post about how I've been type 1 diabetic for nearly 40 years so suffered side effects from steroids. Do accept everyone is different so fair points you've made. Again sorry as the last thing I meant to do was upset anyone. All the best.
Fair play to you for coming back about your initial response. Appreciate that.
I do understand your fears around steroids.
We probably all share them.
Unfortunately we have to take them sometimes.
I was on chemotherapy last year and had truck loads to take. They were not fun.
The last thing I wanted to take this week was another course of them. I worry about all the side effects but hey I can breathe again now. I guess that's paramount.
When needed they serve their purpose.
I too used turmeric milk every night for a good while but I wasn't sure if it helped being honest.
It does seem to help some people with inflammation alright.
I can't take it now because it interacts with a medicine I am on but it is also a very pleasant drink!
Wishing you good health going forward!
Thanks Martin153 for replying. I’m not a fan of steroids, hate the side effects and I’m pretty annoyed I’ve ended up needing them. Years ago I had to have 7 weeks of prednisone after having Swine Flu and getting in a pickle but they rescued me and were the only thing that helped. I’ve managed to avoid the tablet form since then but needed them this week. I have heard of salt therapy, there was a salt cave clinic near where I once worked and I planned to try it one day when my asthma was in a good place and I would notice any effect but I didn’t get round to it. I’m pleased it helps you.
Hi, just wanted to add my own thoughts which are that years ago I got swine flu also and was exceptionally ill. I was on high steroids doses for weeks and nebs every 3 hours and it was hard to get off them. I tried some sessionns at a local salt cave and ended up coughing so much from the irritation they caused that I ended up coughing up blood and back in A&E.I do not recommend salt caves for everyone. For me they were an additional irritant which complicated my recovery.
I am a nurse and I had read some interesting articles beforehand and one or 2 robust evidence papers from Eastern Europe. The caves were run by a Polish GP and I was nedically reviewed by him beforehand but my lungs still reacted badly.
Sometimes I require steroids and I do everything I can to avoid them, but this is just the way it is. I am glad of them when I have a bad flare up (like this week).
Maybe our previous poster doesn't have the misfortune to have a flare up that requires steroids. He wouldn't put up the previous message if he had I reckon.
It takes time to step down from high dose Inhalers. It should be done very gradually, so work in with the GP and Asthma advice line to work out a gradual plan of recovery. Sometimes I have just stepped down when allergy season steps me back up again and so it can be a frustrating experience.
Take care.
Hi Celbie, thank you for your reply, that’s very interesting and helpful. I’m sorry to hear how badly the swine flu and the salt cave affected you, despite the safeguards you took, that must have been frightening. The swine flu definitely affected my lungs long term, before then I only needed a preventer inhaler during hay fever season or if i had a cold and since then it’s daily. I didn’t need a neb with the swine flu but remembering the side effects I think the steroid dose was higher than my current rescue course and I was on the highest Seretide dischaler too, it took me almost a year to ease back down. I just knew this time round I was heading for trouble and felt so much better quite soon after starting the Pred, I was grateful to have it even though I’ve got osteoporosis that won’t thank me. As I’m ticking along comfortably at present I will be phoning the Asthma U.K. helpline towards the end of the week- I’m sure they’ll be in huge demand when they reopen on Tuesday. I hope you feel better soon too, and stay well!
Just wanted to add that swine flu did a number on me too! I didn't think I even had asthma anymore when I caught it (in hindsight I was wrong, there were episodes at uni). It didn't make me need steroids so much as trigger Asthma 2.0 for me, which was definitely more severe than Asthma 1.0 and also less typical. I am on 4 preventers now and still not fully controlled.
When drs etc ask me how old I was when I was diagnosed with asthma I say 'well kind of twice...once when I was 7 normally and then again when I was 24.' It took ages to get a diagnosis the second time though - even with my history of asthma and my family history they kept trying to say it wasn't, but didn't have any sensible alternative suggestions though I appreciated them ruling out likely alternatives like heart issues.
One Dr dismissed my previous asthma as 'preschool wheeze which usually goes away' without asking how old I was.or.for any other details... diagnosis at 7 is a bit old for preschool wheeze!😂
Glad to hear things aren't too bad at the moment, hope the advice line is helpful next week once you can get through.
If yr asthma still giving symptoms,I'd step down slowly ea day but use more salbutamol whn needed x
Thanks Patk1
Thank you everyone for responding and trying to help. I was feeling better this morning and PF was 340 but especially with the weekend and bank holiday coming up I called the surgery again and I’ve been given a rescue pack of 30mcg prednisolone to use if I’m struggling again or keep if not. Hopefully won’t be needed but reassuring to have. I plan to speak to the Asthma U.K. Helpline next week and hopefully get some step down guidelines.
Thanks for the comments, especially about salt caves. I use a salt inhaler. In 2016 I was in Burton hospital for 4 nights. 2 days in the acute assessment ward cus no room in the respiratory ward. Drugs dished out like smarties. I was on steroids & my main reason for not liking them is that they can induce diabetes on people who aren't diabetic. Next month I'll have been on insulin for 40 years as a type 1 diabetic. But I have no long term nasties & do a physical job at Ocado near Tamworth. So when on steroids my sugar levels went high. I was on oxygen & nebuliser often. After 2 days I was moved to a quieter ward & actually got seen by a doc from the respiratory ward. Blood test showed severe allergic reaction but never found out what caused it. Thats when I read up on alternatives to steroids. I got better & left after 4 nights. Was odd that they gave me the duoresp spiromax inhaler as I left, not when I arrived. I found it worked brilliant but I know everyone is different. Having turmeric milk has defo helped the diabetes & for over 2 years I have Abbots healthcare libre2 constant glucose monitor & easily get over 70% in target for sugar levels, 77% at the moment. Hope things improve for you.
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