I was diagnosed with Addisons in May 2023 and have been using inhaled steroids / seretide for chronic Asthma for 20+ years. My endocrine consultant told me to stop taking my seretide which I declined to do, as Asthma extremely well controlled, unless he refers me to Asthma team at hospital to manage this. He has declined to do this. I am on corticosteroids for Addisons and can not reduce these. My Pharmacist suggested trying to reduce inhaler which I did for 2 weeks. This caused a drop in peak flow from 425/450 to 325/350. I also needed to use more salbutamol so felt Asthma not controlled and so went back to original inhaler dose. I am now experiencing other side affects, raised blood pressure and breathlessness which increase after inhaler and hydrocortisone tablet. My GP wants me to change to a non steroid Inhaler. This concerns me as am worried my asthma will deteriorate. I feel medics do not speak to each other enough to discuss the best thing for me. I feel my quality of life has deteriorated and my GP thinks I am being negative about changing inhalers. I am not, and when I asked if he was able to take advice from respiratory team he didn't respond positively.
Any advice from anyone who has had similar issues I will be grateful, as do not know how to move forward.
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Flowerdac
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I can understand your concerns Flowerdac, with both the endocrinologist and GP wanting you to take a leap without a safety net. I think it may be beneficial to discuss your case with one of the Asthma UK nurses. They're extremely knowledgeable and will go through your options and listen to your concerns.
They're available Mon to Fri, 9 to 5, on 0300 222 5800.
I totally sympathise with your concerns Flowerdac. I would also feel the same. My advise is that you should firstly speak to the Asthma UK Nurses on the helpline. Also, are you under the care of the Respiratory Community Nursing Care team in your area? By what you have said your asthma is chronic and does fluctuate so you should have been referred to the team, as they manage and help patients with COPD and chronic Asthma. And their knowledge with all chronic respiratory conditions and treatments is extremely extensive. They would also give you help and advice taking into account all your health history because they would have access to your medical records. And they have the authority to request you be seen by a Respiratory doctor if they believe that is necessary. The teams consist of Specialist Respiratory Nurses, Physiotherapists and Occupational Therapists and work in the community as well as hospital clinics. I would speak to your GP surgery and find out if you need to be referred or if you can do a self referral and the GP surgery will also have the team's contact telephone number.
I send you all best wishes and hope your concerns are resolved soon and that all the changes you are currently experiencing will be corrected and settle down. Take care.
In no way are you being negative. You are being realistic. They are not actively listening to you. Seretide has two ingredients. One is the corticosteroid, the other is a long acting broncodilator. The doctors are concerned that by taking the corticosteroid for the Addison's that you may not need the one in the seretide.
However, they are also taking you off the long acting bronchodilator in the seretide which would be detrimental for your asthma. Also seretide is inhaled which means the corticosteroid in the seretide goes straight into your lungs.
If you have a respiratory specialist, you need to discuss this with them. Taking you immediately off the long acting bronchodilator after so long without any alternative put in place is not in your best interests health wise.
I agree with others suggesting to call the asthma nurses on the helpline. I don't think your GP or endocrinologist really understand how asthma works or how it should be treated, and I'm wondering if you could see another GP at least and try to explain the issue. They at least shouldn't be ignoring your request to see someone who does understand how to treat asthma in this situation.
Inhaled steroids for asthma and hydrocortisone for adrenal insufficiency (AI) or Addison's are doing a different job - and the hydrocortisone is really just supposed to be replacing what you're not able to make yourself.
I'm not a doctor but need to read scientific papers for work and have done some work related to asthma. From what I've read, it seems that currently everyone with asthma does still need an inhaled steroid even if they are also on other medication - the dose and what other medications are given (if any) depend on the patient and their asthma. This is different in COPD where not everyone needs or should have an inhaled steroid, though some people do.
As Tugun points out, by reducing Seretide you're also reducing the long-acting bronchodilator element which won't be helping, Someone needs to consider both conditions and sensible options, but they should not be deciding that your asthma isn't important and that you should just put up with symptoms and inappropriate asthma treatment for the sake of reducing steroids at all costs. That isn't fair on you or safe - uncontrolled asthma is dangerous.
It's also not ideal for your Addison's, because poorly controlled asthma is a physiological stressor which will probably be increasing your need for the cortisol you can't produce yourself. I had steroid-induced adrenal insufficiency and found I needed more hydrocortisone when my asthma was flaring, as do most people in that situation with Addisons or any kind of AI.
I should add that no one ever told me I should even reduce my high dose inhaled steroid (Fostair) when I had AI, except briefly for tests. Even then, my endocrine nurse wrote that I should only stop it for 24 hours not the preferred 48, because I had a hospital admission for asthma once soon after an AI test where I stopped my Fostair, I do have severe, poorly controlled asthma which probably made them more cautious, but even so they were rightly not ignoring my asthma.
You may also find something helpful in this post I wrote. It's more for people who developed AI *from* steroids for asthma, like me. It sounds like that isn't the case for you - so it won't all apply to you. However, you may still find it helpful, including the links. healthunlocked.com/asthmauk...
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