Defining well controlled asthma

[Dogsbody2all]

Hi all. I’ve looked around online as to what well controlled asthma is because that’s what we’re supposed to be aiming for, right? Here’s the gist of what I’ve found:-

• Few to no symptoms day or night

• Perform daily activities without symptoms

• Sleeping well

• Normal (for you) peak flow

Does that mean that I should be able to do pretty much what I want, as long as it's not something ridiculous like walking through woods when tree pollen is a trigger, OR should I be able to do that too? If I stay indoors and keep the doors and windows shut all year round then I can achieve that list but it's no fun and pretty darned boring.

I have so many things on my trigger list that avoiding them all is nigh on impossible. For the most part the meds I'm on (DuoResp Spiromax 160/4.5, two puffs twice a day; Montelukast 10mg at night; Fexofenadine 120mg, one tablet twice a day) do a decent job - until they don't. Plus, my immune system decided that being triggered by cold air (below 10-12 deg C) and tree pollen wasn't enough. Last year it decided that I should also be plagued by grass and weed pollen too! So even less time in the year to go out for a walk, like I used to be able to do before asthma entered my life.

Asthma has taken away so much of what I used to enjoy doing and I'm feeling quite resentful about it. Should I be talking to the asthma nurse or GP, if I can manage to get an appointment, to change meds or dosage so that I CAN go out and about as I want for more than 2-3 months a year, or am I expecting too much and need to learn to settle with where I am now?

Apologies if this is rambly or disjointed. My asthma is playing up at the moment and it always affects my thinking skills. In fact, the brain fog has been an issue since my last exacerbation over Christmas - treatable at home, fortunately.

[Homely2 Administrator]

I am much the same, my asthma is controlled today if I lie on the sofa, with an air purifier on. Anything else and my asthma is very unhappy, with the pollen. However I have not been hospitalised for over a year and no pred for five months, though maybe again soon.

To my mind my asthma is not well controlled until I can do what I want, when I want, within sensible bounds.

So when I next see my consultant, he will be happy that my pred use is way down, my issue will then be making him tweak my meds until I can function again, doing what I want. My consultant will be more wanting to get me off his list, as he will say my asthma is now chronic rather than acute.

I will approach this by going to my consultant with some ideas, mainly gleaned from the medics on the asthma UK helpline.

So yes talk to your medics, but I have always done better when I go to the appointment with some sensible ideas to try.

Also try the asthma UK courses, the breathe easy increased my knowledge, it is free and online.

[Dogsbody2all in reply to Homely2]

I've had a fair few sprawling on the sofa days over the past 6+ years. Hope you can recover without the pred. I've not been referred to a hospital consultant (yet). It might be something to push for. And thanks for the tip about the courses. I'll look into them.

[Chip_y2kuk]

I think this is very personal and individual .... but my stance is *it's normal* to go outside and be in the sun ... pollen and all ... so i should be able to do this too.... if I can't do it something is not right.

[Dogsbody2all in reply to Chip_y2kuk]

It's nice to know it's not just me that feels this way.

[Gareth57]

As others have said you should be able to do pretty much what you want.

This isn't applicable to everyone but I'm a strong believer in exercise, this last year I've got back to it after a spell of not exercising so much which saw my inhaler change to Fostair 200/6 with montelukast added, for 6 months now I've reduced my inhaler use by half and after a review last week I'm back on the 100/6 Fostair, and I can breath deeply without coughing. Unless I've just "grown out of it" again at 67! 🤷🏻‍♂️

[Dogsbody2all in reply to Gareth57]

Glad to see you're improving with exercise. I find it helps with my mental health.

I do strength training three times a week (when the lungs and achy bits let me). It's the cardio side I struggle with. I love going for walks, but a treadmill just doesn't do it for me. Swimming's out because I get too cold. Not quite bad enough for Raynauds but along the same lines.

[Gareth57 in reply to Dogsbody2all]

My dog is getting out more and I cycle when I can which really cleans out the lungs and makes them stronger

[ChromoneLover]

My asthma was really well controlled using (inhaled: Intal/Rynacrom) sodium cromoglicate, for over 45 years, until it was de-listed. I had virtually no symptoms, so could live life to the full and took up competitive mid-long distance running and athletics.

Then, NICE or MHRA DE-LISTED it, as it did not work for everyone, and is a prophylactic 'allergy preventer', NOT an asthma treatment.

I am very unhappy about this, as no other cromone drugs are available for inhalation, in the UK: only as the eyedrops and the 100mg (prescription-only) Nalcrom capsules, for food allergy.

I am now forced to purchase sodium cromoglicate privately, from the USA, or face COPD and very restricted lifestyle, on steroids or Montelukast, since antihistamines don't work for me, and it is the grass pollen allergy that causes my asthma. 😒😢.

[Dogsbody2all in reply to ChromoneLover]

Rolls eyes at NICE/MHRA. You'd kinda think they'd know drugs work differently for different people.

[frustratedasmathic]

Hello, I am sorry to hear you are suffering in this way.

I can only talk from experience and would recommend looking into the new allergy drugs to suppress the immune system. These appear to be ideal for the allergic asthmatic and getting at the root of the problem which is stopping the mast cells producing the histamine and getting relief from the dreadful symptoms wheezing, shortness of breath, runny nose and eyes etc.,

About 5 to 7 yrs ago these new drugs became available but they are due to go generic after the patent has run out which I believe is 8 years. So hopefully about 1 more year. I am hoping that these will become available for people like u and me with bad allergic type asthma very shortly.

Another alternative to traditional medicne is Chinese medicine Accupunture . I have found to be extremely beneficial particularly when having symptoms. No sooner has the clinician applied the tiny needles and I feel the benefit of been able to breath in a way that I very rarely have felt. This is something to be really mindful of particularly as I am extremely cynical of any alternative therapy. But do investigate and go to a qualified practitioner. It's not cheap but certainly after 5 regular sessions I was not using my inhaler as frequently.

Ask to be referred to an Allergy specialist centre. There are a few of these now at some of the main Hospital s in London ie Guys.Brompton and St Mary's.

Go onto the Asthma and lung UK website for any advice. They have qualified Asthma Nurses who maybe able to give alternative advice on controlling the asthma. But based on what you have said I feel an Allergy Specialist is your better option.

Personally I have found Fexafenadine to be a very good antihistamine. Maybe you need to ask your Dr for an increase when your allergies are particularly troublesome.

I hope that the above has been of some help. Please note that I am not medically trained but just a long suffering allergy/asthmatic sufferer.

With every best wish for better controlled asthma and allergies

[Dogsbody2all in reply to frustratedasmathic]

I've had acupuncture for other things, never really thought about it for asthma. I'll look into it.

[ChromoneLover in reply to Dogsbody2all]

Acupuncture can make you more relaxed, maybe airway muscles too(??) but it can't stop you being allergic: that is an immunological reaction.

[ChromoneLover in reply to frustratedasmathic]

I have seen allergy specialists, and am pretty sure that my allergy is (unusually!) NOT histamine-mediated, which is why antihistamines do not work for me. Every time I have been treated with steroids only, the bronchitis (2-3 times per year!) has returned, so something to do with the effect of sodium cromoglicate, is preventing the bronchitis that I used to get at the end of the hayfever season, and at least once during Winter.

I was diagnosed and treated at the Brompton Hospital, but nothing they tried worked, and my lungs were getting more and more scarred, until I was trialled on Sodium cromoglicate, at the age of 21, which was a life changer!!

[Dogsbody2all in reply to ChromoneLover]

I have a telephone consultation tomorrow. Don't know who with. I've asked for any/all of the following - tweak meds, change meds, refer to specialist. Let's see what happens.