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Please can anyone advice me on Monitoring Asthma Patients

10 years ago•10 Replies

Can anyone advice me please, on what type of monitoring should I expect by my GP /Asthma Nurse, on my visits to find out how my well or not I'm really doing on my current treatment, apart from recording my peak flow, which I do regularly myself .

I feel the only way their monitoring my progress is based entirely on how many times I go back to the surgery, I have had my inhaler changed Four times over the last 7 mths, usually by 'shall we try this one' based only on what I tell them as to how I'm feeling , I'm generally concerned the amounts are increasing with every change which I feel is just a 'ok well lets try this one next at a higher dose' ! doesn't sound right to me.

I was changed two months ago to Flutiform from Seretide because of the cost, now this is not holding me for twelve hours , I'm back coughing evening and first thing in morning. I would welcome your comments greatly.

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JuneCov

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10 years ago

Hi June I have had asthma for many years along with copd now. I saw an asthma nurse every 12 months to check how I was doing and to make sure my inhalers were still doing the job and to check my technique of taking them etc. They also took my weight and BP and asked me questions about smoking etc. I always had a peak and flow done. My inhalers were added to or changed over the years and yes most of them were higher doses but I don't see how else they can do it. A lot of it is trial and error to try and find dosages and types that suit you. Not sure what else you expect as it is not an exact science you know.

In fact my only complaint afterwards was that I hadn't been given the symbicort much earlier as when I was diagnosed with copd as well and given better meds my asthma hugely improved and the nurse said I had probably had poorly controlled asthma and maybe not copd at all then though I do have now. x

JuneCov• in reply to10 years ago

Hi coughalot, thanks for your early reply, your info has helped me, thank you I went on the Asthma Uk sit earlier and they tell me the same, also I should have an agreed treatment plan with my GP / Asthma Nurse, and should be offered at very least a check on my peak flow, and or spirometry to check whether I'm improving on the inhaler or not, this as you probably know tells what level of air I can expel from my lungs in 1 second, then compare that to a normal expiration, these details are documented for reference which makes sense to me. I just don't feel I'm being monitored properly at the moment

Take care stay well

peege10 years ago

My asthma is moderate. I was based in SW London for the last twenty years.

Since diagnosis approximately ten years ago I had annual check ups with the respiratory nurse at the gp practice until the last four years when I've been bi-annually.

Quite pleased with my service at the GPs even though they were very slow to take the continuous infections & pneumonias seriously.

However, I shall register with a new practice in Gloucestershire from March. Dreading that they might change my meds when I've been so well on present regime for the second winter running.

Usually, peak flows done, weight etc, any concerns discussed, go through the repeat prescriptions to check they're okay. She would always tweak meds at my request up or down.

In December '12 when I had a chest infection my gp told me to double my Seretide 250 to 500 2xdaily for the whole winter.

With guidance of the nurse I reduced it over several months to 125 morning and 250 at night. (We tried 125xdaily but I was too sob at night hence 250 pm).

It worked very well Raising the dose in winter and lowering very slowly in the summer.

Here in S of France I'm managing on 250 2xdaily. On the whole here it's dry, only getting damp when it's very overcast and raining (5 days of that since arriving early Dec).

JuneCov• in reply topeege10 years ago

Hi peege, many thanks for your responce, gives me some expectations when I go to GP next week, I was good on Serentide 250mcg twice daily then the Senior GP sent me a letter telling me They were going to change my Inhaler to Flutoform a cheaper form, ! initially I was ok but now find it doesn't hold me for more than 8/9 hrs and I'm losing sleep again coughing. I feel really down about my care ( or lack of it) we live in a lovely village away from the town, but only one practise which is a training practise for Gp's training in community medicine which means four of them leave every few months so you rarely see anyone regularly, the two senior GP's don't see patients !!it's awfull for those of us with chronic conditions.

Anyway you take care and good luck moving to Gloucestershire a lovely place to live have a good life

peege10 years ago

Grrr. Awful for you. I was once put on the powdered capsule Acchaler because it was cheaper. When I got it I saw it held only 60 doses necessitating a repeat prescription every month. The spray inhaler holds 120 doses so lasts two months! Where's the economy of that. I also had to go in several times with throat thrush on the Accuhaler. Grr

Investigate the prices (I think there's a website or ask the pharmacist) to check.

Persuade one of these younger gps to put you back on Seretide.

Good luck hon. P

JuneCov10 years ago

Thanks for that good to get my frustrations off my chest.

Offcut10 years ago

My old GP's I saw my Asthma nurse every 6 months was given rescue meds, AB and steriods. I was rarely changed but always given good advice. Since moving house in 2002 I have seen their respiratory nurse once and that was for a spirometry after I found I had worked with asbestos. When I asked for the numbers on the test she refused to give me them? Saying "It has to go to the doctor first?"

Even though I have been in ICU for 32 days with respiratory failure plus 4 bouts of pneumonia and the gooey chests but until about 2 years ago they would not acknowledge I had a lung condition and blamed it all on my heart?

With my conditions having no real fix I have been told to "live with it!" The only positive side is they have a marker on my notes that means I will get an appointment if I call and they are open on the day?

Sorry rant over

Be Well

JuneCov• in reply toOffcut10 years ago

Good heavens, what a situation you are in, pleased you have a marker which tells them they must see you that's good. thanks so much for giving me some advice anyway . I do hope you stay well take care,

Maximonkey10 years ago

Hi June, I have had asthma for the whole of my life and until 5 years ago it was well controlled. However, since I developed Bronchiectasis I have had my inhalers changed and I have an asthma nurse who I can phone at any time. I may not speak to her straight away but she will call me back. I also have a good relationship with my GP and her nurses, who also understand me. The best piece of advice I can give is firstly, always take your PF if you are feeling any different to usual. Asthma can come on very quickly with no symptoms. If you Peak Flow is lower than usual monitor yourself by taking your PF morning and evening until you feel better, however, if your PF falls to half the usual reading (the reading that is normal for you) you need to call a doctor urgently. Sometimes it takes times to get use to a new inhaler. I am on Symbicort for instance, and when I was first prescribed it I misunderstood the nurse and took to many puffs which caused me to feel ill. I phoned her and we solved the problem over the next day or so. Have you had lessons on how to use your inhalers, I know it sounds stupid but you would not believe the number of people who do not use their inhalers properly. Good luck and take care of yourself. Maximonkey

JuneCov10 years ago

Hi Maximonkey thanks for your responce, I have asthma for several years and only ever needed a Reliever it was very much a seasonal thing, until eighteen months ago ? I had a bad chest infection which kicked off my asthma so they started me on Seretide 125 mcg 2 puffs am and pm also oral steroids I improved and stayed on that dose until September last year, if you remember it was muggy for month before and still was, the air quality in the midlands was really bad so I started to have breathlessness and continual coughing? At that time our Asthma nurse had upped and left ?? She was very good to me so I was quite worried., I saw a Gp who didn't know me she was very concerned as she said she is no expert she upped my dosage to 250 mcg twice daily gave me oral steroids I did improve but not as well as I had hoped. Then .earl December iwas made to change my Serentide to Flutiform same dose because it was cheaper ! This was on the instrutions from the Senior GP who never sees patients, who hasn't a clue how I have been for years the instruction came via a letter to my home. Now going back to see the doctor tomorrow who put me on seritide 250 lAst year as I'm not good on this Flutiform coughing is back with a vengance , still no asthma nurse appointed I have never had any spirometry at my surgery I test my own PF and tell them I use a spacer nobody checks me I'm really fed up with it all at the moment Thanks for your advice