Step 5 options?

I really am hoping I can avoid step 5 when at the chest clinic in a week and a half. However, the reality is that things aren't great right now (maybe not helped by the additional stress of me wanting to get to step 5).

If it does come to it, what are the potential things that they might suggest? Can anyone give me an idea of the options? I know the meds will have a big say but it would be good to have an idea. I'm just looking for some options I can read up on so its not so scary on the day.

I'm currently on the top end of step 4 and not really well controlled at all (although some pred has helped in the last few days).

Tina

18 Replies

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Asthma-girl

8 years ago

Step 1 - Occasional use of inhaled short-acting beta2 agonists: In case of very mild asthma, your doctor is likely to recommend short-acting bronchodilators such as Salbutamol or terbutaline. These medicines are normally used as inhalers to relieve minor symptoms. Beta2 agonists alone are prescribed when its occasional use allows you to lead an active and normal life and you do not suffer from symptoms at night or after exercise. In case you need to use beta2 agonists inhalers more than once a day or three times a week, the treatment regimen will be as for step 2 of asthma management.

Step 2 - Regular use of inhaled steroids: Medicines recommended for this stage of asthma includes inhalation of short-acting beta2 agonists whenever necessary and inhaled steroidal anti-inflammatory medicines. These could be either beclomethasone or budesonide or fluticasone. The normal adult dose is about eight hundred micrograms per day. In case of children, sodium chromoglycate or nedochromil sodium may be used instead of inhaled steroids.

Step 3 - High dose of inhaled steroids: Medicines recommended in this stage of asthma severity include inhaled short acting beta2 agonists as required plus an inhaled steroid in a higher dose. The dose of inhaled steroid is normally in the range of eight hundred to two thousand micrograms per day for an adult. In case you need to inhale large doses of steroids through a metered dose inhaler, it is desirable that you use a large volume spacer, which has a hold chamber. In case you use dry powder inhalers, it is desirable that you rinse your mouth after every inhaler treatment in order to avoid candidiasis in the mouth or throat.

Step 4 - High dose of inhaled steroids and regular use of bronchodilators: Treatment of severe asthma involves inhalation of short-acting beta2 agonists as required, plus a high dose of inhaled steroids, plus regular use of bronchodilators.

Since there are several types of bronchodilators, and each of them act differently, your doctor is likely to try and manage your asthma with one or more of the following medicines:

Inhaled long-acting beta2 agonists such as salmeterol or formoterol. Sustained release theophylline. Inhaled ipratropium bromide or oxitropium bromide

Long-acting oral beta2 agonist such as sustained release salbutamol or terbutaline preparations

High dose of inhaled bronchodilators. Sodium chromoglycate or nedochromil sodium

Step 5 - Addition of oral steroids: Treatment of very severe asthma includes (a) inhaled short-acting beta2 agonists as required, (b) inhaled steroid in a high dose of about eight hundred to two thousand micrograms per day, (c) one or more of the long acting bronchodilators and (d) oral steroids such as prednisolone. The dose of oral steroids is maintained at the minimum that is able to control asthmatic symptoms.

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8 years ago

Hello again TS,

Let us know how you get on. Have also been at top step 4. Think the only thing that hasn't been tried is theophylline or similar, not sure when/why that would be done. Now on x1 bd seretide 250 accuhaler but have also been on x2 bd seretide 250 accuhaler which is maximum licensed dose & can go higher. I take it you have seen the guidelines then to know the step you're on. Have had several courses pred already this year and have just been given some to keep if needed.

G.P. is convinced if sinusitis can be controlled, lungs will behave. Doesn't seem keen to refer for asthma, if sinuses not improved more in a fortnight-on 6wk course of 4th antibs- they will then to ENT.

How did you find getting referred to see consultant first? I haven't got very severe asthma, not been to A&E or admitted. Suspect referral could happen then for me or if need more pred. You said your stomach doesn't like it, have you had the enteric coated aka red smarties? It's often prescribed as the standard white tablets now.

Ratty, also interested in seeing what people come up with.

yaf_user681_8101

8 years ago

TJ, Yes I've seen the guidelines. Last time I was at chest clinic he was thinking about xolair, am not keen on that and am hoping that my control isn't bad enough for it. I too, am not anywhere near as bad as some here. I think my asthma is just being difficult. I've managed to get away without A&E visits as I usually know when its kicking off so can get pred before it gets too bad.

I don't like the smarties! This time, they tried to give me the white ones. Seems there is no difference between them and the coated ones, other than the white ones are more effective. I managed to get the coated ones, the white ones and my stomach really don't get on.

I was refered early on, compared with some on here. If you need the referal, it might be worth asking about it as there always seems to be a long wait time (weeks, sometimes longer). I'll let you know what happens at chest clinic, its in a week or so.