I am just querying something really...I spent from last Friday evening until Monday night as a patient in hospital ( even spending time on my own ward of all places) with exacerbation of my asthma...I was on Prednisolone four weeks prior to that due to a slight attack, and my Gp had just started putting me on a reducing dose of the stuff, but being in hospital I have had to take them again and will be doing for another 5 weeks or so. I have never been on steroids before this, and was wondering if many people get side effects from them...When i wasin hospital I had awful palpatations and could feel my heart beating in my head when I laid down, but the docs just said that was from the nebs...But I have not had any nebs now since Mon and still get this horrid feeling of my heart beating too fast and hard, especially at night, is this a side effect to pred or to the Aminophylline that my Gp has since put me on, or a combination of them both...also my Gp changed my inhaler to Seretide...
Another query is about Pred, how much of a protection do I need to take as in relation to going near people who have infections as I work in hospital on the wards and many people go into hospital as they have some sort of infection/illness etc and wasondering if I was able to go back to work soon, or do i have to wait until I have finished my medication?
Anyway thank you and sorry to bore you all, I am just new to all this
Sorry to hear that you've been poorly and had to spend time in hospital. I hope you're now beginning to improve. I can relate to the embarrassment of being admitted onto your own ward - that has happened to me one or two times when I was working, too.
In answer to your questions:
The palpitations are probably due to several of the medications that you are taking. Nebs obviously can cause your heart to race, as can your salbutamol reliever inhaler. Salmeterol in the Seretide can have that effect too. The biggest thing, though, that is contributing to your palpitations is probably the aminophylline. This drug can be a very useful one for asthma - some people describe it as their wonder drug - but it can be a tricky one to take. There is no one set right dose for everyone, and if you take too much of it it is easy to get toxic levels in your blood. Whether you are toxic or not, you can still get nasty side effects such as palpitations, nausea, vomiting and headache, but these are worse if your levels are toxic. It is usual to do a blood test a few days after aminophylline is started, to see what the levels are and see if the drug needs to be increased or decreased. If your GP has not made plans to have this done, it is worth mentioning the palpitations and asking if you need your levels checked.
In terms of the steroids, they do not usually cause palpitations, but they do have plenty of other side effects, as I'm sure you're aware. Most of them are more of a problem if you are on them long term, which hopefully you won't be. The most common things you might experience being on them for a few weeks are indigestion, increased appetite, weight gain, impaired healing, bruising, skin changes such as stretch marks, red flushed face, high blood pressure, water retention, increased susceptibility to infection, infections such as oral thrush. If you were on them for a longer peroid, say 3 months or more, you would also have to worry about things like diabetes, osteoporosis, muscle wasting, eye problems like cataract and glaucoma. I know this list sounds daunting but many people who take pred for weeks or even months at a time don't experience much in the way of side effects at all.
In terms of protection at work while on pred, I have worked on the wards whilst on oral pred for years. In fact I have been on oral steroids for most of my working career since I started medical school in 1996. I have asked both Occupational Health and various infectious diseases doctors on several occasions and have always been told that it is not a problem. The only thing that you do have to guard against particularly when on pred is contact with chicken pox, as chicken pox infection can be particularly severe if you are on steroids. If you do come into contact with chicken pox whilst on pred, you should let your doctor know immediately so they can arrange for you to have treatment. If you are unsure about whether you are fit or safe to return to work, you should of course talk to your GP or Occupational Health doc.
It does sound like you're having a rough time at the moment. Do you have a respiratory physician who is following you up after your admission? It sounds like your control has been a real problem, and you could probably do with some specialist input.
Hope this helps
Em H
Hi Sam, normally I would wade in with answers to the amino question but Em got there first
We wrote the book on amino between us (well mainly Em)
Bex
Thanx for the reply EmilyH..
You are a star....I am off back to my GP in the morning....I have not slept now for days because of this medication, is there anything that can stop the palpatations. Also over the last few days I have noticed that my belly has swollen and i look like i am heavily pregnant, I saw that Emily had mentioned water retention, could this be it? And I am getting terrible cramp, again especially at night, in my legs hands and feet...
I am really not feeling very well at all ( sorry to sound like a whimp), and i don't know about any of you other guys, but this humid heat is really not doing any good for the breathing is it????
Anyway I will see what my Gp has to say tomorrow..
And Emily, No I have been referred to a resp con after my admission, they just told me at the hospital that I should be ok as long as I have regular appointments with my GP ( I don't really like to keep going to see my GP though as I feel that I could be wasting her time and that people more sicker than me could be having that appointment, and I feel like i am bothering her)...When I was admitted to the hospital in Nov I was refered to one of the respiratory nurses at the hospital and only saw her twice and she was not very nice and did not see her until the Feb ( After an admission in Nov) and she put me off going to see my own asthma nurse ( and have not been to see my asthma nurse since seeing this one at the hosp) and going to see my GP until I really had to go and then my GP said I should have seen her sooner...
Anyway I hope everyone is doing ok
Take care
Sam x
prednisolone
hi everyone i wonder if anyone can help me ive been suffering from asthma for the last 6 years ive been in and out of hospital over the last 6yrs ive been put on so many different inhalers but they only seem to help me for a little while then they stop working then my gp puts me on something else recently though i ended up in hospital again after having another bad attack the doctor at the hospital has put me on predisolone ive only been on them for a few days and seem to have noticed a difference with my breathing but the doc said i should'nt be on them long term but its helping my asthma better then the inhalers have been doing is the doc right about these tabs or can i stay on them ive had enough of having to carry 3-4 different inhalers around all the time please if anyone can give me any advice i would appreciate it very much..
thanks again.. lindsey.xx
In answer to Sam...
Hi Sam,
I'm sorry to hear that you're still not feeling good, you must be getting very frustrated. I agree that the weather does not help. I'm glad you're off to see your GP again today, sounds like a good plan.
The palpitations and sleeplessness certainly sound like they are most likely due to the aminophylline - it's well known for causing these sorts of problems. There are two explanations, really - either your levels are toxic, in which case a reduction in dose might help, or your levels are within the normal therapeutic range and you are just quite sensitive to the side effects. If the latter is true, then it may be that aminophylline is just not the drug for you, and that your GP will have to think again about how best to control your asthma. There aren't really any drugs that you can take to control the palpitations in this situation.
The tummy swelling could be due to water retention from the pred. Steroids do tend to make you preferentially put on weight around your tummy (and on your face, sometimes, too). It's worth mentioning it to your GP, though, just in case there's something else going on.
The cramps you describe are familiar to a lot of us - along with the 'funky chicken dance' which is what we call the mad leaping around the bedroom when a cramp has woken you from sleep! Not fun, and can be extremely painful. Muscle cramps are a recognised side effect of the beta agonist drugs - salbutamol (Ventolin) and salmeterol (in Seretide) (and also formoterol and terbutaline). It's common to get cramps with big doses of these drugs, for example when having nebulised salbutamol or subcutaneous infusion of salbutamol or terbutaline, but it's also possible to run into problems with the standard inhaled doses, as you've discovered.
Cramp can also be a symptom of disturbances of the various electrolytes (salts) in the body - low sodium, potassium and calcium and high magnesium can all cause severe muscle cramps. The most relevant one here is the potassium, as beta-2 agonists, aminophylline and steroids all cause low potassium. It’s worth asking your GP if he/she thinks you need your potassium levels checked. It's also worth trying to eat potassium rich foods such as bananas, tomatoes, oranges and potatoes, provided there is no reason that you can't eat a high potassium diet (for example, kidney problems) and provided that you are not allergic to any of these, of course. Electrolyte disturbances can also be caused by other factors such as kidney disease, severe diarrhoea and other drugs like diuretics (eg furosemide, bendroflumethiazide).
Dehydration can also be a major contributor to cramps - so make sure you are drinking plenty throughout the day and have water by your bed at night. Obviously very sugary and carbonated drinks like coke are not the best for preventing dehydration. If you're drinking orange juice, for the potassium, it's best to have it with a meal, I believe, to minimise the effects of the acid on the teeth. Caffeine, alcohol and nicotine can also contribute to cramps, so it's worth cutting down on these.
In terms of dealing with the cramps - massaging the affected area, pulling back on the foot to stretch the hamstring, for leg cramps, and walking around can all help to ease the cramps off more quickly. I find that if I am getting recurrent cramps in the same area, a hot wheat bag can help to keep them at bay.
If the cramps are severe, your GP may prescribe quinine tablets to be taken at night – these will not produce instant results, they do take a few weeks to build up in the system, but they can be useful. In extreme cases the doctor might prescribe muscle relaxants like diazepam (Valium) to help, although most doctors will be pretty keen to avoid these, as they can be addictive and can cause respiratory depression.
I'm sorry to hear that you've had a bad time with your asthma nurse and that you've been reluctant to see your GP. Please do think again and give the practice asthma nurse a chance - they will probably be very different from the hospital asthma nurse in their attitude. The asthma nurse can be a very useful person to know, as they can do a lot of the day to day stuff to help you manage your asthma. Please don't feel that you are wasting your GP's time, though, or that there are other people who are more 'deserving' - asthma is a serious condition, which needs to be treated properly, and you've obviously been quite unwell, and are on a fair bit of medication, have been in hospital, and so on. You need to get this sorted - the vast majority of people with asthma can be almost completely controlled, with little or no interference with their day to day lives, so you shouldn't be satisfied until this is the case.
If you don't have any success in getting things under control with the treatments that your GP is trying, please think about asking for referral to a specialist respiratory consultant. They have access to more tests and have more expertise in controlling difficult asthma, and can be very useful people to know!
Hope this helps and you have some luck at the doctors today, do let us know how you get on.
Take care
Em H
In answer to lindsey...
Hi lindsey,
I thought I would answer you separately to avoid creating the longest post ever!
Welcome to Asthma UK, I hope you'll find us a friendly bunch and find the site useful. There is a lot of good information on here if you have time to browse around.
Firstly, a word of caution - I say this to all new members. Message boards like this one always attract a disproportionate number of people who are at the severe end of the spectrum - we have a lot of members who have difficult/severe/brittle asthma. You will probably read accounts of poor control, multiple medications, hospital admissions and even Intensive Care admissions. Obviously, some of this you have experienced yourself, but if there is anything that seems strange or unfamiliar, please don't be frightened or put off by it. Experiences like that, whilst unfortunately common on this board, are extremely rare in asthma as a whole. The vast majority of people with asthma can be completely or almost completely controlled, once the right combination of medication is found. Asthma should be taken seriously - in the worst cases, it can be fatal - but as a rule it does not have to stop you doing things or limit your life.
Having said that, it certainly sounds like you are struggling at the moment - I'm sorry to hear that you're having a rough time. I know it is extremely frustrating to keep having attacks, be reliant on a lot of medication and to have hospital admissions and so on. Is this the first time you've had prednisolone? I know that often when you take prednisolone for the first time it can seem like a wonder drug and you can feel like you've got your life back.
Short courses of prednisolone to get you over bad patches with your asthma are extremely safe. There are side effects - see my post at the bottom of this page for details - but they are usually not severe or dangerous. Long term steroids are a different issue. There are a lot of us on here who do take long term steroids, by necessity, because it is the only way to control our asthma and keep us out of hospital, but it is something of a last resort in asthma management. The side effects are much more significant when prednisolone is taken long term. Weight gain, high blood pressure, diabetes, osteoporosis (thinning of the bones), muscle wasting, and eye problems are all very real possibilities.
Personally, I have had brittle asthma for about 12 years and have been more on pred than off it for most of that time, and on it continuously for about the last 3 years. I have steroid induced diabetes, which I have to take more tablets for and may one day need insulin for; I have gained over four stone in weight; I have muscle wasting which means I can't stand for long, walk far, or do things like wash my own hair; and I have high blood pressure and high cholesterol. Other board members have had similar problems, as well as broken bones due to osteoporosis, cataracts in their eyes needing surgery, and other problems.
I don't want to frighten anyone with this list; taking steroids for a short time is very safe, as I have said. Anyone who is on them long term will hopefully be being monitored very closely by their doctor for any sign of the above side effects, and there are things that can be done to prevent some of them. The decision to put someone on long term steroids is one that is not made lightly - the risks and benefits will have been carefully weighed up by your doctor. To anyone reading this who is on long term steroids and is concerned, I would say, please do discuss your worries with your doctor, but do not stop taking them without your doctor's advice - this can be very dangerous.
Even if you were on steroid tablets long term, you would still need to carry on taking your inhalers. Steroids are given as well as your other treatments, not instead of them. Inhalers are by far the preferred treatment, because the medication is getting directly to the lungs, where it is needed, without having too much effect on the rest of the body. If your asthma is not completely controlled with inhalers, there are several other tablets that your GP might try to control it - again, though, these would be as well as your inhalers not instead of them.
Please do go back to your GP and ask about other treatment options. As I said to Sam, below, if you are not having any success in getting your asthma under control, and you are having hospital admissions, it might be worth asking your GP to refer you to a specialist respiratory consultant.
Hope this helps
Em H
Hi Sam,
do go back and see your GP please! If he/she makes you feel like you are bothering them, try another GP - even if it means changing practice. I know it is hard to be assertive, but you are clearly really not feeling at all well.
And please tell your GP all the symptoms you are having - palpitations, bloating, cramps etc. As Emily has outlined, they are very likely side effects of the medication, and there are things that the GP can do to address them. But I was in a similar situation, and wrote off all the niggley (and not so niggly) things as related to asthma or the medications I was taking for the asthma, and it turned out that they were symptoms of a different condition - in fact the asthma itself has been a symptom of another condition! Which means now I am being treated slightly differently i am feeling loads better than i have for the last three years. It is unlikely to be anything like this, much more likely to be to do with the medication, but whichever, if you don't tell your GP they can't do anything about it.
hope you feel better soon,
Ali
Hi Guys
Thank you so much for everyones help...I have been to the GP this morning and I have got to go back to see her in an hour or so for her to take some blood to check my levels...She said my pulse was running a bit too fast for what it normally is. She also gave me these horrible tasting lozenge things because I have a horribly sore mouth....
And she has signed me off for another week.....
Speak soon
Sam x
Hi Sam,
I also had to be on steriods for quite a long time(10 months) due to recurrent intermittent severe attacks. I was in and out of the hospital every now and then. Sometimes words could not describe how bad it was_ requiring max. flow Oxygen, adrenaline inj., iv aminophylline, iv hydrocortisone 200mg 4 hrly, 15 minutes nebs & oral pred.
For about that period of time, i had swollen feet(pitting oedema), palpitations, temors and severe headaches thinking they were all side effects of those drugs but further clinical investigations revealed other medical conditions .
as far as i know aminophylline and pred can give those side effects. i am happy to hear that u've bn checked by your Gp to rule out any other ailments.
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