Hi, today i went back to my doctors as i have had a severe constant pain in my left ,ung for about 2 weeks now. After speaking to many on here i thought it was about time to pay him another visit! Usually he seems to listen to my chest and then put me on a lod of anti-biotics his favourite to put me on his Amoxilcillin! But today was unusal. Normally he just uses the stephascope at the top of my chest and puts me on ab's. But he called in a nurse and did a more thorough examination. He said your chest sounds clear, (sods law it always sounds clear!) But he then reveiwed my meds and told me if i was on anything higher or anything else i would be practically over dosing myself. The nurse had a few questions too, and they realy took notice. When i was there i was coughing a lot, and wheezy and a little short of breath. He might have paid a little attention but not much, and then he just said i want you back in 6 months to see how you are, i thought thats a long time what do you think? Considdering that i have had over 5 months of school and not done p.e in over 2 years! And im breathless just walking around or up some stairs! Well atleast he has not put me on more ab's. Im probably immune to them now! Do you think its right to say oh i think its a chest infection have some medication (in other words... i dont know what it is!) Im only 13 and im taking Highest strenghs of Becotide, Serevent, and Ventolin, so i cant even take Pred as its too much steriods for my body to cope!
When you say ""highest strengths"" of becotide, serevent and salbutamol, can you clarify what you mean? What doses are you taking? I am curious as I would find it difficult to envisage a situation in which someone would be inelligible for pred, unless they were allergic to it.
Hi Cath Bear, i went to my doctors and he said that im on the highest strengh of medication ect. mg. Not sure what atm cos i run out and waiting for them to come into chemist! Least im not on more meds. I mentioned going on Pred, and he just said nope, cant do it!
x Holly x
Fair enough... how many puffs etc of each do you take in a day? You mention that you have becotide four times a day. Hope you don't mind me asking - I have an enquiring mind and being of a medical bent I am keen to know details before I can comment on your doctors' management.
Hi CathBear,
I take Becotide 2 puffs 4 times a day
Serevent 2 puffs 2 times a day
Ventolin 2 puffs morning, evening, 15 minutes before excercise and when needed!
Hope this helps!
Holly- May x
If you have been ill enough to take 5 months off school (I hope other arrangements have been made, at this stage in your education missing that much could be extremely detrimental), and your meds are as you state, then I cannot imagine why you are not on more medication.
Is your doctor aware of how much time off school you have had? What do your parents think about the impact your asthma seems to be having on your life and education?
Hey Holly-May, I see you aren't too far from my neck of the woods! Sorry to hear you're having such a tough time with your asthma. Did your doctor ask you to do a peak flow? It might be an idea to keep a peak flow diary for a few weeks which would give your doctor a better idea of what is happening with your asthma. Feel betterSparkly Fairy
Hi May, I can't imagine how severe you must be to need 5 months off school. It must be an awful worry for you and your parents. Just a thought but preventor inhalers should be taken every day as prescribed, maybe not a good idea to run out and have to wait for chemist to supply? My son is on the severe end of scale and I put in his repeat scipt every three weeks and keep spares of all meds. Could you possiblely get a second opinion on pred? My son takes 1200 mg am and pm of steriod inhaler and yet has also been on oral steriods since he was 2. are your parents must be pushing to get you seen by a resp con at a specialist hosp as you so unwell? I hope so, its such a shame to suffer so much so young.
Hope you see some improvement soon.
Julie
Hi CathBear, yes my doctor is aware that i have been off school so much, i know this because my school and Doctors have been in contact a lot regualrly!
Hi Sparkly Fairy! Thanks for your comments. Yes i did a peak flow for my doctor. and i also do my peak flow every morning, night and if my asthma gets bad! My peak flow should be around 400, but my highest only ever reaching 350. I was on the brink of being karted off to hospital when i went to see my doc, He did my peak flow and it was only 180!
You poor thing. What do your parents think? Have you thought about seeing another doctor for a second opinion or asking to be referred to the hospital to see a respiratory consultant? I have been much more controlled since I was referred a year ago. They are in a better position to review your symptoms and choose the right treatment for you. 180 is quite low considering your doctor doesn't want to see you again for 6 months.
Hope things start to improve for you soon.
Sparkly Fairy
Are you getting any help with your schooling as you have missed such a lot. There are lots of ways to still get school work to you so you can do your best to try and keep up. Your parents must be so worried and for you it must be hard worrying about getting behind.
Not sure what my parents think... but i can tell you that they are not worried! I have not been refered to see a resp cons. Or anything like that.. i guess i'l just have to take it as it comes. This even may include taking a lot more of my inhalers without being advised by a health professional. And as for school work, i am trying my hardest, especially as i choose my options in a couple of weeks, its just so hard to concentrate with the annoying pains, and breathlessness!
Thanks for your comments! x
Sorry had to butt in here. May, you should never increase your meds without the advice or supervision of a medical proffesional, be that a doctor or nurse. Please get advice before changing meds as overdoses, even small ones are very dangerous.
Exactly what I was going to say nutbug!
Holly-May, increasing your medication without guidance from your doctor can be very dangerous and can have all sorts of side effects. If you are worried please go back and see your doctor. There are lots more asthma treatments available. Is there anything in particular which triggers you? Perhaps an allergy? Taking your options at school can be a stressful time, does stress make your symptoms worse?
Take care
Sparkly Fairy
Just throwing in a quick comment here:
You are taking Ventolin 2 times a day every day ? This is a mistake. Ventolin is a ""rescue"" medication, and should normally _only_ be taken when you need it. I don't necessarily mind you taking it as a precaution before exercise, but it is a strong drug and should not be used lightly or freely! Would you take paracetamol every morning and evening just in case you get a headache?
Serevent is designed to act as a long-acting version of Ventolin and is a serious drug. If you are taking Serevent you should (theoretically) >>almost never<< need to take Ventolin, even when exercising! There have been many serious problems associated with Serevent in the past and when I was on it I found that my asthma got much much much worse if i forgot to take it, and that sometimes my Ventolin didnt actually work.
So just checking that you wrote down your drug regime correctly. Becotide and Serevent regularly - fine. Ventolin regularly? Not fine.
Actually, taking ventolin regularly can be part of a recognised and controlled treatment regime, and most certainly can be used alongside serevent/seretide.
The thinking behind this is to open the airways before taking regular medication so that the preventative/protector medication can actually reach the parts it needs to get to.
Even though serevent is a long-acting bronchodilator it does not necessarily put your ventolin into ""retirement"". Adding in serevent is step 3 on the treatment ""ladder"" - i.e. there are other medications which can be added in if asthma symptoms are not controlled.
Taking salbutamol fifteen to twenty minutes prior to exercise is also a recognised and often advised method of avoiding exercise-induced asthma as well.
Can I ask what you refer to when you say ""many serious problems with Serevent in the past""?
Hi Cath,
I'm not sure taking ventolin regularly is actually part of a modern recognised and controlled treatment regime any more, at least not according to the modern BTS guidelines. Ventolin is short-acting after all, its hardly a preventative measure! If you are wheezy, or feel tight chested, then take it - but it should not be taken unnecessarily or ""to open up the lungs before taking preventers""!
As for Serevent, there was a lot of controversy over it about a year ago. It was actually considered to be banned, but they decided to put strong warning labels on it instead. To quote wikipedia (reliable sources) from en.wikipedia.org/wiki/Serev...
In November of 2005, the American FDA released a health advisory[1], alerting the public to findings that show the use of Long-acting β2-agonists could lead to a worsening of symptoms, and in some cases death.
Whilst the use of inhaled LABAs are still recommended in asthma guidelines for the resulting improved symptom control,[1] further concerns have been raised, by a large metanalysis of the pooled results from 19 trials with 33,826 participants, that salmeterol may increase the small risks of asthma deaths and this additional risk is not reduced with the additional use of inhaled steroids (e.g. as with the combination product Fluticasone/salmeterol).[2] This seems to occur because although LABAs relieve asthma symptoms, they also promote bronchial inflammation and sensitivity without warning.[3]
_______________
I'm not saying that you should stop taking ANY of your medication May! That would be very bad - your doctor always knows best! I'm just saying that for me, Serevent was not good. Please, please don't change your medication based on something someone said on an internet forum!
The BTS guidelines are not the be-all and end-all of modern asthma medicine, Xephos. Neither do they actually contain all the information and treatment regimes used and recognised in asthma management. Guidelines are exactly that - guidelines.
There is actually good physiological reasoning behind using short-acting beta-2s prior to taking preventers/protectors. And you will note that in no way did I say it was a ""preventative"" measure. If you practice in medicine - AS I do - you will find that this strategy IS used.
The ""problems"" in relation to salmetarol that you refer to were highlighted from the SMART trial in America. The problems occurred in the group taking salmetarol ONLY to control their asthma vs taking an inhaled corticosteroid plus salmetarol. This increased the morbidity and mortality vs taking salmetarol with an inhaled corticosteroid. Which isn't really a surprise. Hence the guidance as a result of the study was that salmetarol should not be used without an inhaled corticosteroid in addition. Which has been the recommendation of the BTS guidelines for a number of years.
Xephos,
I am sorry to inform you but, sometimes regular ventolin sometimes are used as part of treatment. I regularly use regular inhaled or nebulised ventolin as part of my treatment plan.
I think it was found that the major contributing factor to the increased number of deaths from LAB was the fact that there was no inhaled steroid been used along side of it which, in the UK has never been the case.
Xephos,
Perhaps you are not aware that Cathy is a doctor, and is therefore unlikely to want to base her treatment decisions on information gleaned from Wikipedia.
Concerning the question of regular versus as required salbutamol, please see my comments and quotes from the BTS Guidelines on the ‘Side effects, salbutamol and beclomethasone’ thread – the BTS guidelines certainly do allow for the fact that some people may benefit from using salbutamol regularly rather than as required.
Salmeterol has been shown by several large randomised controlled trials and meta-analyses to only be a problem when given without regular inhaled steroids; when given with regular inhaled steroids there is no evidence of any problem, which is what is recommended by the BTS anyway.
Emily H
Oooops sorry Cathbear for treading on your toes there I must of posted at the same time.
Wanda
Me too... glad to know we concur on this one anyway!
Quote
""If you are taking Serevent you should (theoretically) >>almost never<< need to take Ventolin, even when exercising! ""
Ha Ha I wish!! Theory and reality can be very different particularly of you are a severe asthmatic as quite a few of are.
Oh and do you mind me asking where you get all your info from given that you are as you say on your profile only a ""mild asthmatic"" whose only medication is ""occasional puffs of ventolin"" again I wish!
I would much rather get my asthma info from a reliable source such as a doctor in opposed to information gleaned on the internet. A little knowledge can be a dangerous thing!!
Wanda
I give up!
Ok, ok, this isn't helping anyone. I'll try to keep my advice on-topic, sensible and helpful in future. Sorry for messing up another thread with good intentions.
Going back a bit in the replies here...
I have to say that, Holly-May, I'm very concerned both with the fact that your parents are ""not worried"" despite you missing so much school and that you are/were considering increasing your meds without seeking medical advice!
As Nutty/Sparkly have said, the latter is very unwise. You must see your GP and enquire about being referred to a respiratory consultant if your asthma is so bad that you're missing so much school.
Also, I can't believe that your parents are not worried by this! I'd be beside myself if you were my daughter, with options coming up and having missed so much school. Perhaps you should have a chat with your parents. Do they know how bad you're feeling, and are you correct in thinking that they're not worried - perhaps they're putting on a brave face so as not to worry you.
Thanks Steve for getting us back to the original topic... I am sorry Holly-May that we have allowed ourselves to get distracted from trying to respond to your original problem!
I'm really concerned too that you have such severe symptoms and have missed so much school, and yet that you feel that your doctor is not listening to you and your parents are not worried. There are lots of other treatments you could be on and I'm not sure why your doctor wouldn't consider them when you have been having such problems. As Cathy said before, it's difficult to understand why he says that he couldn't give you pred, for example.
Please don't change any of your medications without talking to your doctor! In any case, randomly increasing them if you are already on the maximum recommended dose is unlikely to help very much as the effect usually plateaus at the higher doses. That's why asthma that is uncontrolled on these sorts of doses tends to be treated by adding in different medications rather than increasing the dose of the existing ones.
I wonder if there is anyone other than your parents and your doctor that you could talk to about your asthma? Maybe your school nurse or another relative? I think you need someone to act as an advocate and explain to your doctor and your parents how much difficulty you're having at the moment. Could you perhaps go and see your GP with a parent or other adult with you, at a time when you are not acutely unwell, and have a full discussion of all these issues? It might be worth seeing if Reception will let you book a double appointment so that you have plenty of time. If you keep peak flow and symptom diaries you could take those along too to show to your doctor.
If you don't feel after this that your doctor is listening to you, is there another doctor in the practice who you can see? If it is a group practice you should be able to see any of the doctors in the practice. At the end of the day, though, you have the right to ask to be referred for a second opinion if you are not getting any joy with your own doctor.
Hope this helps and you get sorted soon...
Em H
A long while ago and by that I do mean a long time ago when my asthma was going down hill and my symptoms changing I had an awful lot of time of school and the LEA where involved with in weeks of me not being able to attend I am surprised they aren’t involved with you. (And I am very surprised you do not see a consultant, and have not got an asthma nurse) and helped with funding home ed, also my GP realised at this point back then that she and the surgeries asthma nurse couldn’t help with my asthma any more and was referred to the local asthma clinic who slowly over a few months changed my medication and I ended up like my aunty on sub cut infusions which has helped an all full lot. I think you should get referred to a paediatrician at the local asthma clinic as this would help a lot. My chest is clear sounding to the doctors when I am having a real bad attack mainly due to not enough air getting into my lungs to produce a wheeze but otherwise it sounds all full. Also do you keep a peak flow diary as this should have started early on in your treatment and if so what are your pfs. I hope you don’t mind my questions just trying to help you also you must not change your medication ive also been there done that and in no other way of putting it nearly kills myself. You must speak also to your parents or an other family member who can help you. and say this is what you need that you need a second opinion from another gp and get them to go with you so you can get this sorted I have never heard of a doctor saying they would not give anyone pred as this drug is a life saver to asthmatics. Unless you are allergic to it or something any how I don’t want to sound real horrid but do you understand your asthma
/ and not just reading things into it that aren’t there you need to get specialist help hope it works out ok
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and being of a medical bent I am keen to know details before I can comment on your doctors' management.
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