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Advice needed please about options & where next, on step 4 management?

Last 2 months have prob. been my worst so far. Never had colds/flu... before or felt wheezy, usually just coughed a lot and tight chest/felt like breathing through a straw. Had sinusitis for years too & hayfever/allergic rhinitis but now constant stream of green gunge down my throat. Had several lots antibiotics, no better or even feel worse since the last lot with prednisolone 30mg 2 weeks ago.

Never been referred to hospital or gone to A&E yet. Came close to calling out of hours GP/A&E last weekend as ventolin not helping much. Have asthma nurse appt 2moro so hope that's useful as need new action plan, review & new peak flow meter. Not sure what can be changed, on step 4 management (see BNF/British Thoracic Society for guidelines). I've montelukast, Seretide Accuhaler (fluticasone & salmeterol) 250 twice a day, mucho Ventolin with spacer, fexonfenadine 180.

Apart from higher dose/longer course steroids and/or hospital referral, is there any other options? Never been on Symbicort for example or theophylline? Is there much difference/benefit between the different steroid inhalers? Had been on various doses up to max Beclometasone before I couldn't stand the non CFC taste of Clenil.

Very glad I've got a prepayment cert. but why do some often less severe conditions mean free prescriptions for life? At least we have the NHS though. Glad I haven't moved back to Ireland, A&Es awful & pay full prescription costs, prepayment per month is the same as year cost here.

Urrgh, rant over. Hope everyone's doing ok!

7 Replies


Try not to go into despair just yet. Symbicort 400/12 replaced my Sertide for which I was on the top dose of, and since you haven't tried oral Theophyllines, no reason, why you couldn't request giving them a go. Though there will need to be some trial and error, some brands suit some people and others do not. But once you find the right brand you must stick to it. It also be necessary to do routine blood tests for a while to find the right dosage for you.

Sometimes people do go though rough periods with their asthma and come out the other side. Lets hope you are one of these.

Also if your sinusitis is playing up alot it is when known that there is connection between that and poor control of Asthma. May well be worth looking at treating that with some steriod sprays or nasal rinses. I know little about the nasal rinses but sure someone on here can pass on their experiences.


I'm no expert but im on the same treatments as you are seretide 25/125 4 times a day montelukast and salbutamol alot of the time so i went to my doc and was refferd to the hospital they just ran a spirometry test which confirmed moderate perssistant asthma then they put me on seretide and i now am under the hospital and seeing them again in six months. i have also never had a hospital admission but have been to A&E with asthma symptoms it is quite worrying cause you can tell its getting worse but there is nothing you can do about it... don't worry see your doc and don't hod back tell him/her everything and you might be able to get somewhere. i don't know of any other treatments and have never even had a course of pred so i cant be any help there i just wanted to let you know your not alone and that i am in the same boat as you and it is very fustrating as i am still having trouble breathing despite changing inhalers and using 4 hourly salbutamol (raises peak flow slightly then drops again) so don't worry your not alone

lots of love and breathe easy

Amy xxx


I was in the same place for a long time, things have calmed down since the consultant upped my seretide to 250 (2 puffs, twice a day - an accuhaler).

Don't lose hope! I think there are things they can do, maybe they just need to work out whats best for you.


Been to asthma nurse today who I've not seen before as only moved 6 months ago. Basically told them what's going on, had them agree and I've to come back in a week after continuing with Seretide 250 top whack dose i.e. 2 puff twice a day which I've already been doing as per action plan for a week. They're going to have a think about options in the meantime, feel like I could read off the guidelines and tell them what to do almost! Anyway getting new spacer and hopefully digital peak flow meter but didn't sound 100% on that on the NHS.

Sinusitis wise have had on and off steroid nasal sprays for years and doing sinus/nasal rinses. Can't seem to shift that either. And I thought moving from a city to a county town would be better. Grr turns out in a bowl/valley and pollen/air quality not great.


I am also on step 4 asthma management and I am having a really bad time too at the moment.

I am at present on 10x100mg salbutamol every 2 hours, 2x500mg Seretide twice a day, 10mg Montekulast at night and 10mg Cetrizine at night too. I have also been on 40mg Preds with no effect.

I don't know what the next step is but I am going to see if I can have a referral done to the consultant at the hospital


TJ - sorry to hear about your asthma but hope doctors sort you out. There are more options but try the inhalers first. Afraid asthma is so variable and everyone different, so it's a matter of trying different things out and seeing what helps. Do you take antihistamine for the rhinitis? Teenage son is on 2 antihistamines and Avamys spray, the latter has really helped him.

I smiled at your comment about living in the country/city helping your asthma. I thought moving from the town centre to outlying countryside would help us (I have asthma too), but far from it!! Then I thought son would benfit from going to secondary school in a larger town centre - get away from all the pollen etc. But now he catches everything going from the other kids AND has the pollen at home!!! GP often used to tell me we should move to a hot country, but that's not an option! Just can't win.


Sorry to hear that you are struggling so much there ae certainly other options available to you.

I am on BTS stage 4 and I am on

Seretide 500 one puff twice daily

Mentelukast 10mg once daily

Phylocontin 225mg twice daily

Tiotropium respitmat 2 puffs in the morning


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