Medication advice needed please

I am seeing my asthma nurse on Tuesday for my annual review on Tuesday and my asthma has been pretty poor this year compared to last year and at the minute my pfs are running 60-80% of my predicted despite taking my double dose of flixotide.

My current meds are

Flixotide inhaler or nebs

Salbitamol nebs and salbutamol inhaler

Tilade

Phylocontin

Accolate

Atrovent nebs

Oxis inhaler

Saline nebs

I don't really want to have my meds increased further but is there anything that might be worth trying?

Thanks Wanda

9 Replies

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  • Are you on any oral steroid as maintence?

    Bex

  • Thanks Bex, no I am not on regular pred and they are trying to avoid it at all costs but, it has been discussed as a possibiity in the past.

  • After two cancelled appointments I have finally seen my asthma nurse. I have been put on prednisolone for a short course and they are going to do a number of blood tests to try and find out if there are any underlying problems. The feeling is that my theo level may be too low, it was 6 last time it was checked.

    They are also going to check my liver function and postasium levels as well.

    Wanda

  • Hi Wanda,

    Sorry to hear you've been bad this year. It sounds like you're on pretty much every class of asthma medication really. The only thing missing from the list is, as Bex says, maintenance oral steroid. This can often help at even a fairly small dose, but, as you know, has significant side effects and has to be considered carefully.

    You mention your annual review with the asthma nurse but you don't mention who looks after your asthma. With poor control on that list of meds, and especially if oral steroids are being considered, it's worth asking for a referral to a consultant respiratory physician if you don't already see one.

    A few other things you might consider:

    - combined steroid/long-acting beta 2 agonist preparations such as Symbicort (budesonide (Pulmicort) and formoterol (Oxis)) or Seretide (fluticasone (Flixotide) and salmeterol (Serevent)) are thought to be more effective than using the two prepartions separately.

    - substituting a drug for another within the same class can sometimes be useful as different people respond in different ways - ie changing zafirlukast (Accolate) for montelukast (Singulair) or changing fluticasone for budesonide.

    - are there any other factors which could be aggravating your asthma which would require different drug treatments? - eg reflux, postnasal drip, rhinitis, premenstrual exacerbations.

    All these things are worth considering I think, but again it really needs to be a respiratory physician who is doing the considering, so I think it would definately be worth asking for a referral if you have not already done so. If you are already under a resp physician, it's worth pushing for an early review by him/her.

    Hope this helps,

    Em H

  • Thanks for the advice Emily

    I wnet to see my GP on the advise of my asthma nurse after my theo levels came back at 6.7 however rather than increasing it he chose to send me my local hospital.

    I have been under chest consultants in the past and haven't really got anywhere and in one instance was told that if I did have asthma then it certainly wasn't severe bacause my lung funtion was fine and severe asthma didn't behave how how mine does.

    However, my new consultant has told me that I am a severe asthmatic and explained to me how recent research has shown that some asthmatics continue to have lots of symptoms despite good lung function mine was 102% and pf was 410 yet, he said he could see that still had evident symptoms. Unfortunately there is nothing they can do about this.

    However, is going to try and reduce my inhaled steroid dose because he's concerned that over the years that people have put me on bigger and bigger doses to try and get me under control with no success. Everything else he is going to remain the same for now he is also going to do bloods for IGE and ESR and possibly at a later date PD20 challenge.

    Wanda

  • hi wanda,i'm glad you got a new referral to a new cons. it sounds as though he has a head on his shoulders. is he at the qe? what's he called (just in case i've come across him here in frh before)?how do you feel about all the cons has had to say?thinking of you and hoping your virus disappears fast.becky.

  • Hi Becky,

    Thanks for the message. Good to hear that things are moving in the direction you though sorry to hear about MRSA.

    My consultant is called Dr Allcock and yes he's at the QE. He seems to the first consultant I have had that has actually listened to me and really believed what I am saying. I was amazed that he is happy to keep me on tilade. Plus he's going to send me a letter out in the future explaining everything to me. I guess that will come in handy when I see a GP other than my own.

    At the minute I am ok about it but it hasn't really sunk in at the moment. I guess my feelings might be a bit different once it has sank in.

    Unfortunately it seems that the virus is deleoping into a heavy cold and has decided to go and pay my lungs a visit.

    Wanda

  • hey wanda,

    if your cons is dr rob allcock then i know him of all - since he was an sho and through most of his reg-ship. he is lovely and he will listen to you and do everything that he can. he was initially the person who got me direct access to my ward, many years ago now. he did a significant amount of is training under my cons, so comes at things with a very holistic approach. you've hit on a good one with rob, so i hope you get on as well with him as i did when he was here. i didn't know he was at qu now as the last time i heard he was at dryburn or the other durham hosp, though i think that was for the end of his spr bit. anyway, yes, i hope you get on well with him.

    sorry to hear things are so tough. let me know if there's anything i can do. i hope the virus moves away from the lungs as quickly as possible and that you manage to get through it splat free.

    take care honey,

    becky.

  • Hi Becky,

    I am not sure if his name is Rob but I am 99% confident its the same guy. I have looked on the General Medical Register and there are several ""Dr Allcocks"" there but only one is a resp specialist and he's called Robert John so I think he's the same Dr Allcock you had.

    Thanks for confirming to me that he's a good consultant, I have had so many problems in the past that I was scared about visiting a new consultant and even though it went well I am still feel a bit wary about hm.

    Thanks for the offer Becky. Once I get over this lot and your a bit better we should maybe meet up.

    Sending spoons and diggers.

    Take Care

    Wanda

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