What is high dose corticosteroid? Also stepping down treatment?

I'm trying to work out what step of the asthma treatment guidelines I'm on. I take symbicort 400/12 2 puffs twice daily, Montelukast and Salbutamol as and when required.

What bothers me is that despite being on the above for the last six months, my PF is still not back to my best and I am still more symptomatic than I would like, even though it has got lots better in the last couple of months.

I know it isn't 'bad' compared to lots of people but for me it feels like a lot of meds.

Also how successful have other people been in stepping their medication back down when it's been increased in the past?

I was meant to see the consultant in Feb but it's been put back to April - not sure why - so I will ask him then but wondered if people had any advice in the meantime.

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  • i would suggest that you book an appointment with your GP (specially if there is a GP in your practice with a special interest in respiratory conditiions) or better still the Asthma Nurse. they can discuss options with you and help you to understand stepping up and down. i would suggest that stepping down isnt an option yet as you are not back to your best. just because you are currently taking more than one medication notwithstanding the inhaler, doesnt mean you should come off any of them without medical guidance. Oral corticosteriods are often prescribed to help control asthma symtoms. my GP gives me a three day course of 60mg (a pretty high dose), with only a short course he doesnt feel that i need to be weaned off it and there are less possiblities of side effects. i hope this information is helpful, however please see your GP. ><>

  • EmC, I assume you are asking about high dose corticosteroid inhaler?

    The asthma guidelines (inc 2011 Quick Reference Guide) are available here from the British Thoracic Society brit-thoracic.org.uk/guidel...

    Steriod doses are in relation to beclomethasone (known as BDP equivalent) e.g. budesonide/formoterol aka Symbicort is the same. You take 1600mcg (400 x 2 puffs twice daily) which is high dose i.e. 800 –2000 mcg daily and therefore step 4 of the guidelines.

    I know what you mean about being on a lot of meds, I have also had Atrovent added last year, had several short courses prednisolone almost monthly for a while plus been on Seretide accuhaler 500 twice daily.

    I saw a consultant after I was on the max levels meds GP could do and still having problems. They are not sure what to do as normal test results (done when well) so I have been referred to a difficult asthma clinic. I am also having medication stepped down i.e. seretide and some stopped. I am ok for the last few weeks but have been rough. Seeing GP for reflux medication reviews as that does seem to be linked for me.

    Good luck with your consultant appt, go back to your GP or ring the cons secretary if you feel you should be seen earlier. I have had a lot of appts changed at short notice, seems that clinics are booked before consultants diaries are confirmed.

  • EmC, think TJ has sort of answered this, but I was in a position like you last year, my asthma nurse didn't know what else she could do but gave me 3 months to see if I would recover before being refered to a consultant. I wasn't going sit and wait so asked to Atrovent to be added, she didn't think it would work but agreed. Anyway 3 month later my PF's were back to normal and she was astonished and now use it for other patients who don't recover from blips. I'm unique in that I keep a very detailed PF chart and she knows it was what worked. If I was you I'd ask for Atrovent from your GP see if that works, you have several months before seeing the con and that's a while to be not good.

  • Fair point woody-som, in the midst of my rather lengthy answer (oops) I didn't say why I had started Atrovent or how it had helped. It was added in my case after max dose seretide wasn't fully helping. GP agreed to try it around the same time as referral to see a consultant.

    Unfortunately consultant didn't listen when I said it has made the most difference for me. They don't agree with it in asthma and advised to stop it, grrr. Luckily, new GP agrees with me and thinks that's a step too far. Just waiting for clinic letter now.

    Thanks to you and others here who mentioned it previously :)

  • I will ring today and ask the asthma nurse at the chest clinic to see me again. My GP seems to be leaving it to them really. The asthma nurse said she didn't think she needed to see me again before my consultant appt (in Feb) but now it's been pushed back I'll ask.

    What exactly is atrovent? I looked at it in the bnf but I couldn't really understand why it is used.

    Also how do you know Montelukast is working? I think it might be doing a bit of good (not quite so wheezy, and miraculously no chest infections yet this year :) although I don't know if that's linked).

    My pf is about 85% of my best which is a huge improvement from where I was a few months ago but I feel like I should be able to get back to 100% and with all the meds i don't understand why I'm not.

    I dont know if they think I would be bad enough for another med.

    I appreciate the support by the way!

  • EmC,

    Atrovent/ipratropium is a bronchodilator but longer acting than Salbutamol. Useful for me to as a non steroid approach when I was already on the max dose Seretide GP could do. It can be difficult to find information for its use esp in asthma as it's often seen as more for COPD and old fashioned.

    It can be frustrating about peak flow with all the meds.

    Good luck with asthma nurse.

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