steroids again

after another week of not feeling well i went to docs yesterday and was given another 40 steroids , this is my 4th lot in about 3 months now, i have to go and see asthma nurse on Thursday to see if she can change my inhalers, but why couldnt my doc do that yesterday, iam on symbicort 400/12, Ventolin inhalers, i take singular on a night, what do u think she could change me to, do u think she could put me on a nebulizer at home, iam so fed up of not been able to breathe properly, do u think iam having a flare up or could it be weather. so for long story but i am fed up now

Jill xxxxxxx

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Hi Jill,

I'm really sorry to hear that you're having problems again and have had to have another course of steroids. It must be getting very frustrating for you, I'm not surprised you're fed up.

It does sound like you are having a bit of a flare up at the moment - I guess it could be the weather, a lot of people seem to be struggling at the moment with it being hot and muggy and the high pollen count.

In terms of whether you could be put on a home nebuliser, this is not necessarily the answer. As I'm sure you know, nebulisers are usually used with salbutamol, which is exactly the same as is in your Ventolin inhaler, only in a higher dose. Most people, unless they are in a very severe acute attack, should be able to get the same benefits from using several puffs of their Ventolin inhaler via a spacer (discuss this with your asthma nurse first if you have not been told you can take more than two puffs at once).

The decision to give someone a home nebuliser is one that has to be considered very carefully and not made lightly. The decision will usually be reached by a hospital respiratory consultant in conjunction with the patient, the GP and other healthcare professionals such as respiratory nurses. The patient will usually be given very strict protocols about when to use it. Most people with home nebs will have had many hospital admissions before reaching the point when it is decided, either for safety reasons (ie for sudden onset attacks, whilst waiting for the paramedics) or for quality of life reasons (ie the person can't get out of hospital without one) that they should have a home neb.

There is a very real danger that someone who has a neb at home will have a false sense of security about how easily their asthma can be treated, and will keep nebbing when they really should be getting into hospital and having other treatment. In a severe attack, nebs will often not work alone, and other treatments like IV hydrocortisone, IV magnesium and IV aminophylline may be needed, or even, in an extreme case, intubation and mechanical ventilation. By the time someone gets to the stage where nebs aren't working, they are usually extremely unwell and need to be in hospital very quickly. The large majority of asthmatics, if they are ill enough to need nebs, should be in hospital. It is a very small minority of asthmatics who will benefit from and be safe to use home nebs.

A good proportion of the deaths that occur in this country due to asthma are entirely preventable, and occur because people have underestimated their symptoms and have not got themselves into hospital quickly enough - and a lot of these are associated with the use of nebs.

Looking at your medication list, there are other medications that you could try before considering the 'last resort' of home nebs. I am not sure why your GP has not made changes and has left it to the asthma nurse. It sounds like they are struggling a little to think what to change next. I think your best option is to ask for referral to a respiratory consultant, if you don't already see one - they have more expertise in managing asthma and have more treatments that they can try. They can also do tests to see if there are any other conditions that are contributing to your asthma - such as allergies, post-nasal drip or reflux.

Hope this helps

Em H

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i have asked to be seen at the local hospital but i have been refused for the last 3 years now the doc says i am not bad enough, but in my opion as not been able to breathe i should have gone a long time ago, buy who am i to no wts right and wrong , thank you for your answer i will go on Thursday and see wt asthma nurse has to say

thank you Jill xxxxxxxxxxxx