What if pred doesn't work for you?

Might be paranoia but I was just wondering - what happens if pred doesn't work for you?

My lungs seem to be a bit odd. I've had a very backwards approach to asthma treatments, mainly because I was told I didn't have it. One of the first things I tried was a 2-week reducing course of pred starting from 40mg - I was not on anything else at the time. It failed to do anything whatsoever. I'm now a bit better on montelukast though still getting through a lot of blue esp in last couple of days - my GP has started me on Symbicort and I know I have to give it some time to work, but just wondering - as pred is the usual next step when you're already on a steroid, LABA and add-on and they aren't controlling things, what happens if it doesn't work? Or might it work in combination with everything else? (Ventolin didn't work for me on its own; tbh it still doesn't seem to work that well but it does have some effect now).

Has anyone else had this issue or am I just weird? It's probably not an immediate concern while I try the Symbicort but just wondering given that it seems to be so effective in most people (if unpleasant).

8 Replies

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  • Sorry I don't know the answer but I can sympathise as I am also a bit weird, in that I don't always respond that well to ventolin, despite the fact that my symptoms aren't severe, just persistent like yours. I have had a 5 day course of pred before and still not been better, although improved, and couldn't get more pred but as it wasn't severe I just had to put up with it and gradually got better. Sorry probably not what you wanted to hear!

  • Thanks - actually it does help to know I'm not the only one like this, especially right now! Lungs aren't that happy, bit tight and breathless and the Ventolin is not shifting it BUT it's not that bad, I can still walk ok/talk normally etc, have just got back from the theatre. So don't feel I need to rush off to OOH, it's just annoying and uncomfortable (but if it does get worse will go).

  • I'm a bit weird too. But at the moment I'm on levabuterol, ipatropium nebs, and flovent (steroid inhaler), sigulair, and allergy meds. I find when I get bad that I really need a steroid, but if I miss any of the other meds it also doesn't work. It really does take a while. Right now I've been on 40m pred. for four days as well, and it is working, but there are times during the day when I definitely need breathing treatments. Also all the other meds were working pretty well until they started doing construction at my work. Have you been around anything that might make the asthma worse lately? Right now I'm even afraid to walk outside!

    Bee

  • Might you have an untreated infection? I had a flare up in July that 10days on Pred didn't really help with. They tried Accolate but I was getting pins and needles and numbness in my face and hands (as I did with Singulair) so had to stop. I was feeling a bit rough but assumed that was because of the pred followed by the Accolate. One GP (who is usually very flaky but came up trumps this time) suggested Clarythromycin for its anti inflammatory effect rather than because she thought I had an infection. One week on high dose (500mg twice a day) then a month on low dose (250mg once a day) - it seemed to work.

    When I finished the months low dose course I wanted to see whether I would be OK without the Clarythromycin. After a few days my asthma started to go off again so this time went straight onto Clarythromycin again as well as pred and am improving quickly.

    Seeing consultant tomorrow so will try out my ""have I got a chronic infection?"" theory with him and see what he says.

    A

  • A small number of people can be steroid resistant which means that steroids will not have as much affect if any on them. Do you take an antihistamine? Sometimes an undiagonsed allergy that you are in contact with day in day out can be an issue, also sometimes ventolin does not suit people nave you tried bricanyl. There is also the symbicort smart regime...not sure what this entails but may be worth a try.

  • Thanks for all the replies and suggestions! I'm honestly not sure, it seems to be the same wherever I am (and have been in various places) so not sure if it's an 'allergy' kind of thing (plus I am not very 'allergic' if that makes sense). It could be the weather getting colder though, weather is a major trigger for me and I have been walking around in it. Honey, my GP has raised the possibility of steroid resistance but hasn't said what the alternatives would be.

    Still puzzled by the Ventolin though - I tried both before, neither worked. This time when I went on montelukast my GP told me to try both again to see if they worked - the Bricanyl was sort of working, very faintly, but I found the Ventolin was much better and really had started to work, though it would take quite a few puffs in the evening. Now it just seems to have given up again, in the last couple of days - not sure if it's worth taking a puff of Bricanyl to see if it does anything.

    Also not sure if I should be doing anything - can't go to GP before Tuesday at least as I'm busy in London tomorrow, plus he knows I am using lots of reliever and have only just started the Symbicort so unless it is properly urgent will maybe just tell me to wait for the Symbicort to start working? There is a kind of walk-in place attached to the hospital where I will be tomorrow afternoon (work, nothing to do with asthma), not sure if it's worth going there as this doesn't seem that 'urgent' after 2 days of the same.

  • Hi, if you're having problems...like the meds don't seem to be working as well as they did a few days ago, I think it would be appropriate to go to the walk in, or at least to call your doctor. I know for me that unless I'm on the right combination of meds, it can feel really frusterating. But my allergist is actually brilliant with how to combine the meds to make them work...and I would call if I felt they need tweaking. Once I called with a similar problem and they called in a course of pred., which is kind of a pain, but it did work, and once I'm through it the other meds work on their own. Take care.

    Bee

  • Thanks BeeThere! Called AUK nurse yesterday, she suggested I call the asthma nurse at my surgery which I did today, and she has told me to take 2 puffs of Symbicort twice a day instead of 1 puff, and to use it as a reliever as needed, and come in to see her for an asthma check, so combining it with my flu jab appt on Friday. Hopefully it won't get worse before then, chest has felt pretty horrible today but not to the extent where I think there's any point doing anything about it!

    Haven't been to see an asthma nurse since I was about 8 - hopefully this one will be good and a) take on board that my lungs are not textbook (and not send me off with pred...) and b) not make me run up and down on the spot for 3 mins like I had to when I was 8!

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