asthma action plans

Hi everyone,

I had an 'annual asthma review' at the surgery today and came out with a nice new supply of pred as an emergency supply (having been off it as maintenance for about six months), but I am now thinking that I should maybe have a bit of a more systematic idea about when to use it than 'when I am struggling'. I wondered what sort of plan other people use, esp when the standard formula doesnt quite fit? so, for example,

- I have a 'best best' PF which I pretty much only get when been on whacky meds in hospital and an everyday best which I use to monitor things, but then waiting till 60 or 50 % of that is hard, but is that what other people do?

- If you're on max of e.g. symbicort is there anything you do else as a first step, not being able to double preventer? (other than just using more ventolin).

- do you have guidelines on how long to take pred for, and when to do something if it isnt working?

- also just wondering if you keep a record of how often you have an exacerbation that needs pred, or just work on 'when the pills run out go and get more'?

I've been playing around finding stuff that works for me, and I'll go and discuss with doctor (cause I really would feel happier having some guidelines) but it would be useful to go armed with some ideas of what guidelines other people use.

thanks,

ali

[yaf_user681_25874]

Hi Ali

I need to get mine updated - its well out of date as it was written before several changes to meds, but basically it was along the lines of:

PF 80% of best or better - carry on with std meds (symbicort, pulmicort, ventolin)

PF 60 - 80% of best - increase steroid inhalers until back above 80% for at least 3 days

PF 45 - 60% of best - start short course of pred and arrange to see doctor urgently, continue with pred until pf back to 80% for min 3 days

PF below 45% - ring MAU and arrange to go in for assessment

I would certainly ask for guidelines - the %s might need to be different for you tho, and you need to agree what is best. You say waiting to 50 - 60% of daily pf is hard - it might be more appropriate to go for 50% of best best - or is there a level that you know tends to be the point of no return?

Also - increasing steroid inhalers seems not to be seen as the most appropriate treatment for a mild/moderate exacerbation now as it takes a while to build up in your system - so they might have diff views on what you should do, and when you should opt for the pred.

Go armed with a list of questions, and the action plan that you can order from this site if poss - you can then just fill out the dtails as you agree them.

Hope this helps

Kat

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Hi Ali,

Your experiences sound so familiar…!

I always used to be given an emergency supply of pred by GP plus rather vague guidelines concerning when to take, although in all fairness was some years ago and well before the action plan type diary cards that are used today.

However I now have a mutually agreed protocol with hospital difficult asthma clinic which includes monitoring peak flow and symptoms and restarting pred if my pf falls to 70% of my best on two consecutive days, and for two weeks, regardless of upping other meds, -I’m taking max doses of symbicort as well. Plus any more than four nebs in twenty four hours, when taking pred, must ring for an ambulance and/or tell them I’m coming in. ( Errr…. still working towards that agreed action.)

My ‘normal best’ pf is low ( especially early am) compared to what the average is for my gender, height and age. In addition I always get high ‘inflammatory’ type test results, e.g. eosinophil counts and IgE levels etc, so my protocol wouldn’t be suitable for others.

It’s definitely worthwhile getting a more detailed and personalised action plan though. You need some baselines to work with even if your symptoms are controlled. For example I know that if my pf is a certain level yet I’m symptom free, I will experience problems when I go running, and that’s in addition to EIA which I’m used to managing.

I’m not and never will be little Miss Perfect, and I still take chances, but I have learnt to plan ahead thanks to a detailed asthma action plan.

If you can pin your doctor down or, more appropriately, both decide upon when, and by how much, to increase pred and other meds if necessary, you will feel more in control and more confident about the next step.

Mia

XXX

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Plan

Hey guys

I have had asthma for about 5 years, and have regular visits with my GP and annual visits to the asthma nurse - I have had now all-but a referral to a cons at the local district hospital. Bu I have never had one of these action plans you speak of!

I don't know if and when I should see a GP (all too often I feel like I'm wasting their time), when my meds need reveiwing, how bad is ""bad"", or how to even up my meds if things get a bit hairy!

I am on Seretide so it's not like I can double up on steroids, and I don;t have a supply of emergency pred....I know i could always ask the doc for a plan, but what would it include? Do i even need one?

Ta, Emz x

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I don't have an asthma action plan either, although i see a consulant regularly. Although i have had asthma for ages, It has been uncontrolled to times, so i think that they are still trying to find out whats right for me, and i am assuming thats why i dont have an action plan yet.

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thanks Kat and Mia for advice. Working something out with a doctor sounds a very good idea, rather than trying to adapt or work round the formula that comes with the pre-printed cards - thank you Mia, for that idea. If I went by the book I'd either be back taking pred most of the time (if i judged it by my best best pf) or leaving myself very little leeway between starting pred and being in big trouble (if i go on my everyday best). And as I dont have sudden splats, only ever slow slides, although I dont want to be taking the stuff, I'd rather do it when I can turn things around with the least amount.

I've got an appointment at the resp clinic at the end of the month so I'll try and bring the idea up. I really dont feel confident judging for myself. I actually would rather not have so much autonomy - i got a script for 200 tablets which is enough for me to self-medicate for at least six months at current rate. I should have asked for more help at the review but I seem to become struck down with stupidity as soon as i walk into a doctors.

For those who asked what an action plan is, there is more info on the main asthma uk site here asthma.org.uk/all_about_ast...