To take pred or not?

The doctor I saw last week gave me a prescription for pred, but told me to fill it only if my peak flow dropped to 210 (50% of my best). Since my peak flow never goes below 300, even when I have ended up in A & E, that's not a very helpful measure but she didn't give me anything else to go on. All she said was I don't have an infection.

My peak flow is still just above 300 (best 430)which is actually lower than it was last week, I still have a cough and am very breathless if I do anything more than sofa surfing. However, am not waking up in the night and don't have the tightness I usually get with a flare up - often when I have pred I feel tight even if I do stay glued to the sofa.

How long do I wait before deciding I'm not going to get better without the pred? Do I go back and ask the doctor whether I should take them? I don't really class it as an emergency, because I have the prescription and could fill it if it was, but won't be able to get a same day appointment if it isn't and don't know how far away the appointment will be if I pre-book.

Feel torn because I hate the effects of pred on my brain, but don't want to spend the entire holiday doing nothing if I could just take the pred and it would be sorted.

16 Replies

  • Sorry to hear you are feeling poorly. In my experience, I know when I need pred when my asthma is set off by yawning or laughing etc. it not always causes me to cough at night however I do wake up in the morning feeling the need to reach for my inhaler to relieve the tightness. This is all on top of the deteriorating symptoms I usually get of shortness of breath, tightness and pain.

    If the dr has given you Pred to take I you feel the need, your PF is on the low side and you don't seem to have seen any improvement of your symptoms, then I would personally be starting the Pred. I find that it can take up to 48hrs to start taking effect so think of this when tryin to time starting on it.

    Hope this helps and you are on the mend soon xx

  • I would go for it if you're stuck sofa-surfing. In my experience it's better to get on top of things earlier and if you're finding it hard to do things it's not premature! My GP's view is that a little pred earlier saves more pred later (pity my cons has weird confusing views about it). I also hate the effects it can have but hate being stuck on the sofa more.

    Sounds like the GP you saw wasn't that helpful either but she did give you the pred and leave it to you; I was also told with what sounds like a milder flare-up than yours a couple of months ago by the OOH GP that he'd advise it and I was actually not bad when I saw him, but based on what I'd told him he thought it was appropriate.

    Do you feel like you're getting a good night's sleep? Everyone is different but I get disturbed sleep without necessarily remembering/waking up always so it might be affecting you more than you think at night.

    If you're really not sure perhaps give the adviceline a ring?

    Hope you feel better soon anyway!

  • Hi thanks for replies. I think my views on when I need to see GP/take pred are affected by the time I had just after my asthma returned a couple of years ago when I had pretty much constant symptoms, was regularly needing 6-8 puffs of ventolin to settle symptoms down (often daily or more than once a day) yet any doctors I saw weren't listening to me - I was told there was nothing they could do because I'd already had a course of pred, even though the AUK nurse told me I ought to continue pred until I felt better. Because of this I think I tend to only feel I need it if symptoms are really affecting me a lot ie. needing ventolin every couple of hours as I have historically found it impossible to get anyone to do anything until I was at that point or even worse.

    Philomela no the GP wasn't that helpful at all - she actually said she didn't think my asthma was that bad after I'd told her I was waking in the night coughing and ventolin wasn't helping much (although I was so shocked at her attitude I didn't fully describe my symptoms).

    I do feel that my sleep isn't brilliant although I'm not actually waking, and when I wake up in the morning it's much earlier than I normally would and I cough a lot and can't stay in bed reading (which is what I would normally do) because I then can't breathe when I lie back down. I do tend to doubt myself and play down any symptoms a lot and it really isn't helped by doctors like that. You're right though, I don't want to waste my holiday sitting around doing nothing, or doing what I did yesterday and wrecking the rest of the day because I had the audacity to want to go out!

  • Oh I do completely get where you're coming from! I am still in that phase as my cons has bizarre views on me taking pred (I'll never need it apparently, despite him then saying to expect flares in winter and also the fact that I was given it by his colleague in Oct and it definitely improved symptoms and spiro). My GP (and a former cons) have the view of 'better to hit it a little hard earlier on and get on top of it' and after the last few 'episodes' I see his point. I don't have a plan and seem unable to get one but I do find it's better if I can get on top of things earlier, though not trying to carry on as usual also helps.

    Has your regular GP given you a plan of any kind? I am exactly the same with second-guessing and still feeling like I won't be taken seriously if it's not really awful, which is kind of frustrating now when I suspect I could avoid getting to the sofa-surfing stage with a combo of me being sensible (I wasn't this time round, but it was just normal life!) and the dr being willing to help me get on top of it and not confusing me. I completely get them not wanting to give too much pred and I don't like it either but catching things early seems sensible and it would be helpful to have some general guidance over when to wait and when not to. ANd it is awful when you can't even go out for a bit without feeling horrible afterwards; if you are at that stage then I'd say definitely go for the pred!

  • I do have a sort of plan from my GP, but it is very generic and vague. Basically goes by peak flow, which is not helpful, because although mine does drop noticeably when I'm struggling, it isn't by the same percentage as the general guidelines give for the zones. The other things are just general symptoms but the reactions I've had from other doctors have made me ignore them as it says if 2 puffs every 2 hours isn't enough to prevent symptoms I should see a doctor - but when I do they tell me it's not that bad and they won't do anything.

    Maybe I should make an appointment and discuss the general plan as well as current situation with my normal GP who is usually much more helpful.

  • im fed up with docs who only ever go by peak flow, as i pointed out to C when i visited her in costa - when my lungs are happy, i can blow a, say, 500, then without breathing in again at all blow 250. My thinking therefore is that just with air sitting around in my trachea, plus a bit of clever 'flute playing' type tricks and a little bit of air left in my lungs (as obvs you cant fully exhale everything) i can get 250, so 250 must be a really bad number for me - i can get it without being able to breathe in at all!

    I'd say with pred (especially if you havent had LOTS of courses and are not likely to get stuck on them long term) its probs better safe than sorry - if you were given them then the doctor clearly felt that you were potentially going to need them, and without VERY clear guidelines about when to take them, no-one can blame you for taking them when a doctor feels that maybe you shouldnt. Like any meds, its always nice to be able to avoid them - but as someone (i think philomena said) better to take a 5ish day course now, than end up on them for ages at a later date :-)

    Like you - my peak flow has never dropped below 250 (and i suspect the time it was that low it was contributed to by a slightly poorer technique when im suffocating) and rarely drops to 300 - for me 50%, whereas i know of people who can happily have their peak flow at 55% and still be plodding about, and actully they only feel the need for 999 once they are at about 40% - i think its such a poor and variable method that i wish there was less dependancy on it. I can see that its nice to have an objective number to go by - but if its not accurate then it could do more harm than good. I personally carry a bit of paper that mentions lots of things, including the fact that my PF doesnt drop much, most of the time if i get a decent doc who reads that then they just ignore PF until i 'look' well enough to go home - and then check my PF is good enough to go home (going by the theroy that why waste valuable effort and breath on PF)

    deffo sounds like a good idea to speak to your normal GP - and as i've said a few times, GPs get lots of 'emergency' appointments that are a lot less than 'currently i struggling to breathe and cannot really leave my house and im not sure what i should be doing about the medication i have' id say thats a pretty valid thing for an emergency appointment - although our surgery has a good filtering out system for people who dont really need appointments so i have much less of a stressy time trying to decide if i need one today :-)

  • Thanks Soph. Unfortunately I'm also a non-wheezer, so lack of wheeze + peak flow of 75% means they don't take me seriously when I say I can't do anything and ventolin isn't helping.

    Definitely going to try to get an appointment with my normal GP in the morning as today again I felt fine until I went out and since then I've been coughing constantly until I was gagging. Will get the pred tomorrow even if I can't get an appointment but want to speak to GP about my action plan and making it more suitable for me as well.

  • ive had a couple of non-wheezing attacks (as well as a couple of mistaking 'no breath sounds' for 'clear chest' by paramedics) so can really understand what an absolute nightmare it must be sometimes. The one reason me and my lungs are still on speaking terms (ive decided their poor attitude demotes them from being part of my body - they have to sit in a corner and think about their behaviour before they can join the rest of the group) is that they can make some good noises and so i can be treated without too much debate!

    sending lots of good luck for the docs tommoz, id recommend walking as much as poss so your lungs are kicking up a right fuss when you get there :-)

  • ive had a couple of non-wheezing attacks (as well as a couple of mistaking 'no breath sounds' for 'clear chest' by paramedics) so can really understand what an absolute nightmare it must be sometimes. The one reason me and my lungs are still on speaking terms (ive decided their poor attitude demotes them from being part of my body - they have to sit in a corner and think about their behaviour before they can join the rest of the group) is that they can make some good noises and so i can be treated without too much debate!

    sending lots of good luck for the docs tommoz, id recommend walking as much as poss so your lungs are kicking up a right fuss when you get there :-)


    LOL..I love your relationship with your lungs. It made me laugh out loud....and then cough and cough...but it was worth it!

  • Good idea about walking, not sure how I'll manage it as I have to drive to the surgery but the walk from the car park is very short, and my GP is usually running very late so there's a good chance that even if I go for a walk before going into the surgery I'll have recovered before I get to her office. She's right at the end but since it's indoors it won't have the same effect as the equivalent distance outside. Maybe if I can keep track of how many ahead of me, when the one before the one before me goes in I can go for a quick walk outside!

  • i just have a brilliant image of you going for a jog in between patients :-)

  • Soph :)

    One time I was at OOH in the middle of the night because I was so breathless I couldn't get to sleep. The GP made me walk round and round the waiting room, then asked me why I was stopping when I stopped to lean against the wall!

    Have realised my normal GP doesn't work Wednesdays so I will have to try tomorrow morning.

  • Good Luck with your GP tomorow

    Luckly my GP goes on symptoms but I have no plan

  • Ok, I'm usually a very patient person and have waited up to 2 hours to see my GP before without saying a word, but I'm actually really cross today.

    Phoned for an appointment and when I got through was told would have to triage with the nurse - decided to go with it rather than try to just get an appointment anyway because I like to do as I'm told and co-operate (last week OH said but she's asthmatic and having trouble breathing and they just gave me an appointment straightaway). Waited 45mins for the nurse to ring me back, explained to her and she said she could see me. So I said no, I want to see my GP, told her that the other one last week hadn't been helpful and I'd been getting worse for a week so she's fitted me in at the end of the surgery after I insisted. Now I feel guilty for asking for an appointment and as if I'm making a fuss about nothing again - although when I think about how I've been this week and how little I've been able to do I know I'm not really but I always doubt that it's bad enough anyway.

    I was considering writing to the practice manager about the new appointment system anyway but definitely will now. I've never had a problem getting an appointment when I needed one until now, the longest I've ever had to wait to see my own GP was overnight. The practice have a policy that you can only see your own GP because it improves care to have continuity so I don't understand why they're making it so difficult to see a GP at the moment. Even if they can respond with a good reason I'll feel happier about it but at the moment I'm very annoyed. At least I should get to see my GP and I don't mind how long I have to wait because she's brilliant and worth waiting for.

  • Well I got to see my own GP in the end and she said to take the pred and go back down to normal dose of seretide and go back next week if not better. Think the virus that started all this off is actually going now so I'm just left with the horrendous cough and hopefully the pred will sort that out.

  • I am pleased you eventually got an appointment to see your GP, I hope you start to feel better soon.

You may also like...