Attack out of the blue

Just wondered if people get warning that an attack is imminent? Everywhere seems to state that attacks build up over hours if not days.

Sometimes I know things have been going downhill over a couple of days, but sometimes, like today, I'm absolutely fine minute, but within half an hour my symptoms have come on really strong, chest really tight, sob, using accessory muscles, can't speak in sentences etc. I needed 10 puffs over 30 mins which brought things under control, since then I've needed a further 4-6 puffs every 4 hours, I'm feeling washed out now, and really sore.

For the last two weeks my pf has been between 78 and 93% which I would have thought was OK, I've not woken through the night and I've had symptoms 3-4 times each week. Have I missed some early warning signs? Could I have done something to prevent today's events? Are things supposed to go from fine to not fine so quickly?

34 Replies

oldestnewest
  • Aww no! MIne are mostly very very slow-burn and I'm not even sure when or if an 'attack' has started - I tend to call them flares rather than attacks.

    I did once have a small attack though after an eye appt to see if I was suitable for corrective lens implants, where they put dilating and numbing drops in my eyes. It wasn't as bad as yours sounds but I'd been doing ok and suddenly in the evening needed about 12 puffs of Ventolin; I wondered given I'd been fine if I'd maybe had a delayed mild reaction to the drops. Is there anything you might have come across today that you could be sensitive to?

    I saw my GP yesterday and was saying how I need to be more proactive about seeing him for steroids so I can take just a few and avoid getting admitted again (since I don't know why it happened but I had been getting gradually worse). He mainly agreed but then did say 'these things can come on suddenly' (in my case, maybe running for a train in high pollen was just too much).

    I do hope it goes as quickly as it's come and you feel better soon! (Also that you work out why it came on and maybe be able to avoid it happening again).

  • I also have the delayed reaction thing. Yesterday we parked outside the town centre and walked into and around town then back again. Although it was very windy so lots of pollen blowing round, I didn't notice anything at the time. Then in the evening started feeling hayfevery and tight chest and sob just came on later - I'd been sitting on the sofa working for most of the evening. Not as severe an attack as yours but quite sudden for me, still feel tight now and ribs are really sore. So agree with philomela that it sounds like a delayed reaction to something you came across earlier in the day.

  • Thank you for your reply Philomela.

    I do mostly have the 'slow burn' flares too, with the main triggers been cold/viruses. Things go down hill over a couple of days and then during these periods I have peaks and troughs with my symptoms. But as I say at the minute on the whole I've been feeling generally ok and no cold or virus in sight!

    The reaction after your eye appointment doesn't sound fun, and I've been thinking if I've come into contact with anything new, but I can't out mu finger on anything. I visited a friend who has a new dog, but I have a dog. Otherwise I haven't been anywhere that I haven't been before?? Puzzling!

    It's interesting that your gp said that it can come on suddenly, everything you read send to suggest that you should have some warning signs.

    Anyway, I haven't felt right since the attack the other day, I'm managing now without regular reliever and my pf is coming back up, but if feel sore, a bit like after you've pulled a muscle of woken up with cramp!

  • Mine tend to come on very rapidly (fine to not-breathing in seconds), but also go rapidly (though with 10-20 puffs of ventolin via spacer). When I get in trouble is when I have a slow-burner and then an acute one on top, and then it doesn't resolve nicely and then there's a downward spiral.

    The main thing I think is that anything that is unusual for *you* warrants a bit more thinking and attention.

  • Hmm puzzler! But:

    I visited a friend who has a new dog, but I have a dog.

    Are they different breeds? I say this because I wouldn't consider myself allergic to cats. My family has always had cats, we had them when I was first diagnosed age 7 and I was fine with the cats we had, who were Burmese (meant to be a good low-allergenic breed apparently though of course doesn't work for everyone).

    However, then my family got a ginger moggy from the shelter, who liked to sleep under my bed, and suddenly, though my asthma wasn't really bad at all, it was noticeably worse apparently (this is according to my mum since i do not remember much about all this!) Certainly bad enough that my parents decided to rehome the cat with a friend.

    So I just wonder if maybe, you're ok with YOUR dog and some other dogs as well but for some reason your friend's new dog set you off? I should say I've not had the same problem since, but then I realise that I've not been much in contact with cats I don't know inside a house since I was rediagnosed this time - I've stroked them on the street but not really been in houses with them, and I suspect that if you are allergic to an animal it's probably worse to be in the house with it; I would probably have been ok with Chester (my 'allergy cat') if I'd stopped to stroke him in the street then walked on. It is weird that it was just one cat and maybe it wasn't that after all but just thought I'd mention it because you said about your friend's dog.

  • Thank you spooymilo and curioser, I'm glad I'm not alone with fast attacks! This certainly isn't the first time its happened, and as you say curiouser, when it happens alongside a slow decline, that when there's trouble, but I'd been reading some information online which seemed to suggest that there should be some warning of an impending attack, which isn't something I get, so wasn't sure if I'd missed something.

    Philomela, that's interesting about your cat experience,and maybe the dog was the cause, my dog is certainly not a low allergy dog, he molts everywhere and has long fur, but maybe my friends dog disagrees with me, he's a crossbreed so could be anything lol! Its certainly an experiment waiting to happen ( its the scientist in me!), but obviously next time I meet him I will be prepared with my inhaler and spacer! I am currently taking an antihistamine for hay fever so would have thought an allergy would have been reduced though, or do different antihistamines work differently?

    Out of interest, how much variation in peak flow is acceptable to say things are under control? As I said above, peak flow is between 78 and 93%, (except during the attack) no nocturnal symptoms and day symptoms 3-4 times a week. To me, I feel well controlled,but I wondered if the numbers suggest good control? I am seeing the gp again in approx 2 weeks and hope for him to see me 'well' so he can see how bad 'bad' is for me after the struggle I had getting pred last time.

    Thanks again for your replies

  • I think this is so difficult to give any definite answers to because everyone is so unique and no 2 attacks are ever the same.

    I also do both slow burns and really fast burn outs. I find the slower ones the hardest to handle, knowing things are going downhill but not sure then at what point something should be done. I tend to leave these too late. I find the sudden ones easier to manage because its almost easier and more justifiable to myself what I need to do etc. I also agree with curiouser about the hardest (and scariest) being a sudden one on top of a slow burn!!

    It's good that you feel well controlled at the min and better than before the pred. Perhaps it's worth discussing with to though next time you see them about whether they feel you're well controlled needing reliever 3-4 times a week with guidelines saying 2x a week is not adequate enough control?

    Laura x

  • I think with animals, it's the protein in their saliva you're allergic to which then gets spread around on their fur - so you can have the fluffiest animal who sheds but if you're not allergic to their saliva it won't be a problem. There is a breed of cat, the Siberian Forest, which is huge and immensely fluffy but meant to be good for people who are allergic to cats because it lacks a common allergen in its saliva. I don't know about the antihistamine - I am on double montelukast and now fexofenadine and at times I still seem to have problems so if it was the dog or another allergen which was a strong trigger it might not be enough!

    Interesting re the slow decline plus sudden attack. I now realise that I'd been getting slightly worse for a while, then I think various things on Friday just became too much and explained what happened at the weekend. I think that's probably going to be how I would get a 'bad' one (for me), since normally I am not one for the sudden attacks. I can see my GP's point, but I think it depends on the person; my grandfather apparently was one of those people who can be fine a lot of the time then suddenly have an attack. I'd say mostly though I am unlikely to have that and in this case I think I wouldn't have ended up admitted if I'd not already been having problems; with me it's never a 'fine then bang' thing, and even when I ended up in hospital it was a slow thing, I didn't feel like I had to get there asap or call an ambo or anything whereas I can imagine there are some people who would go from ok to needing an ambo very quickly (in fact, isn't that basically brittle asthma? Which I definitely don't have, or severe asthma).

  • My cons at the allergy clinc always corrects me when I say I am allergic to animal fur for this reason and it is possible to react to different breeds in different ways. I am on several medications for allergies and find I still get symptoms. With multiple allergies, I find this particularly true if there are several things all at once (eg walking outside in pollen may be ok but then if I was to walk with a dog I would be bad). Recently, I kept a detailed log of symptoms for cons and found that night time symptoms were worse if I had been outside with high pollen count even if I didn't have symptoms at the time. My cons said that this can happen as the antihistamines dampen the response for a while (although this did develop over a few hours). I find allergic reactions can be quite variable and there are lots of factors to consider (another investigation I wonder). I have a severe allergy to tree nuts - sometimes they make me very SOB, wheezy, hives but Piriton and 10+ puffs of Ventolin can sort it out and at others the same sort of thing causes a full on anaphylaxis. Again my allergy cons thinks this is entirely normal.

    I never know what my asthma is doing and go through periods of different attacks. When my asthma was last very bad, (at secondary school) I would be in a class, chatty and normal and then suddenly feel tight chested and SOB. Now though I tend to have slow burning types where I go down over several days and there is almost always a trigger (virus, temp, allergies). They also tend to be a lot more responsive to relievers etc. Then I have times where I barely have attacks at all! (I was diagnosed as severe asthmatic, possibly brittle about 15 years ago and was on maintenance pred, then went to just needing brown inhaler and reliever only really having attacks in response to an allergy and then slowly got to where I am today - technically severe diagnosis but I don't really have severe attacks). I am definitely not a usual case and can really confuse even my cons!

    Take care

  • It's good that you feel well controlled at the min and better than before the pred. Perhaps it's worth discussing with to though next time you see them about whether they feel you're well controlled needing reliever 3-4 times a week with guidelines saying 2x a week is not adequate enough control?

    Laura x

    That's what my concern is, I don't think my GP will agree that it's controlled and my ACT score disagrees too. My diurnal variation is about 15%, but I have no idea what it should be? If he doesn't think I have control, what would my next step be? I am currently on montelukast, 2 puffs, twice a day of 250um Seretide and 10mg certirizine.

    I think with animals, it's the protein in their saliva you're allergic to which then gets spread around on their fur - so you can have the fluffiest animal who sheds but if you're not allergic to their saliva it won't be a problem.

    Ah, I didn't realise that about the saliva been the allergen.

    I am on several medications for allergies and find I still get symptoms. My cons said that this can happen as the antihistamines dampen the response for a while (although this did develop over a few hours).

    When my asthma was last very bad, (at secondary school) I would be in a class, chatty and normal and then suddenly feel tight chested and SOB. Now though I tend to have slow burning types where I go down over several days and there is almost always a trigger (virus, temp, allergies). They also tend to be a lot more responsive to relievers etc. Then I have times where I barely have attacks at all! (I was diagnosed as severe asthmatic, possibly brittle about 15 years ago and was on maintenance pred, then went to just needing brown inhaler and reliever only really having attacks in response to an allergy and then slowly got to where I am today - technically severe diagnosis but I don't really have severe attacks). I am definitely not a usual case and can really confuse even my cons!

    Take care

    Interesting, so the antihistamine only takes the edge off a reaction? I wouldn't like to be in the same situation without having had the antihistamine then!

    I'm not alone in having fast attacks then! Its odd how asthma can change over time isn't it, I too have had periods since diagnosis in 2010, where I've reduced my seretide down to 1 puff, once a day of 125um 125um total steroid per day) and had no symptoms at all, yet now I'm on 2 puffs twice a day (1000um total steroid a day) and still have symptoms.

  • I think with animals, it's the protein in their saliva you're allergic to which then gets spread around on their fur - so you can have the fluffiest animal who sheds but if you're not allergic to their saliva it won't be a problem.

    thats really interesting.. I've always been told its pet dander by resp folk.

  • It's good that you feel well controlled at the min and better than before the pred. Perhaps it's worth discussing with to though next time you see them about whether they feel you're well controlled needing reliever 3-4 times a week with guidelines saying 2x a week is not adequate enough control?

    Laura x

    That's what my concern is, I don't think my GP will agree that it's controlled and my ACT score disagrees too. My diurnal variation is about 15%, but I have no idea what it should be? If he doesn't think I have control, what would my next step be? I am currently on montelukast, 2 puffs, twice a day of 250um Seretide and 10mg certirizine.

    From the sounds of it you're on step 4 of management. There are other things that they can try though also!! Are you on any sort of nasal spray? You can also use different antihistamines - I find fexofenadine more effective tbh. You are on the max Seretide cos of the Salmaterol component, but they could also add another inhaler with the Fluticasone if you need a higher dose of ICS?

    At step 4 and beyond if you're not entirely controlled, a cons referral might be beneficial? I used to be on Seretide - and it did give some control - for a while until my asthma got much worse.

    My current meds are: symbicort 400/12 2 puffs 4 times a day, (3200mcg ICS :-/), Atrovent 2 puffs 4 times a day + PRN, Sablutamol PRN (999 at 20 emergency puffs), 40mg pred (tapering to maintenance of 20mg, but cant get below 35), Montelukast 10mg, Fexofenadine 180mg, Omeprazole 20mg, Alendronic Acid 70mg (once weekly), cetirizine 10mg (as required). But I have NO control at the min.

    Not ideal by any means (and possibly unhelpful), BUT hopefully that will give you an idea that there are a load of other things you can try :-)

    Hope GP can help :-) Laura x

  • From the sounds of it you're on step 4 of management. There are other things that they can try though also!! Are you on any sort of nasal spray? You can also use different antihistamines - I find fexofenadine more effective tbh. You are on the max Seretide cos of the Salmaterol component, but they could also add another inhaler with the Fluticasone if you need a higher dose of ICS?

    At step 4 and beyond if you're not entirely controlled, a cons referral might be beneficial? I used to be on Seretide - and it did give some control - for a while until my asthma got much worse.

    My current meds are: symbicort 400/12 2 puffs 4 times a day, (3200mcg ICS :-/), Atrovent 2 puffs 4 times a day + PRN, Sablutamol PRN (999 at 20 emergency puffs), 40mg pred (tapering to maintenance of 20mg, but cant get below 35), Montelukast 10mg, Fexofenadine 180mg, Omeprazole 20mg, Alendronic Acid 70mg (once weekly), cetirizine 10mg (as required). But I have NO control at the min.

    Not ideal by any means (and possibly unhelpful), BUT hopefully that will give you an idea that there are a load of other things you can try :-)

    Hope GP can help :-) Laura x

    Hmm, maybe a referral would be useful, however I can go through very quiet periods where I reduce my medications and require no salbutamol, and then I have flare ups which don't control well, so I'd feel a bit of a fraud if I saw a consultant while having a quiet period!!

    What is atrovent? I've heard of it but not sure what type of medication it is.

    Thank you, as you say, there are plenty of options available, just to see if my GP is happy with my control or not?!

    mine don't have much warning can have a humdingerout of know where...never really have had a slow burn. I am diagnosed as difficult brittle...but don't try and focus on the words

    Yay, more people who have surprise attacks!! (not good for you though!)

  • Interesting, so the antihistamine only takes the edge off a reaction? I wouldn't like to be in the same situation without having had the antihistamine then!

    I'm not alone in having fast attacks then! Its odd how asthma can change over time isn't it, I too have had periods since diagnosis in 2010, where I've reduced my seretide down to 1 puff, once a day of 125um 125um total steroid per day) and had no symptoms at all, yet now I'm on 2 puffs twice a day (1000um total steroid a day) and still have symptoms.

    I think antihistamines will usually work but sometimes it may not be totally effective (this is what I have also been told when I ask how I am having so many reactions on antihistamines.

    I have recently been rereferred to the cons for asthma (have always seen them in a roundabout way for allergies though) and when I saw them in April was worried because I had was going through the best patch in a while (hadn't needed pred for 4 months, managed a wobble by putting up seretide to 500 twice a day and was generally getting by back on seretide 250, Monkelaukast and the occasional puff of Bricanyl). The cons understood my conch but said this is perfectly normal for asthma (there was still indications like IgEs etc bit LF was essentially normal (if a bit all over the place). My GP referred me because of the number of flares and how long they lasted (often knocking me out for a month) rather than the severity of attacks. He was also be proactive as I was needing Seretide 500 quite a lot and he said if it suddenly got worse (like it has recently) he wouldn't really know where to go. It take a few months to come through so am grateful for it in January (even though at the time it didn't really feel like it.

    The cons is currently exploring different options (all of which my GP could do - like trying Symbicort SMART, changing accuser to MDI) but has others like Theophylline in the background. She has also suggested atrovent but this seems to get mixed responses (not sure why though). I seem to remember cons saying it was inhaler but not a steriod, just works on different receptors? (although I may be very wrong on this).We have also discussed trying treatments that I can manage like adding extra ICS when bad but stepping down again when not. It may also be worth looking into nasal sprays (my allergy cons said these can sometimes be more beneficial than antihistamines if it is mucus production that is a problem) or trying a different antihistamine.

  • Oh maybe I said it wrong - I thought it was that the dander is what they shed - the skin cells - which contain the allergen? So if you're allergic, it gets everywhere and causes problems, but if you're not allergic it doesn't matter how much they shed, you won't react.

    Not sure now where the saliva comes in - maybe it's actually that they excrete it through their skin and so it's in the dander, but with cats also because they are OCD about grooming you probs get saliva on the dander from where they've been grooming.

    Anyway not sure if I'm making sense - just how I understood it is that it's not the fur per se but what's in/on the fur, shedding is just how it gets into your lungs. (I was reading this from a breeders' site for Siberian Forest cats:

    siberian-cat-club.co.uk/vie...

    'Most (but not all) cat allergies are cause by the FelD1 allergen, transferred from a cat’s saliva onto the coat when they wash themselves, flakes of which then become airborne causing irritation. Research has shown that the Siberian Cats' fur contains less FelD1 than other breeds. However, as everyone responds differently, if you suffer from allergies it is very important that you have an allergy test. This involves visiting a breeder and sitting with their cats for an hour or two, this also gives you a chance to learn more about the breed and meet some of their cats and kittens.'

  • mine don't have much warning can have a humdingerout of know where...never really have had a slow burn. I am diagnosed as difficult brittle...but don't try and focus on the words

  • I am a severe brittle too ... scary at times. I can slow burn or crash and burn with virtually no warning. Seriously scuppered when have a crash and burn on top of a slow burn - like last week!!

  • Last week was a nightmare for me too...had 3 massive attacks in 2 weeks ended up in ITU twice first time was tubed second not thank goodness and yet inbetween I was okayish...oh the joys of weird asthma. Hopefully back to work for me tomorrow...am missing the normality. If you can call teaching normal

  • I have recently been rereferred to the cons for asthma (have always seen them in a roundabout way for allergies though) and when I saw them in April was worried because I had was going through the best patch in a while (hadn't needed pred for 4 months, managed a wobble by putting up seretide to 500 twice a day and was generally getting by back on seretide 250, Monkelaukast and the occasional puff of Bricanyl). The cons understood my conch but said this is perfectly normal for asthma (there was still indications like IgEs etc bit LF was essentially normal (if a bit all over the place). My GP referred me because of the number of flares and how long they lasted (often knocking me out for a month) rather than the severity of attacks. He was also be proactive as I was needing Seretide 500 quite a lot and he said if it suddenly got worse (like it has recently) he wouldn't really know where to go. It take a few months to come through so am grateful for it in January (even though at the time it didn't really feel like it.

    I thought cons appointments were just reserved for those with serious and frequent attacks - i am certainly not either of these. Maybe this is something I can discuss with the GP when I next see him then, unless he is happy with my level of control for the time being?

    Last week was a nightmare for me too...had 3 massive attacks in 2 weeks ended up in ITU twice first time was tubed second not thank goodness and yet inbetween I was okayish...oh the joys of weird asthma. Hopefully back to work for me tomorrow...am missing the normality. If you can call teaching normal

    Sounds awful for you Honey! Its weird how asthma can fluctuate so much so quickly isn't it!

  • Butterfly - like Kayla says I don't think you need to have serious/frequent attacks for referral. I was initially referred because of doubt re diagnosis (it wasn't really that bad then) but later, while that element was still there I think it was much more my GP feeling that things were hard to control even if not severe sudden attacks and he didn't know what to do. I should think the idea is that if the GP is unable to keep things under control, even if that's not in and out of hospital, then they need a more expert opinion, and it does sound like you don't really have good control right now.

    Honey - :( Hoping you can avoid that happening again!

  • I should think the idea is that if the GP is unable to keep things under control, even if that's not in and out of hospital, then they need a more expert opinion, and it does sound like you don't really have good control right now.

    Thank you for your reply Philomela, the thought of a cons appt is much less daunting now, now I aren't worried about being a fraud lol!! As I said earlier in the post, I feel fairly well controlled, but everything else is suggesting otherwise ;-/ we shall see what the GP thinks!

  • Well I have often felt like a fraud too! Esp as I seem to be annoyingly difficult even if not severe. But I have to remind myself that it's not unreasonable to want better control than I have and if my GP is stuck then I do need expert input.

  • Hi Butterfly,

    Like Philomela says, a referral is prob needed when primary care are doing all they can do and you still get symptoms. I held off being referred from last summer to January on this basis (haven't been hospitalised for nearly 15 years) but was much happier about it when GP says they have to consider the frequency and length of flares as well as severity. Apparently Monteleukast was as far as he is comfortable to go and prescribing Seretide 500 was really pushing uim! II was also surprised to be diagnosed with severe asthma on this basis (I wouldn't class myself as severe at all). My cons thinks that although my asthma is bad, I respond well to relievers which generally keeps me out of hospital (I was also told not to become complacent about this though).

  • Hi Butterfly,

    Like Philomela says, a referral is prob needed when primary care are doing all they can do and you still get symptoms. I held off being referred from last summer to January on this basis (haven't been hospitalised for nearly 15 years) but was much happier about it when GP says they have to consider the frequency and length of flares as well as severity.

    Yes I guess I've had a number of chest infections and associated flare ups requiring pred this year, and whilst I do respond to pred, it takes a while to bounce back. Plus, since my diagnosis in 2010, my symptoms are much worse, I don't want to be on a slippery slope downhill without further support, and I suppose I can always be discharged if I regain good control like I've had in the past.

    Philomela, I definitely follow you on the 'non textbook' asthma!! And as you said, whilst I may feel controlled at the minute, I have had to make lifestyle changes and compromises eg I can no longer run, I was running 10ks 2 years ago.

  • Kayla, apart from the earlier bit (I was fairly mild as a kid) you sound so much like me! I wouldn't consider myself severe either and apart from some blips this last week have not needed hospital, but do seem to have the same kind of pattern that you have with lengthy, fairly frequent but not severe flares. AUK nurse today acknowledged the breathing pattern thing (she remembered me from before and I had been saying about how previous cons thought I used inhaler too much, as she was asking me why I hadn't had more today) and other issues but even with that said 'what you've got there is moderate to severe asthma and yes, I see what they mean about the inhaler and breathing pattern but you are having a flare-up and your PF is down, so you need to take it'.

    I am inclined to go with moderate, but severely a pain in the ass nonetheless especially right now (kicking off again today after trip to London, which is not very convenient as I have a lot to do and I have to go to London again next week).

    Butterfly - yes, I am kind of in denial about 'having a chronic condition' but even at moderate (and not being sporty) I think I have had to make some changes. :( re the running though, I guess I'm lucky that with perfectly normal lungs I wasn't inclined towards sports, though some degree of stamina and being able to have a go at things would be nice. I don't like how it affects my oboe-playing and at times singing though.

  • I have an appointment with gp for next week, will mention a referral and see if he is happy with the level of control I currently have.

  • I saw the gp today, he agrees my level of control isn't ideal, pf is quite variable and reliver 3 days out of the week isn't great. He doesn't think I need referral yet as I had good control last year and thinks that is the next step if his next options don't work. So basically I've been given 3 options:

    1) do nothing, stay as I am and review in 3 months (with strict instructions to return if inhaler usage increases to 4-5 days out of the week)

    2) try a long term low dose of oral steroid

    3) try theophilline (sp?)

    4) increase seretide (although he has little faith that this will work!)

    My concerns are:

    1) I'm at risk of serious attacks/decline if I get a cold/virus

    2) don't like the idea of long term steroids

    3) sounds scary how easy you can go from therapeutic dose to toxic dose!

    4) its unlikely to work!

    I would really rather take as little as possible, so my initial thought is to wait as I am and see.

    Can anyone offer any advice/suggestions?

  • I saw the gp today, he agrees my level of control isn't ideal, pf is quite variable and reliver 3 days out of the week isn't great. He doesn't think I need referral yet as I had good control last year and thinks that is the next step if his next options don't work. So basically I've been given 3 options:

    1) do nothing, stay as I am and review in 3 months (with strict instructions to return if inhaler usage increases to 4-5 days out of the week)

    2) try a long term low dose of oral steroid

    3) try theophilline (sp?)

    4) increase seretide (although he has little faith that this will work!)

    My concerns are:

    1) I'm at risk of serious attacks/decline if I get a cold/virus

    2) don't like the idea of long term steroids

    3) sounds scary how easy you can go from therapeutic dose to toxic dose!

    4) its unlikely to work!

    I would really rather take as little as possible, so my initial thought is to wait as I am and see.

    Can anyone offer any advice/suggestions?

    I am currently on montelukast, 2 puffs, twice a day of 250um Seretide and 10mg certirizine.

    I was on the same meds last summer, and after repeated short and occaisional long courses of pred it was obvious that I needed a step up in meds, so I've had the same options offered to me. First I doubled the seretide in early October, which improved things, but still had times when pf would drop belowe 50% so then added theophylline in January. I'm soo much better and have massively reduced the frequency of pred courses and pf variability.

    1) Like you say, if you come across a big trigger/cold/virus then it won't be good. You also had an attack a couple weeks ago which could happen again if things stay the same.

    2) I think there are better options than to start on long term pred (like the options below) when using reliever 3 days a week. Plus, I'm pretty sure the NICE guidelines say that you should be under a cons if this is considered.

    3) It does sound scary, the potential side effects and the toxicity thing is something I thought about a lot before taking Theophylline, but I don't have any doubts about taking it now, I would be much worse off without it. It's also normal to be under cons when on this.

    4) It made a difference to me, so I think it's worth trying. I've tried going back to the lower dose and my symptoms worsen.

    You may be happy enough to put up with current symptoms with current meds and deal with any exacerbation, probably with pred. Or, you may wish to up Seretide or start Theophylline to try to avoid the exacerbations and emergency courses of pred.

    Just my personal opinions and experiences, but I hope it helps.

  • Diurnal variation for non-asthmatics averages 8.3% , more than 20% is considered above the upper limit of normal and indicative of asthma/poor control.

    Maybe go with the seretide first and then if it doesn't help, consider the others?

    Of your choices, the least likely to work (increasing seretide ) is also the one with the least side effects - it probably won't hurt and it may help - which is a much better choice than doing nothing which definitely won't help and may make you sick more often.

  • Thank you Beth, I hadn't thought of it like that!

  • Thank you for your reply Lou, its useful to see you have had positive benefit both from increased seretide and theophylin. Out of interest what dose or seretide are you now on? How do they decide what dose of theophylin to start with? How soon did you see a benefit?

  • I'm on 2000/200 per day of Seretide. 4 puffs morning, 4 puffs evening of the 250/25 evohaler. I had the 500/50 accuhaler for a while, but kept suffering with sore throat and oral thrush with the powder inhaler so switched back to the MDI+spacer.

    They just started me on the lowest dose, and planned to increase after initial blood tests. I started on the 200mg of Uniphyllin, which happens to be my theraputic dose, any more and I'll show signs of toxicity. I seem to remember lungs improving within a few days (Iguess this wouldn't happen though if you started on a sub theraputic level). Just looked back at my pf charts and I can see that it started improving almost straight away and steadily improved for a few weeks until it plateaed.

    Whatever you decide to do I hope it goes well and do please keep us up to date. xx

  • I have had time to think through things, and just can't bear the thought of adding more medication at this stage, I know its ridiculous, I'm finding it hard to justify it to myself even, but given that I'm not to bad at the moment, I want to see if things can improve first. My plan is that I will monitor pf/symptoms etc, if I start to wake more than once a week/use ventolin more than 3 days in a week, I will get the gp to up my seretide, and if this has little or no effect I will try theophyllin. In the meantime, if I see no improvement in 2 months I will see gp to increase seretide anyway as I want to enter cold/flu season in a stable position asthmawise seen as that's my biggest trigger.

    I know I'm probably just putting off the inevitable, and only have myself to blame if I have a crappy time with my asthma.....but that's just me, I always put off until tomorrow what I could've done today!!

    Thank you all for your advice, it has been very useful, and made me feel more confident about using theophyllin should it come to it.

  • You're welcome. Hopefully it won't come to needing to up meds. xx

You may also like...