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stepping up advice please

So after a 4-5 month period of NO symptoms what-so-ever asthmawise, I have been experiencing an increase in asthma symptoms since recovering from a throat infection 2 weeks ago. I have noticed big increase in mucous production, because of this I'm coughing more, Peak flow had become variable , I am aware of air trapping, I don't 'wheeze' as such but feel noisy/wheezy.

Since symptoms had disappeared I had reduced seretide to one puff once a day, but am allowed up to two puffs twice a day. Since having a return of symptoms, I have stepped up to one puff twice a day, but wondered in other peoples opinion, how long I should remain at this level before increasing further seen as it takes some time for the steroid part to work? I had thought maybe a week, and if symptoms remain step up again.

Also any advice on reliving air trapping? Obviously I am using ventolin, but still feel I am air trapping.

Thank you in advance

2 Replies

Hi there,

on air trapping - carbocistine (from GP) can help thin the mucus, and regular steam inhalation (not too hot) also helps if you're not already trying that. Having a regular routine - eg 10 coughs every hour - can also help prevent things from building up.

Seretide has 2 parts: the steroid, fluticasone, takes about 5 days to reach steady state when you adjust the dose. The salmeterol, slow acting ventolin, is effective immediately. Personally I would go straight up to the maximum 2x2, wait for symptoms to resolve, and then scale back down, rather than building up steadily, as the longer your lungs are inflamed the longer it'll take to get that good control back.

I've found that montelukast and hydroxyzine hydrochloride have been the best thing for my mucus plugging/air trapping, though I'm about to start on carbocistine again I think.

Could your mucus be partly post-nasal drip?

Also - something you probably know, but I didn't find out until last year, is that for most people with asthma the standard cough-and-cold meds actually make things worse - I get a lot more air trapping if I take lemsips and so on because the beta-blockers in the antihistamines cancel out the beta-agonists in the asthma meds. (Night nurse is ok though - yay!)

I hope that's vaguely helpful,



Thank you for your reply.

I shall give steam inhalations a try and see how that goes, and have stepped up to 2x2 seretide as your advice makes good sense. I am also on montelukast already.

I often think I may have post nasal drip, what can I do to prevent/minimise this?

I never thought about that, the use of otc cold medicines. To be fair though I often find they don't help anyway.


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