Another viral exacerbation

Hi Everyone

I'm suffering another viral exacerbation of asthma. I absolutely cannot manage if I get a cold. I got the symptoms of a cold last Thursday and by Friday I was seeing the GP as an emergency. Peak flow down to around 270-300 so he started me on Prednisolone. However, I think there was some gradual deterioration too since for about a week before I'd been coughing and wheezing, especially at night. I'm attributing this to the weather.

I last had Prednisolone in March, after a viral exacerbation and before that it was December, with another cold.

I'm getting really fed up now with frequent doses of oral steroids.

My usual medications are:

Seretide 125 2 puffs BD

Montelukast 10mg daily

Salbutamol PRN

Best PEF 480, usually around 450

I've tried Symbicort SMART using 200/6 and was taken off this to be changed to Symbicort 400/12 before returning to Seretide. I've also had 28 days Theophylline during November 2012 when I was ill for most of the month!

Any suggestions as to what I can try, I'm under the care of my GP/Asthma nurse. Am thinking of specialist referral. I use a Volumatic spacer of all inhaled medications so don't think my technique is poor.

Thanks

33 Replies

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  • Hi

    I take 3 puffs of 250 seretide twice a day but that was increased gradually by gp and other docs cant remember who and maybe that would help u a bit more of the steroid inhaler but remember i am not a doc and my asthma is still not well controlled ?. I also take theophylline and montlukast and sabutamol regularly and when needed. But the best thing you can do is get a referral as soon as possible as i had same trouble a year ago and just struggling at the moment?. Didnt think that time it will be this bad.

    However, i hope you get better ?

  • Hi Hb1977,

    I too get viral induced asthma (also allergic asthma) and am always picking up colds as I work with small children. I was on pred pretty much all the time from Oct-Feb as I would reduce down and then pick up another cold. My cons said it was a bit of a vicious circle as my poorly controlled asthma was making it easy to pick up viruses and then that would make my asthma bad again.

    Like Yas suggested you could ask for a higher dose Seretide (250) and I take Spiriva too but this was through a cons. I would suggest talking to your GP/asthma nurse about how you can alter your treatment when you feel the first symptoms (like you I have about a week where I gradually feel myself getting worse when it is a viral exacerbation). I reduced my oral steroids considerably from Feb to May (when allergic asthma started to take over!) despite having several colds when I asked if there was anything I could add in without going straight to oral steroids - I have been on Symbicort in the past and could up my dose to 2 puffs a day but since being on a high dose Seretide I could no longer do this. For me I add Flixotide (which is the steroid part of Seretide) at the first sign of deterioration which seems to have some benefit. It might be you could increase you Seretide instead? Like I said it seemed to work for a few months and I am hoping the lack of response now is due to a different trigger. If your GP can't offer you anything else then I would ask for a referral.

    I hope this make sense. The other suggestion would be to ring the helpline at the top of the page. The nurses there are excellent at suggesting different treatments you can try as well as practical advice about when you should be referred, how to have tricky conversations with the doctors etc.

  • Sorry to hear another cold has sent you downhill. Unfortunately viruses have the same effect on me and I'm suffering right now because of one. In fact I'm waiting to see the Gp later this afternoon because of it. I was fine until Sunday when I could feel the cold coming on and my pf dropped, I can only manage about 50% today and am using ventolin every 30minutes so fortunately the Gp has fit me in as an emergency.

    I would definately suggest you ask if a higher dose of seretide would help, my GP allows me to adjust the dose up to 2 puffs twice a day of the 250 depending on my symptoms, this means I'm not on too high a dose when I'm ok, but can increase if I'm struggling without having to see the Gp.

  • Hi

    Thanks everyone for your replies.

    I've made an appointment to see the asthma nurse at the surgery. I don't find her very useful but will give her the benefit of the doubt. Will take in good records of how many days sick I've been off work this year as well as the number of courses of pred. I will discuss that by the time an exacerbation has passed there is not much recovery time before I get another. I don't want this pattern to continue!

    Hopefully she will have some good advice, if not then at least I've tried and then can tackle the GP about a referral before the winter!

    Thanks again

  • Hi

    Ended up seeing the GP on Friday; he's given me another 5 days of steroids and then wean them over about 10 days. I'm getting so fed up now since my peak flow hasn't recovered this time and in fact has dropped again over the last couple of days.

    Very frustrating; still have symptoms of a cold but am actually thinking that this may be a sinus problem or hay fever as the pollen count has been ridiculously high in the last couple of days.

  • Hi Hb 1977,

    Just joined the forum to reply to you as I recognise your frustration with infections. I am a perennial cold sufferer and have been since I was a child. Inevitably I would be off school or later, work with colds/flu. As an adult onset developer of asthma I have seen colds play havoc with my asthma over the years.

    I have kids and work in an office so it is pretty hard to avoid infections. I have managed to reduce the amount of infections though over the past 2-3 years. The solution? Red grapes. It helps that I really like them but they have prevented goodness only knows how many infections. My health is better as is my sickness record.

    It does not stop everything and viral stuff is trickier, however if you are able to take them I would heartily recommend the grapes. Hope that helps and the PF is on the up again soon.

  • Hi

    Just joined the forum.

    Do you eat dairy? When I was able to tolerate dairy products, I always had to come off them completely whenever I had a cold (or any illness). It was the only way I could manage my asthma. (Dairy products are well know for causing the body to product mucus, though it seems telling asthmatics to avoid them when ill or having issues is not something that often comes up - it was my GP many years ago who told me about this). But just be careful once you have recovered if/when you try to go back onto dairy, for me it put me back in A&E which established I was actually intolerant to cow's dairy and sadly now I am allergic to cow's dairy and intolerant to all other dairy sources

  • Hi I have allergic asthma too and viral exacerbations. My last exacerbation (viral) was around this time last year and yep I'm right back to where I was then. The Montelukast I was put on in June '13 has helped a little but the high & very high pollen counts have plagued havoc with my allergic responses and I've needed a weeks course of Pred to take down the swelling of both eyes, my skin on my face and neck has felt like it is creeping and prickling :(

    I'm on Symbicort 200/6 1 puff twice daily but I'm doubling this dose at the minute.

    Montelukast 10mg

    Ventolin reliever as needed.

    I've just finished a course of Amoxicillin 500mg TID.

    I love the summer but it's been a bit miserable so far.

    I'm sorry that you all have had a miserable time too.

  • Hi

    Well, it's been an eventful 5 weeks. After doubling the Seretide 125 to 4 puffs BD as well as a week of antibiotics and 3 weeks of Steroids I had amazing (best ever) peak flows.

    Saw the asthma nurse mid July who told me to go back to Seretide 2 puffs BD. Since then my peak flow has gradully fallen and I've developed a cough and a need for Salbutamol. Latest peak flow is only 75% of best.

    Really don't want anymore Pred if I can help it, going to see GP this week to see what else I can try. Wondering if I should increase the Seretide on a more permanent basis?

    Don't even think I've got a virus this time, if I have then it's gone straight to my chest without causing a cold! Think the weather may be contributing now.

  • Sorry you've been having a rough time too, sounds to me like you need to double up your seretide again. But run that option past the doc first.

    I had to go on another course of antibiotics and this time it's Clarithromycin. The course finishes tomorrow and I'm still having to use my salbutamol through the day (around 4-8 puffs)

    Viral exacerbations just take so long to losen their grip.

    A friend of mine is a doctor and she says that she often tries her patients on Atrovent in these kind of exacerbations before she prescribes Pred. I've not used it but it might be worth asking your doctor about it.

    Good luck and let us know how you get on.

  • Hi

    I've doubled the Seretide and having regular Salbutamol. Seeing GP later in the week so will talk to them about increased Seretide in the next few months until things calm down and see what they think about Atrovent. Would rather not have any more Pred having spent most of June on it, before that it was March and December.

    Think there is also an element of the weather as a contributory factor; will keep you all posted. I know quite a few asthmatics are having issues at the moment.

  • Hi, sorry to hear you're suffering too. I too have had pumps changed, 2 lots of pred and antibiotics.

    Started at easter and no better. Still got chest infection from June.

    I've been on atrovent since mid May to little affect, take it 4 times 2 puffs also on seratide 125 twice per day 2 puffs and ventolin.

    On montelukast, clarithromycin and fexofenadine too at the mo.

    Its so annoying that the docs cannot work out whats going on with all of us. Surely we've had hot weather before.

    But in 20 years this is the worst, i've not managed a whole week at work in 6 weeks. At hospital tmoro for further tests.

    Hope we all get better soon.

  • Hi

    Another update after yet another appointment for Asthma.

    Have been switched to Seretide 250 (2 puffs twice a day) and also given Atrovent to try. This is in addition to the Montelukast I'm already on plus Salbutamol.

    GP says there isn't anything else that can be offered in general practice and he'll need to refer me to a respiratory consultant if things don't pick up.

    We've agreed that we'll try and avoid another course of Pred and give this a chance to work, I'm happy with this approach having only finished steroids at the beginning of July.

    Fingers crossed!

    PS I use a Volumatic spacer, which the Atrovent doesn't fit. Is there a spacer that fits everything?!

  • Hi hb1977

    I use an able spacer and an aerochamber, both good but get on with able spacer better. Both fit atrovent.

    My update today had allergy test-very reactive to grass pollen and sightly to dog & horse. Also had lung function which was normal....

    Straight after saw specialist who had upped seretide to 250 and have to return in 6 weeks plus see own asthma nurse next week.

    Hope you have some improvement lets see what seretide 250 does for us :-)

  • I finished my course of Clarithromycin today and I won't miss waking up with its awful taste each morning ?

    I feel better than I have done since mid June so while I'm not 100% back to my normal yet I'm hopefully heading there. Till the next time...

    Hope you all improve, this summer and it's very high pollen count has been very difficult.

  • Hi

    Sorry to hear you're all suffering so many bugs going round to say it's supposed to be summer!

    I caught pneumonia and was hospitalised at the beginning of June and haven't been right since except for 1 week last week :( truly fed up now. Got antibiotics which cleared the pneumonia and was back to work after 2 weeks. Then after about 2 weeks and a week after finishing the antibs I got a cold had 3 severe asthma attacks resulting in a month of pred and another lot of antibiotics. So have been fine last week after finishing the pred after a tapering dose (started on 80mgs) daily and finished them a week last Friday. Guess what caught a cold yesterday and today went to the docs and got put back on 80mgs and antibiotics again no air getting to the bottom of either lung he said.

    So my question is this.... Should I be on more stuff to stop me reacting so badly each time I get a simple cold because from what I understand the steroids make you more prone to catching stuff anyway?!

    I'm on 4 puffs 2 times a day of clenil modulate 100, 6-8 puffs of ventolin every 4hrs and 2 puffs twice a day of serevent. Ventolin seems to be massive now surely shouldn't have been told to have that much each day?! I thought there general idea is that you don't need it at all?

    I'm very confused and fed up of it lol. 2 am and I've just finished cleaning the oven (mask on) because I'm so wired I can't sleep with the pred. Got to be up in 4hrs for work :(

    Thanks for any advice sorry to have rambled!!

  • You have my sympathies ?

    When I was on Pred a few weeks ago I could not concentrate enough to even read.

    The specialist I saw at the hospital 12 months ago who put me on Montelukast did so because he felt that each cold virus and resulting exacerbation was damaging my lungs even more each time. You could mention Montelukast to your doctor. Though I've since had a viral exacerbation even whilst taking Montelukast.

    That's a lot of ventolin, I'm sure you're headachey ?

    My asthma nurse told me that in the absence of an exacerbation well controlled asthma shouldn't need ventolin, but when your poorly if you need it then take it. I hope you feel better soon (hugs)

  • Thanks cici. Yes headachy crampy wired bit shattered and got the shakes something chronic lol . Got to go back to go Thursday eve so will see what he suggests will mention montekulast thank you. Because I would have thought if can't go on like this every time I get a simple cold I've got 2 kids under 5 so constantly one of them is ill and passing it to me lol. X

  • Thanks cici. Yes headachy crampy wired bit shattered and got the shakes something chronic lol . Got to go back to go Thursday eve so will see what he suggests will mention montekulast thank you. Because I would have thought if can't go on like this every time I get a simple cold I've got 2 kids under 5 so constantly one of them is ill and passing it to me lol. X

    Headachey and. Shakes, yep I know that well. lol

    Unfortunately every time I get a cold I get an exacerbation, but fortunately I only get a cold once or twice a year. Though this last cold wasn't even that bad ?

  • Hi

    I don't quite believe it but I've got yet another cold. So after a trip to the GP's today I'm now on another 5 days of Prednisolone and a week of antibiotics.

    I'm already on Seretide 250 2 puffs twice daily, Atrovent 2 puffs 4 times daily, regular Salbutamol and Montelukast.

    So annoyed that after exacerbations and Pred in December, March, June and now I'm having the worst year with asthma!

    Hopefully the drugs will kick in soon and I'll feel better real soon.

  • Hi

    I don't quite believe it but I've got yet another cold. So after a trip to the GP's today I'm now on another 5 days of Prednisolone and a week of antibiotics.

    I'm already on Seretide 250 2 puffs twice daily, Atrovent 2 puffs 4 times daily, regular Salbutamol and Montelukast.

    So annoyed that after exacerbations and Pred in December, March, June and now I'm having the worst year with asthma!

    Hopefully the drugs will kick in soon and I'll feel better real soon.

    Yikes! Can you start drinking strong Manuka honey in hot water with lemon? It's not a cure but I find it helps me a little. Sorry you're poorly again (hugs)

  • Since i last posted i'm now had seretide increased to 250. Still on montelukast daily and fexafenadine.

    Asthma had been bad today, tightness and heavy feeling when breathing. I had an allergy test last week & unsurprising I had a huge reaction to grass but not tree.

    Lung function was fine..how can that be? Got to return in 6 weeks.

    Really looking forward to the end of summer if it makes us better.

  • Poor you I sympathise. I started 5th lot of pred on Monday since June I'm fed up of feeling like a zombie from

    Pred stopping me sleep and not liking the elephant on the chest feeling that just won't go away. I wonder why there are so many bugs about in the summer?! Worries me a bit it's like this now September soon kids back to school them wham it's cold/flu season. Worries me it's this bad now what's it gonna be like then?!

    I do hope the pred kicks in soon. I can already feel my lungs are less twitchy and feel less sticky but still don't feel brill.

    Out of interest what antibiotics did you get? I got levofloxacilin but the pharmacist scared me a bit as she said it can cause toxicity and shouldn't be taken with pred as it can cause your tendons to rip off your bones! Back at the doc for assessment tomorrow so will ask why he gave me them together and hope something doesn't go snap in the meantime! X

  • I sympathise! Poor you! I got 5th lot of pred on Monday since the start of June. Only been off it 5 days in that time and on 40mgs now but was as high as 80 to start with. I got pneumonia was hospitalised at beginning of June and have not been right since colds keep setting asthma off. Worries me how many bugs are about this summer. What's it going to be like when it really is cold/flu season once the kids are back at school?!

    Hope the pred works real quick for you and you manage sleep! I've had less than 5 hours in total over the past 2 nights feel like a zombie.

    Out of interest what antibiotics are you on? I got given levofloxacilin but pharmacist told me they shouldn't be prescribed together as they can cause toxicity and make your tendons snap off your bones! A worry!! Back at docs tomorrow as they like to check pred is working so shall ask but wondered if you knew?

    Sorry you're having the worst asthma year ever! Me too :(

  • Hi

    I don't know the answer about the antibiotics, best ask tomorrow.

    Hope we all see some improvement real soon, can't believe things have been this bad this summer. Am dreading winter.

  • Well, didn't get the improvement as expected although I now think there's an element of hay fever, rhinitis or sunisitis which is adding to my lack of asthma control. I feel constantly congested and snotty even though the cold should have gone.

    Peak flows still all over the place. Saw emergency GP again and have been started on theophylline and referred to a chest consultant. Hopefully I will get seen soon as I feel absolutely dreadful and am very fed up.

    At this rate I'm absolutely dreading the winter!

  • Hi Hb,

    I just wanted to say - in case it was at all reassuring - that right now the air quality & pollen levels are horrendous. I've just had my first really bad exacerbation for over a year. Even our dog is suffering - she has corneal abrasions because her hayfever has been so bad.

    Hopefully when this warm and windy weather is gone things will start to ease off...

    Cx

  • The pollen count is supposed to be low but I still have to take antihistamines every day as I wake up feeling that my skin is crawling off my face ?

  • Yeah - I think it's the gusting about that is the issue. Plus the cycle of rain (pulls down all the pollen from the skies) and then sun, which dries it out and allows it to blow around again...

  • Things didn't improve for me in the way I expected!

    GP started me on Theophylline and referred me to a respiratory consultant who managed to find me an appointment ASAP.

    I've had chest x ray, ECG, lung function tests and blood and sputum tests.

    Consultant is going to write me a new action plan and has spoken to me about considering Fostair and Tiotropium and has given me additional emergency supplies of steroids and antibiotics in case I have another exacerbation before my next appointment.

    Consultant doesn't like theophylline and neither do I so we've agreed to stop it.

    Will update when I know more.

  • Things didn't improve for me in the way I expected!

    GP started me on Theophylline and referred me to a respiratory consultant who managed to find me an appointment ASAP.

    I've had chest x ray, ECG, lung function tests and blood and sputum tests.

    Consultant is going to write me a new action plan and has spoken to me about considering Fostair and Tiotropium and has given me additional emergency supplies of steroids and antibiotics in case I have another exacerbation before my next appointment.

    Consultant doesn't like theophylline and neither do I so we've agreed to stop it.

    Will update when I know more.

    I hope your new treatment regime works.

    Keep us updated.

  • Don't dismiss theophylline completely. It doesn't seem like you've had enough time to see if it works for you or have levels checked. At first it doesn't seem like a nice drug, in fact it seems pretty scary, but has been amazing for me. Even though i was very dubious about starting it at first i'm now so glad that i tried it and stayed on it. I was having many viral (and other) exacerbations before i was on it and pf varying by 40% +or- a bit everyday, also found it near impossible to stay off steroids, only lasting a few days to a fortnight max before being back on them again. I'm now so much better than i was before starting it, have vastly reduced the amount of steroids that i take, and although i still have exacerbations they're less frequent, less severe and easier to handle.

    I hope the fostair and tiotrpium help you. But if you want to ask any questions about my experience with theophylline i will gladly answer them.

  • When they started me on uniphylline about 18 months ago it seemed scary and I didn't really want to need a drug like that and I can tber feeling awful when I first began taking it. But out if everything I take to manage my asthma it's the thing that has made the biggest difference to me. I am still taking it and am guaranteed to be very unwell of my levels drop for any reason. IV Aminophylline is also my magic drug when I am really unwell with my asthma. It's one of those drugs with lots of listed side effects but it's is worse for some people than others. I wouldn't dismiss it, it doesn't spud as though it's had a fair shot.

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