Confused about action plan

I've recently been given an asthma action plan, which when the gp gave it to me, made sense, but now I'm unsure.

So it says: if use reliever more than 4 times a week, symptoms return or peak flow goes below 450 (best 570), to increase seretide to 4 puffs twice a day and ventolin up to 2 puffs every 4 hours.

So in the last 7 days I've only used ventolin 3 times (Actually all in the last two days) and pf yesterday was 440 and today 420 (taken first thing before preventer).

Q1. Do I have to wait to fill all criteria or the fact that my pf is less than 450, is enough to start the action plan?

Q2. Do I have 2 puffs of ventolin every 4 hours aswel as the increase in seretide? Or just one or the other?

It says if pf hasn't improved above 450 after 48 hours to see gp urgently.

Q3. Is that still taking pf before the preventer? Or take the preventer then measure pf? Seretide has a long acting dilator so ought to improve pf.

Q4.If it does improve within 48 hours, how long should I stay on the increased dose?

Sorry for all the questions!

30 Replies

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  • Never been given an action plan, but I think the best thing is to phone the surgery for clarification :-)

  • Thank you, yeah good thinking.

  • Hope this helps but remember the usual caveat that I'm not a qualified health professional!

    1. The critical issue would be the drop in your peak flow reading. Sometimes it drops as a warning of problems in the offing so even if you don't feel too bad be alert to the fact that you need to keep a close eye on it. The criteria they are setting out really are just about measures for not feeling well. If your peak flow drops but you feel ok & your breathing is ok, I'd still increase the seretide as advised until it climbs back up again.

    2. The seretide increase is the priority; ventolin if you feel you need it (for example you are more out of breath than usual or coughing).

    3. If your reliever is working it will lead to the peak flow improving. I would tend to take it before taking the reliever, just to give you a benchmark. There's no harm then taking it again as that might be useful information if you have to see the doctor. Seretide does as you say have a long-term bronchodilator so (in my experience anyway of taking it) it doesn't tend to influence peak flow immediately. That's only my experience though. I think though sometimes when I used to get sirometry at the GP surgery occasionally they would tell me not to take it beforehand. I think it' one of those things you just need to monitor over time to see how you are with it all.

    4. Being honest if it hasn't improved over 2-3 days the best advice is probably to go back to the GP as they may want to prescribe you steroids to try & shift it for you.

    I hope that's of some help anyway. As always though, if in doubt speak to someone qualified to help you :)

  • Thank you, your comments are a great help.

    I have increased my seretide today already and will see if it has any impact. To be honest I have found my symptoms increasing since posting this anyway so have now exceeded '4 puffs of reliever' . I haven't actually managed over 450 even after double seretide and 2 puffs of reliever.

    I was wondering about making a gp appointment for a couple of days incase it hasn't improved, with a view to cancelling if necessary.

    Thanks again

  • If your symptoms are deteriorating then yes I think there's no harm in booking an appointment...I hope you soon feel better anyway.

  • I will try again to ring the gp for advice today (couldn't get through yesterday) and ask if I can book an appointment for the end of the week

  • Hi -Butterfly-,

    Like starveycat I've never been given an action plan, though I do have a mental one of my own.

    As a rule, I take peak flow readings before I take my preventer medication and then take another set about forty mins to an hour after I've taken it. If I need to use ventolin during the day, I will take a further reading before I take the ventolin, and another one about thirty to forty five minutes after I've taken that. I also keep a record so that I have that data to hand if things don't improve and I need to see a GP.

    If you still worried about this, I'm sure your GP would not mind you contacting him/her to ask for clarification on some points. If you cannot get hold of your GP directly, ask reception if you can leave a message asking for a call back when it is convenient and explaining why. I find the doctors at my local practice are very good at calling back with answers to any medical concerns I have.

    Hope this helps

  • Thank you for your reply.

    I think contacting my gp is going to be best, I did try yesterday but couldn't get through. I will try again today.

  • You should take pf when you feel symptoms or before inhalers morning & nighttime. If pf down after 2 days you could see gp or asthma nurse or sooner depending on how bad your symptoms are. You should take both ventolin and seretide when your symptoms are getting worse. You don't need all of the symptoms to start your action plan. I wouldn't reduce your seretide unless you've been seen by gp or asthma nurse just to be sure your flare up has settled.

  • Thank you for your reply.

    I gave up and started my action plan yesterday without ticking all the criteria, thank you for your clarification that I don't need to have ALL symptoms, I was worried I was rushing into it unnecessarily.

    So for example, I doubled my preventer yesterday therefore I should see an improved pf this morning before my inhalers? And if by tomorrow I haven't improved above 450, I should see the gp?

    The bit that confused me, is that even if it had improved by tomorrow, surely I shouldn't just drop straight back to my original dose. Like you said, it's probably best to get confirmation that the flare has passed as 2 days is usually not enough, it can take me weeks to settle back down . Plus my pf usually hovers around 550 so it has a long way to go to be 'back to normal' for me.

    I really appreciate your advice

  • I don't think any reasonable medic will criticise you for approaching them if you're worried, even if you aren't ticking every box on your management plan. The plan is just a guide really to help you monitor your symptoms and give you some points of reference.

    For what it's worth, & this is only my experience but when I was taking things like sertedide & beclametasone, if I needed to double up I would keep it doubled until I started to feel OK in myself & the peak flow started to look like it was heading in the right direction. Unfortunately all this is probably as much art as science!

    Ultimately, if you don't FEEL right, you should always seek help (even if all they do is give you reassurance).

  • My problem is the opposite though, I tend not to go to the gp 'till I can't do anything but, and end up being in a mess. I worry about wasting their time and so put it off and put it off. ;-(

    That's why appreciate the help on here, whilst I know no-one is medically trained, I can seek reassurance that I'm either doing the right thing or comforted that I'm not wasting gp time if that's what I ultimately do.

    ( I've had bad experiences before where gps have made me feel like I'm being a hypochondriac and wasting their time ....turns out i was actually doing the right thing as I was very ill, took them a while to find that out though)

  • The Action plan is only a guideline . Start the increase as soon as you feel the need. You cannot overdose on ventolin but if your pf. Doesn't improve after taking it -see your gp. Take readings before and after. Stay on increased dose til your before reading improves , then gradually decrease dosage.

  • Thank you for your reply

  • Hi Butterfly,

    Hope you're starting to improve!

    You've started quite a discussion!

    If in doubt - you're GP should be happy to see you & clarify.

    In the meantime...,

    1. For the action plan its if you get any one of the criteria.

    2. The evidence & advice has now changed to say you should take the ventolin regularly as well as increasing your seretide (some are now recommending it instead of increasing preventer(!) - but go with what has been recommended for you on your plan).

    3. If your peak flow is still dropping below 450 at all (& it would be at lowest before taking inhaler so taking it then is probably best).

    4. I used to be told to stay at increased dose until 2 weeks after you're asthma has stabilised (I.e. Peak flow back up to normal & not needing reliever).

    If you start taking reliever regularly & are wondering when to cut that down I would wait until 24-48hours after peak flow has stabilised at normal value & no wheeze/tight chest/shortness of breath symptoms, then return to using it as needed.

    Hope that helps.

    If you're unsure you're GP would much rather you ask :)

  • Thank you, yes it's lovely that so many people can give me advice. Sometimes it seems a silly question but everyone is keen to help, that's what I love about this site.

    Still no improvement yet but there's still time, I only doubled it yesterday.

    When I re-read the plan, it says ventolin when needed up to 2 puffs every 4 hours. So I've stuck to only taking when necessary, but I think that's averaging every 4 hours anyway. My pf is dropping when my symptoms appear again (about 380-400), but the ventolin is definitely bringing it back up again (430-440) and it lasts the 4 hours.

    Your answer to 4 makes sense, I didn't want to just stop taking it! Hopefully I'll see improvement soon!

  • I eventually got through to the gp surgery to ask advice, unfortunately the receptionist was of no help.

    She was not willing to leave a message for the gp as they 'don't do that', and that I would have to book an appointment.

    I said I was hoping to save the appointment for someone who needs it as all I needed was a quick clarification, she wasn't interested.

    I asked if I could make an appointment then, but as it isn't an emergency, they can't fit me in until a week on Monday!

    She also added that she couldnt hear me wheezing much therefore it can't be that bad! Actually I don't often wheeze so the fact that I am, is a bad thing. Also I had just taken my inhaler, otherwise I wouldn't have managed the phone conversation without getting out of breath!

    So I'll see what the next few days bring, if my pf improves I will go to my appointment a week on Monday. If it doesn't I will try to get an emergency appointment instead.

  • I have to admit that I'm appalled at the attitude of the receptionist. I really do recommend that you contact the practice manager and make a complaint - because that type of attitude is very unhelpful. Nor is it her job to make a diagnosis on the basis of what she can hear over the phone - I very much doubt that she has the medical training or qualifications to do so.

  • Aww!! Sorry you had such a rubbish experience with the receptionist.

    You would count as an 'emergency' so if your peak flows not up make sure they give you an emergency appointment tomorrow - I wouldn't want you waiting any longer.

    Virtually needing your reliever every 4 hours with peak flow dropping with your symptoms - sounds like you're pretty close to needing a course of oral steroids &would need to be assessed by a doctor tomorrow to see if you need them tomorrow. So if you have any trouble with receptionists tomorrow please persist - tell them your asthma plan says you need a same day appointment & educate them that you can have bad asthma without wheezing!!

    Keep an eye on the criteria of the next zone of your asthma plan to make sure you're not meeting them & so you're aware if you do - it's easy to not realise & then end up getting worse than you would have if you seek help earlier (coming from someone who worked in healthcare, thought they knew their plan & only realised when they were in hospital that according to their plan they met criteria earlier than had thought!)

    Take care,

    Hoping you recover quickly & have a really friendly & helpful receptionist tomorrow!

  • Thank you, I shall see what tomorrow brings and take it from there. I'm not very good at being forceful so I do hope my pf has improved lol.

    Oh dear, that doesn't sound like a good experience for you, and i bet they told you off especially being in the healthcare field! I have looked at the red stage of my plan and are safe from that at the minute but thank you for the heads up! My pf needs to be at 300, reliever lasting less than 2 hours etc.

    Thank you again for your support xx

  • No problem. Hope things have improved for you this morning!

    Yeah - I was probably slightly rosy cheeked when I realised!! - just proved to me how easy it is to think you know the signs when you don't - I've now had to vow to myself that whenever my asthma gets worse at all - I'll get my plan out & check what it says rather than relying on memory.

    Good luck today! xx

    Ps. Sometimes when I have to be assertive I find it easier to blame it on someone else - 'My asthma plan says...' or 'my friend in healthcare says..' I need to be seen today. - probably not being properly assertive, but at least it makes it a bit easier!!

  • It annoys me when someone tells go to your GP for Advice. If they do not know the answer to your query why answer at all? of course you know you can go to your GP but the purpose of this forum is to share experiences not to tell people go to GP, it's ridiculous.

  • Sorry susanavalentina, but I think you are wrong to state that. Yes, the purpose of this forum is to share experiences, but sometimes the best advice and help one person can give to another is to go back to their GP. Those of us who have had asthma for years do know when it is time to consult the doctor, but many of the people who join the forum are new to condition and are still learning about what is normal for the asthma sufferer and what is not.

  • Sorry to upset you susanavalentina.

    You're right that the forum can be useful to get advice, and share experiences.

    However as MaggieHP said sometimes the best advice we can give is that it's time to go to see a doctor - sometimes people need examined by a doctor in order to determine what is best for them, also sometimes the doctor is needed to prescribe treatment.

    As MaggieHP put so well sometimes when people are new to the condition they can be uncertain about whether they need to go to the doctor or not. Even those of us who've had the condition for years can sometimes either not recognise that we're sick enough to need to see a doctor urgently or we recognise it but are trying to avoid it - sometimes we need a bit of encouragement to point us in the right direction!

  • Oh yes what you say it's true but it's not the purpose of the Forum. Forum is to share experiences not for telling you go to the Doctor.

  • I think we will have to disagree on this one susanavalentina. Sharing experiences is one of the aims of the forum, but people also come on it to ask for advice, as I note you have done in the past. There are situations (and it doesn't happen with every post I respond to) where the best advice I can think of is for the individual concerned to seek medical help from their GP. Personally, I do not think there is anything wrong with doing that.

  • I a m not saying it is wrong!!! I have never said that. but in a Forum to say someone go to the Doctor without sharing your experience first...... I am sorry to say leaves people with no information. The forum had been created to share experiences and tell other people what they can do to improve their suffering because most of the time they cannot get this information from their own Doctor.

    NB: I have never asked Advice in this Forum before....only today...you probably confusing me with someone else.

  • I am sorry if I have upset you susanavalentina, but all I, or anyone else on this forum, can do in any response to a post is to draw upon experiences. After all, everyone on this forum either suffers from asthma, or has a family member or child who suffers from it. Sometimes when I respond to a post my experiences in a similar situation have resulted in me going to my GP, so that is what I recommend. I might add at this point that I have never had any problems getting information from my doctors at my current practice.

    I said that you had asked advice from the forum in the past because if you click on the name of someone who has made a post you will find the history of all the posting queries that individual has started. Having clicked on your name I discovered that you raised a query and asked for advice from members of the forum nine years ago. If this was not you, then I recommend that you get in touch with healthunlocked or asthmaUK and request that they amend their records, because if I can make that mistake, so can others.

  • Seretide should not be doubled as it is a fixed dose combination and does not have a SMART licence. The long acting part of Seretide Salmeterol is fixed dose, if you need more your Dr should prescribe you a higher dose

  • My asthma plan written by my gp tells me to double it though

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