Steroids - to take or not to take

I've had asthma for a few years, it started after a viral chest infection. I'm on symbicort SMART 200/6 2 puffs twice a day, plus 10g montelukast. A couple of weeks ago I got a bad cold, which immediately affected my chest. As soon as the cold started I went up to 2 puffs of symbicort 3 times a day, as instructed, and I'm needing another 3 puffs as a reliever on top of that every day. On Thursday I went to see the GP as I was thinking I might have a chest and/or sinus infection. She prescribed amoxicillin and said that if I was no better in a couple of days I should go back for steroids. The sinus infection is much improved but there's been no significant change in my chest. As I had an asthma review booked for this morning I decided not to bother with the hassle of trying to see a GP on the weekend. The nurse today said my sats were good but that she could hear a wheeze in my chest. She said she was going to ask the GP to get a steroid prescription ready for me but was a bit unclear about when and whether I should take them. I came home with a pot for sputum culture, feeling rather confused. I know cultures would take many days to come back. I've reacted badly to pred in the past so I'm not keen to take steroids unless I really need them (the script will be for hydro). Any words of wisdom would be much appreciated. Thanks.

23 Replies

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  • Drink plenty of water and do the Active Cycle of Breathing to help get the muck off your chest (there is a video on Utube made by NHS Respiratory Physiotherapists to watch, if you have not been taught this. It really does help. Sputum results take a week to come back, but it is the only way to find out if Amoxicyllin has killed the bug, or you need some different/stronger antibiotics. How do you feel? IS your wheeze the same or getting worse? Are you getting more breathless? Chest feeling tight? Only you, with your medical team can decide whether you need steroids. A word of caution. If you have a chest infection, and don't take care of yourself, and take the meds prescribed, you run the risk of permanently damaging your lungs. They don't call oral steroids a necessary evil for nothing. Hope some of this helps. If confused, ring the Asthma Nurse again. She wont mind. Hope you feel better soon. Let us know how how are getting on.

  • Thank you. I had not heard of ACB and will give it a go. To be honest, my feeling is that this is viral like last time, but I guess sputum culture won't hurt. Part of the problem with me is that I don't have wheezy asthma, I cough, so having a cold/chest infection muddies the waters. On top of that, peak flows don't help at all, I always blow around 400, even at my worst. So all the assessment is based on how I feel and it's a bit like how long is a piece of string. I don't feel too bad, BUT it's been two weeks and 9 puffs of symbicort a day doesn't seem to be doing it. I'm still coughing A LOT...

  • Peak flows are only part of the picture, and are increasingly becoming less. it is more about how you feel, your symptoms, what you feel able to do, are you tired, breathless, feeling like you need more relievers than normal, like you are, and they are not working so well. Only your GP/Asthma nurse can advise you. But it is a long week, and you are already on higher doses of inhaled steroids, which aren't helping much, so I would suggest you do as your Asthma Nurse/GP suggests, and start oral. But I am not medical, so cannot give you medical advice.

  • I didn't know that peak flows were being considered less important nowadays. That's a relief for me. If I had a pound for every time a GP or general practice nurse told me they didn't think I have asthma based on that (even after being diagnosed by a consultant!)

    Thanks for your help/encouragement. I think I probably will go for it. I'm just so tired and my back hurts from all the coughing... Plus I want to be able to go out and see my friends. Being sick is so boring!

  • Peak flows are only part of the picture. They give an indication, but a Spirometry Test is of much more benefit. Peak flows are still very useful though, as an indication that your lungs are not becoming more restricted, that your readings are not declining. Asthma is a funny thing. I have very bad Asthma, my reading tends to be around 180 to 200, when an ok day. It does affect my daily life, though some days I cant bathe without being out of breath, and others I can walk to the bus stop 60 metres away. One hour I am ok, the next hour I am breathless sat in the chair. I am medically retired. I don't know your age, but in my 20s I also had a peak flow around 400. I have had lots and lots of infections, and have now been diagnosed with a immune deficient illness.

  • Oh WheezyAnne, sorry to hear that, sounds awful. I'm 43, no longer as fit as when I was in my 20s! Though not bad, I have a pretty active life, I would say.

    I did ask for a spiro, but the nurse said I had to wait six weeks after a course on antibiotics. Sounds weird and I don't know the reason, but there you go. I've got an appointment for then.

    I've got my prescription for hydro, but couldn't find a pharmacy that had that many tablets (I'll need 112 for a week's course!), so will have to wait until tomorrow. I have to say, I can't wait to get started now. This cough is awful and I'm knackered/sore.

  • Glad you are getting your steroids. The Spirometry Test is carried out when your lungs are normal. If they did it now, it would not give a true picture of your lung volume. Hence the reason why they are delaying the test.

  • Steroids work like magic for me . I have found that a single dose is enough to settle an attack down . If you have reacted badly previously would a single dose benefit you ?

    As we all know , there are serious side effects from steroid use , so it is common sense to keep them to a minimum .

  • Oh I don't know. When I told the consultant how I felt on pred she just said I should try hydro next time. All I know is that after one dose of pred I was not better. So glad they work well for you. I hope hydro has the same effect on me!

  • Hi Griffon,

    What is the single dose steroid treatment, is it dexamethasone? Just asking out of interest as I always end up on at least a 7 day course sometimes 14 days depending of the severity of the attack, quite often a reducing dose. The single dose would be far better if it was effective.

    Thanks,

    Tre

  • Hi Tre ,

    I suffered a chronic asthma attack that lasted continuously for eight months . When I finally got the right treatment for it , which was a three day course of Prednisolone my symptoms disappeared in about two hours after taking the first tablets .

    The next time I had a flare up I took one 5mg tablet and it settled back down in the same time span .

    The doctors are refusing to prescribe Prednisolone because of the side effects , but I have managed to get some off a pollymyalgea sufferer for emergency use .

  • I'm also on Symbicort and have found that good too . After a prolonged asthma attack lasting 8 months it is now being controlled by one puff of Symbicort once a day .

    This may sound very basic , but if your condition is not responding to these drugs are you sure it is asthma that you have ?

  • It largely responds very well to symbicort and montelukast. I went through a few months of not needing symbicort at all. But a cold does tend to exacerbate things. I think it's just inflammation and mucus from that. I was diagnosed by a consultant who was very thorough a few years back and she said it was classic asthma!

  • Dont worry aylabrida its a very very small dose to all of us who have asthma the inhalers are going to your body as MICRO grams ie 1/1000 of a gram but to the correct areas that need it

    Comfort and leading normal life most sacred cheers

  • Thanks Vijay. I'm not concerned about inhaled steroids - I've been on them for years. I was wondering about the course of oral steroids I've been prescribed.

  • For what it's worth, the last time I was on systemic steroids I was probably 9 or so. I still remember that episode clearly, but it was not traumatic because I was already experienced by then. I took Meticorten which I remember clearly as a white pill, and yes I second those who experienced it as magic it tamped down the flair up within hours which by that point in the evening (early morning?) was not responding to Ventolin. According to google it is just prednisone.

    I had a pediatrician/asthma/allergy expert that took care of me until 18. I just discovered he may still be alive at the age of 96? I have to track him down! But I digress. He also treated systemic steroids as a big step so I agree all the advice you have been given. In my humble and less informed opinion you should not start pred without an in person visit to doctor/nurse and then you should be in at least phone contact with them every couple days & keep a diary of every puff you are taking and approx time of day. And as hard as this may sound ... you need to stay calm and positive outlook because stress also adds to it (but is not the underlying cause for me anyway it's allergy). Pred will make you bounce off the ceiling but you have to get your asthma under control it's just life.

    If your infection is on the mend another way might be to try different ICS than the budesonide in Symbicort, it does nothing for me but that is personal. Try switch to Qvar or Flovent (I'm an acknowledged Qvar fanboy, sorry). You can just take Serevent separately as the LABA. But go with you and your healthcare professional's gut on the pred, they seem to make some sense.

  • Thanks for the reassurance. Whilst on Tuesday I was quite keen to take the hydro, by the time I finally managed to get the prescription sorted (it's an unusual prescription and everybody queries it along the way, plus the GP made a mistake which I picked up on) I could not find a pharmacy that had it in stock. On Wednesday when I went to pick it up, the pharmacist queried it (again!), so it took a good couple of hours. By the time I got home late Wednesday afternoon I realised I had not had many reliever puffs of symbicort so I decided to wait until the morning and by then I was feeling better. Maybe I scared myself out of my exacerbation. I'm still a bit mucousy and coughing a bit, but I'm down to my regular 4 puffs plus maybe just the one reliever puff, so perfectly manageable, phew!

  • Good to hear! Some good news around here, I'll take that. By the way I'm not a fan of combination drugs like Symbicort, Fostair as rescue inhaler. I believe in tried and true good old blue - Ventolin (or generic). My $0.02, or 2 pence, 2 Euros whatever....

  • I also used good old clenil for a while. Worked ok, but I get on better with the turbohalers. I also have a couple of ventolin in the cupboard if things get so bad I can't use the turbohaler...

  • Just as an aside, I was put on seretide for a while, which is supposedly stronger than symbicort. Did nothing at all for me! I can see how someone can get attached to their favourite and become a fanboy (girl, in my case). For me, the drug that made all the difference was montelukast. It completely transformed my asthma! Glad you found something that works too!

  • Haha - I was just weighing in my mind 10 minutes ago if I should add serevent or double my Qvar. I'm borderline right now. The leukotrines did nada for me so that is way down my list. In my defense the item in seretide I am admittedly biased against is fluticasone - I think it was way over hyped in the 90s. And I have a modicum of science to bolster my case.

    Readers please always take me as toungue firmly in cheek. I am old enough to know that responses are highly individual.

  • Horses for courses!

  • Have you ever been checked for Gastroesophageal reflux disease GERD? I used to have your symptoms and am on symbicort 400 and was then prescribed Amavys Nasal spray which got rid of congestion and sputum. Give it a try and tell your GP you want to be tested for GERD in case you have any hidden gall bladder problems which sometimes occur when taking steroids and asthma meds such as symbicort as it's a very powerful inhaler. The other thing that made me better is to look at any deficiencies your body may have because meds cause havoc in our bodies. I found iodine worked for my brain fog vitamin D 2,000mcg for bones as meds make us weak and vitamin K and vitamin c and magnesium supplements all helped me reduce my steroid and antibiotic monthly intake. Doctors and nurses don't always know everything. Deficiencies in our bodies are a massive area to consider. I also go gym now three times a week and do 30 minutes cardio and weight resistance on machines. This will help you so much and gives us energy we asthmatics lack and I found exercise also got rid of my sputum along with Amoxil. Dairy foods also cause phelm so reducing them will help. We need so much more energy and oxygen then non asthmatics so we must find ways to help our mind body soul to function at 100%. Keep food diary of which foods make you feel good or bad after eating and keep alcohol to a limit and too much red wine I find makes me wheezy one small glass is enough. Good luck wish you the best of health

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