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Unsure of how to approach GP

Hi,

I was diagnosed with asthma about 10 years ago, though have used inhalers since being about 8 yo (I'm now 23). I used to have Symbicort but over a year ago had a letter from my GP saying that it had been switched to DuoResp to save money. I have struggled to use the new inhaler even after asking a pharmacist for advice. I mentioned it at my asthma review, but the nurse didn't know much about inhalers so couldn't help.

It's got to the point where I just don't use my preventer. To use it properly I have to sit down and concentrate which I just can't be bothered to do once I'm already in bed/ in a rush in the morning. I know I should use it but the amount of effort it requires to breathe it in means I struggle to use it even with the correct technique. I also get a lot of side effects, which again puts me off.

I want to go and ask for something else so that I actually use it. However, I'm not sure what to ask for. Given that I have barely used it for a month or so and am only using my salbutamol a few times a week, I think I'd like to step down to beclametasone, but this is the tie of year when I'm best and I know that that is not strong enough for the winter. My asthma control has improved massively by taking daily fexofenadine- I recently took part in a research trial and that involved allergy tests so I know for definite that allergy is a big trigger for me.

Should I ask for symbicort or just see if I can try dropping down to beclametasone? I want to be proactive and look after myself but I don't want to go to see someone with no real idea of what the best option would be.

What would you do?

11 Replies
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Hi , first of all I would suggest you ask for a double appointment as the gp and explain that you need this time to explore your options.

If this is not an option at your gp then I would ask to be referred to an asthma nurse who can spend the time explaining all the various options to you.

It's important that you are in control of your own condition and being adequately and well informed is part of that.

If it was me, then I'd keep Peak flow diaries and use an asthma plan to assist, for instance I have symbicort as a smart regime meaning I can increase my dose as needed varying from 2 puff a day to 8 per day depending on my symptoms , I also hold steroids at home and I know when to up or down the regime.

You should get to that same point as it's your body and you will know how you feel when well and when your symptoms are worsening

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Thank you for your reply.

I'm not sure if I can book a double appt with a Dr, I can however ask for an asthma review as they are 25 mins long. The issue is that the last nurse I saw for a review openly said she didn't know much about asthma! I'll have to check if there is another asthma nurse because quite frankly there was no point to that review. She didn't have a peak flow meter and decided to ask me about depression instead because she's better at that!

Out of interest, how did you get to that level of being confident enough to play around with inhalers yourself and trusting how you feel? I know it sounds weird but I'm really good at convincing myself I'm ok.

I don't have an action plan but I'll have a go at a peak flow diary, although it never gets taken seriously as my best pf is higher than my predicted because of the amount I exercise. I've had nurses tell me 410 is fine because my predicted is 450, but I actually my best is closer to 500! It gets so frustrating when they forget that everyone is different.

Thank you!

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Hi,

Mine is the same ! My best is 550 and I'm only 5 foot 6 .

I go by everything ! So my Peak flows , waking and night time symptoms, exercise tolerance etc

You know how you feel and if the asthma is active and preventing you from doing your normal things then take action.

educate yourself well and get to know your asthma for yourself !

Then you can work in partnership with health care professionals.

It does help that I'm a nurse too ( although not an asthma nurse or an adult nurse - I am a children's nurse) but I do know that you have to evoke your own expert in your own condition

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Hi AnnaRa,

I'm in total agreement with Pebbles1021 that you need to see your GP and that you should ask for a double appointment. I would be very surprised if you couldn't get one (though you might have to wait a week or more for them to fit you in for a double) but if you don't ask to see if it's possible you certainly won't find out if it is or not:-).

Regarding getting to know your asthma, that comes with experience. Asthma is a very individual thing, and it's important that you try to get to understand your version of it. I now know my condition well and it is very well controlled but I've had ups and downs with it over the years (I suspect most of us have); I have learnt from those less good times what helps with coping with it. Likes Pebbles, I vary the amount of medication I take depending on how my breathing feels. In my case (and I suspect in the case of many asthmatics) there is seasonal variation. At the moment my asthma is quite good, but come the colder and wetter weather in the autumn my asthma will probably begin to be affected and my breathing become harder, so the amount of medication I take will increase.

You say you are taking salbutamol a few times a week - that suggests to me that your asthma is not in control. I said my asthma is well controlled. It is! The last time I had to use salbutamol on top of my preventer inhalers was months ago. That is an example of well controlled asthma. If I was having to use as much salbutamol as you are currently taking I would be asking my GP for a review of my medication. It won't help that you are not taking your preventer medication on a regular basis. You need to take it daily. I currently take one dose of my preventer inhaler (a different one to yours) morning and evening; come the autumn that will go up to one dose in the morning and two in the evening, increasing again in winter to two morning and evening. If you are having problems with side effects from your inhaler that is something else you need to discuss with your GP.

As Pebbles has said, you have to work with your GPs to get your asthma under control. It is a team effort. I made a point of getting to know all the GPs in my local practice. Why? Because if I need to make an urgent appointment to see a GP because of an asthma flare I cannot guarantee I will get to see my usual one. It's helpful to the GPs in that practice that they are familiar with my asthma when I walk through the door; it's helpful to me because I can be reasonably confident that whoever I end up seeing will have a reasonable idea of my history.

Ask if you can have that double appointment. You really do need it. Explain why to the receptionist. If they say you can't have one and they offer you an asthma review instead, make sure it is with a nurse who understands asthma. Explain to them what happened to you last time.

Good luck, and I hope things improve for you soon.

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Thank you

I will ring tomorrow and ask, if not I'll book for an asthma review with a different nurse. I'm always a bit nervous about asking for what I want, I convince myself I'm being unreasonable and that I'm wasting their time. I need to be more assertive! Other than that nurse I haven't seen anyone at that practice so I don't know why I'm worried they won't listen! They could all be lovely.

I'm tempted to wait a week or so for an appt but do some research and make a list of the outcomes I'd like so I have something to work from.

Do you have a written plan? I've been told before to just alter the dose as I see fit but without any clarification as to how much by/ for how long/ what to do when that doesn't work etc.

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I do have a written plan, but I only got one recently (I didn't know of asthma plans until I joined this forum three years ago). I've had an unwritten plan in my head for years, but I developed the condition over fifty years ago when I was a child so I've had plenty of time to get to know it. But you should have one. It will help you to identify the early warning signs that your asthma is going out of control and act as a reminder of what to do when that happens. You should fill one out with your GP or Asthma nurse - which of course helps them to get to know your condition as well.

Don't wait a week or so to book your appointment. You are unlikely to get a double appointment for the next day or even this coming week. As I said above you will probably have to wait a while for one, so even if you ring tomorrow you may not see someone until the week after next. That should give you time to do your research, monitor your condition, jot down questions etc.

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I agree with all the other replies. You definitely need to see your GP. But if you haven't tried it before it may be worth asking about trying Montelukast, and changing to a lower preventer, depending on how well you are. For my daughter who is 20, Montelukast almost completely controls her asthma, and she only uses a preventer if she gets bad hay fever/ allergies or a cold. She also has her reliever for the odd occasion she needs it and sports.

Good luck

R

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Thank you for replying.

I've heard of that drug and was going to ask about it my last review, but the nurse didn't know much about asthma so I didn't bother. If you don't mind me asking, did she ever have allergy tests?

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Hi Anna, I'm 53 and have been dealing with asthma since the age of 11. It is so frustrating because not a lot of health care professionals really know how to help patients with asthma...every case is quite individual. There are many triggers for different people....I live in Florida which is very humid, and full of allergens-pollen, moulds, humidity, air conditioning ( going in and out of it), etc....What has helped me to improve my asthma is nutrition and meditation. I believe there is a psychogenetic component to all conditions. I'm an empath, a sensitive, taking care of a lot of people....I absorb a lot of emotions. Over the years, nutrition and meditation have helped me to clean the psychic gunk (sadness, anger, resignation) off my inner antennae. You may not relate to this, but I'm sharing anyway, in case you find it helpful. I've eliminated wheat, dairy, animal products, and try to stay away from anything that creates more mucus. That helps. I use botanicals, like licorice tea and throat coating teas that help as well. I try to keep my weight down because carbs, like bread and potatoes, etc reduce the absorption of oxygen and fill my belly which pushes up against the diaphragm and can often trigger breathing issues. Listen to your body and log your symptoms and triggers. Look up natural remedies and exercise....yoga is actually really great. I go online (YouTube) and type in 'yoga for asthma' and when I do it regularly....I follow the Indian guys, who do proper yoga...breathing techniques, etc....They really do help. I don't like using steroids, corticosteroids, etc, but sometimes, I have to....I am told by the doctor that I should use them forever, but I won't! I hope you find this somewhat helpful. You are not alone. I also have a water filtering system that makes my water alkaline and because it tastes better, I drink more and that also helps. Alkaline water and foods also reduce acidity and inflammation everywhere and inflammation is everyone's problem not just asthmatics'. Don't despair, you can greatly diminish your symptoms naturally, but it will take some effort and research and a thick skin to not believe everything the docs tell you....listen to your body and emotions, which are not separate. Good luck!

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Dear Anna,

You can get a template for a written asthma plan sent to you from the Asthma UK telephone helpline, or download one from their website. If you take it to your appointment you can work with the GP / nurse to fill it in - it needn't take long, but will cover important ground.

Good luck

Jo

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Thanks for all of your replies. I did make an appointment, but I cancelled it. I'm so worried about wasting their time. There are so many people that need to see someone, I don't want to take an appt away from them. I'm forcing myself to use the DuoResp and put up with the side effects for now. My next review is early next year anyway so hopefully I'll get the better nurse.

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