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Advice please - after attack/steroids - what next?

I've been pretty well controlled since 2010 (discharged from consultant) on simbicort/montelukast/ventolin.

On Boxing day I had a severe attack and had to call an ambulance - the first time I've ever been this bad. It took 4 nebulizers and a magnesium drip to get me under control.

I saw my GP the next day - I'd recently had my meds changed to Fostair and hadn't been getting on well with it. I have gone back onto simbicort and had 6 days worth of oral steroids.

I finished the steroids yesterday, and had another attack yesterday (in the supermarket - I think it was the cold that set me off).

Today I have ignored my GPs advice and will have simbicort 4x day, (as opposed to twice), as this is what my asthma nurse would have recommended.

I feel completely exhausted - my chest is still tight and it's hard to breathe out constantly (peak flow is between 360 and 380, my usual is 400-440). Ventolin doesn't seem to be helping (I'm using a spacer), but it isn't evolving to an attack, just constant mid-level difficulty to breathe.

The asthma nurse at my surgery literally retired at Christmas, and hasn't been replaced yet. I am going on the waiting list to go back to the respiratory consultant.

My question is, in your experience, is it likely I'll get better in a few days/weeks without any other medication (I've had a week of almost constant rest)? Does it seem like I should I go to my GP again tomorrow and ask for more steroids?

I'm planning to phone the Asthma UK helpline in the morning, but I'm also aware that I'll need to phone my GP at 8.15 to get an appointment tomorrow!

Thanks in advance

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See asthma uk website I think answer your question on what you need to do.

How to know when you’re ‘fully recovered’:

Having few or no symptoms of cough, wheeze, tightness in the chest, or difficulty breathing

Not needing to use your reliever inhaler (usually blue)

If you use a peak flow meter, your peak flow reading is back to above 75 per cent of your personal best

If you or your child finish a short course of steroid tablets but you're/they're still not feeling better, see your GP or asthma nurse straight away to review your/their treatment. A longer course of steroid tablets may be needed to get yours/their asthma back under control, and it should be started as soon as you or your child finishes the first course – or as soon as possible. This is to make sure the inflammation in your lungs, which the steroid tablets are helping to control, doesn’t build back up again.

Taking a longer course of steroid tablets

If you or your child needs a longer course of steroid tablets, your GP or asthma nurse will make sure these are prescribed at the lowest possible dose. You may need to take them for weeks or a few months at a time, depending on the number of steroid tablets you’re prescribed, or how long it takes you or your child to fully recover. Remember, you should continue using your preventer inhaler daily when taking steroid tablets to help reduce the inflammation in your airways.

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Thank you very much - I've read quite a lot on the website but hadn't seen this bit :)

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When Ventolin stops working then that's an emergency. Twice I have had a bad attack and both times after I rested for 2/3 weeks before I could walk far which is a pain. Both of those times my go told me 6 Ventolin every 6 hours. I did it. It makes huge difference. Ask you gp / on call nurse / out of hours service can you take that much ventolin. I don't know your situation so potentially there may be a reason you can't. I can and within 2 days doing this I'm mobile in the house and can hold conversation without being out of breath. Ask what the equivalent dosage of Ventolin is versus dosage of Ventolin in a nebulizer. You will be surprised. But ask as it will give you confidence to take the 6 puffs if you need them. Also ask what medicine is in a nebulizer. There are diff types. Get your doc to write down the one that works for you. I used to think they were all the same until I got one that didn't work and second one they tried did. So possibly you got 4 neubilsers of same medicine OR 4 diff medications while they found the one that worked for you.

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Thanks Emer, I'll try the ventolin cycles.

My GP didn't want to give more steroids so this might be a good way to manage over the next few days (eith lots of rest)

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Depends how desperate you are but cleaning out diet also helps. Get rid of dairy which can cause build up of phlegm and breads as can harbour miles until your past this.

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I've done it and it does make a big diff .... so might be worth it until you get over this. Go with plain food. Fruit ... Veg .. etc . .. I've done it and it def helped me but not long term.

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