What should I ask my consultant? - Asthma UK communi...

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What should I ask my consultant?

Choristermum profile image

18 months ago my asthma became much more stable after being switched to Symbicort SMART and Spiriva Respimat by the consultant I saw in addition to Montelukast. After seeing him a few times he was satisfied that things were stable and he discharged me back to the care of my gp. All went well and I had a great summer last year with the addition of Fexofenadine and a nasal spray for hay fever. I also had a great winter with only one course of steroids and antibiotics for a chest infection. Since February I have been terrible. I have had 6 courses of steroids, some long and tapered as well as several courses of antibiotics. I was referred back to the consultant and finally saw him 3 weeks ago. He changed the Symbicort to Seretide 500, 2 puffs twice a day. I wasn’t sure at first but after a few days I felt that my lower lungs felt less tight, however I now feel that my upper airway is tight and full of mucus and over the last week this feels worse. Today I have developed a rattling productive cough. It feels as if I’m coming down with another chest infection. I’m going to see the consultant again tomorrow. He said last time that if the new inhaler didn’t work he would put me on Uniphyllin. Previous blood tests showed low IgE levels and no indication of any immune problems. This seems odd to me as I have had horrendous hay fever this summer and seem to go from one chest infection to the next. My peak flow hasn’t been above 80% all summer and much of the time has been at 50%. I just don’t know what I should be asking when I go back tomorrow. All suggestions welcome - thank you for reading all my waffle!

12 Replies

Try doing some light exercise like jogging or walking. Improving the air quality at home through air-purifier might help. All the best.

Choristermum profile image
Choristermum in reply to mackro


I was on Seretide 250 for a few years , But was told it could cause Chest infections.Its an old type of inhaler also I’m on Relvar Ellipta you could ask about that it’s 1 inhale daily.

It’s worth asking. Thanks

It was recommended to me to use a nasal douche before using my nasal spray by Asthma U.K. and ENT. I buy Sterimer congestion relief and notice the difference when I don’t use it with Dymista nasal spray. In addition do you put sputum samples in when you have an infection to ensure the right antibiotics to treat your chest infections? I have found ringing the helpline at Asthma UK really helpful, think they also use whats app and email as well. The nurses there are very knowledgeable and friendly. Their advice has helped me immensely when unwell. Let us know how your appointment went.

Thanks - I’ve been using nasal douching before my nasal spray for a number of weeks now and I think it has helped a little. The consultant has decided to refer me on to the regional severe asthma clinic so hopefully things will be better controlled once things have been investigated more thoroughly.

My consultant prescribed me Relvar Ellipta and Incruse Ellipta about 4 years ago and my asthma isn’t as bad now. D

I’m not a Medical Proffessional so what follows is only my personal view and needs to be run by your Medical Advisor.

Has your Consultant arranged for you to have a CT Scan? Although to be avoided if possible (as imaging carries its own risks) it could help pinpoint what’s happening.

Someone else mentioned Sputum Tests. You can push for advanced Sputum Tests if the results of the standard tests are not providing any clarification.

It may be that your numerous Steroid Bursts for Asthma this year are being triggered by a recurring infection. You may be aware that Steroids suppress the immune system, which is the primary reason many GPs prescribe antibiotics alongside each course of Oral Steroids (i.e. to prevent you getting a bacteria infection due to low immunity while on Oral Sterois, and to fight any bacterial infection you may already have). If you’ve been prescribed an antibiotic alongside each course of Oral Steroids, it might be worth considering asking for a ‘longer’ course of a ‘different’ antibiotic, possibly clarythromycin (or whatever your medical adviser considers appropriate). I’m talking about at least a 2 Week Course, possibly much longer, e.g. 4 to 6 Weeks. Over the passed couple of years trials have been in progress whereby Asthma suffers have been put on very long (prophylactic) course of Azithromycin which, unlike most other antibiotics, gets into, and remain for long periods, in Cells.

Obviously, antibiotics only defend against / tackle bacteria and have little if any effect on virus infections. Unfortunately, viruses are often the culprit.

You might also want to open a dialogue with your Consultant as to whether he considers you yet qualify for one of the Biological Meds (Mabs).

Anything you can do to bolster your immune system can’t hurt. For example, Fresh Orange Juice Daily from the Supermarket Chilled Counter (rather than concentrated).

Vitamin C in supplement form is the subject of some controversy, as the strength of numerous vit c supplements is consider way too high by many, and might do more harm than good. For short periods, a week or two, you could chance up to 500mg Timed / Sustained Released Vit C once every couple of days, but longer term, much more Fruit & Veg is maybe a good bet. I’m on Orange Juice plus Bananas daily to avoid potassium depletion arising as a consequence of using a Fostair Inhaler, some othe inhalers deplete potassium too. Potassium depletion is something you serious dont want - unless you are already over-producing it. (It’s dangerous to take supplements for Potassium above 100mg Daily. Note, each bite of banana gives you about a 100mg, and orange juice supplies it too).

Unless you have a nut allergy issue, mixed unsalted nuts - especially (my view) unhusked peanuts - are thought to help asthmatics. I add to a Muselli Style Breakfast Cereal, as I also think the calcium from milk is important if you’re depleting calcium due to Steroid Usage. Also, taking a Vit D Supplement a few times a week (but probably not the ‘Super Strong’ Doses some Companies Sell). Also, vitamin K2 from either natural sources (e.g. High Quality Butter from Grass Fed Cows) or in supplement form a few times a week, seems to work synergistically with Vit D. Recent findings for Vitamin D in relation to Intestitial Lung Disease imply a positive benefit for Asthma too (my opinion).

Thank you for all these ideas. I already eat loads of fresh fruit and veg so should be well stocked up on vitamins etc... Have been referred on to the regional severe asthma centre so am hoping for some answers and solutions.

Have you had your appointment yet and was it helpful?

It was helpful, thank you. I have now had several appointments with my consultant. He has referred me to the regional brittle asthma unit and I have an appointment for tests on the 31st December and another on the 4th January to see what they found/want to try. I have also developed a strange Velcro like sound in one lung and am having a ct scan to have that investigated on the 27th December. So, quite a busy Christmas, but hopefully things will be heading in the right direction in the new year.

How are things now? I am just looking at old email notifications

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