I know the usual advice for attacks/poor control etc, but what do people on here who have chronic poor control do for flares that are more than their baseline level, but not enough for hospital etc? (NB the following is very particular to me and is not something I am advising for anyone else, especially if they have normally well controlled asthma. If in doubt, get seen asap or if bad call ambulance etc).
I am at a specialist tertiary centre for asthma where they have done all the tests etc. Pretty sure what I describe here is asthma, not reflux, anxiety, dysfunctional breathing etc. I'm not eligible for any of the new treatments because I have non-allergic (normal IgE) and non-eosinophilic asthma, which they don't help. Already on max dose Fostair Nexthaler, Spiriva Respimat, Phyllocontin, montelukast.
I have a lot of symptoms day to day but also sometimes get 'mini-attacks' - sometimes with an obvious trigger, sometimes not. They tend to leave me just sitting there coughing/trying to breathe and not move; if I have access to my peak flow meter/FEV1 meter (I measure both, but this often happens at work), both will be reduced and/or not responding well to Ventolin or wearing off quickly.
Multiple puffs of Ventolin are needed but usually take a while to work/wear off and then I struggle for a few hours at a slightly less bad level. All the usual signs of an attack, except it doesn't build up into something worse like the attacks I have needed admission for.
Sometimes they do last longer but not at a hospital level, just 'I can't move around my house very easily and my inhaler is not working very well' level, which for me is not yet hospital-worthy as they will tell me to go away. In this case I will contact the asthma nurse at the specialist centre and they ask me to come in, which I do appreciate on short notice. However, once I drag myself in this pretty much 100% results in me doing FENO (which measures steroid-responsive inflammation), them saying ah well pred won't help. and sending me home with nothing saying keep taking your inhaler regularly and rest - which I do. Sometimes I get worse and end up admitted, but sometimes just carry on at that level.
I contacted the asthma nurse recently about the short-term flares I've been having as described above, and she said 'you're doing everything right, contact us if it lasts longer than 24 hours and you're worried' (I'm not, I just feel crap and frustrated).
Problem is, what I'm doing doesn't seem that helpful to get on top of these flares. I appear to be partially steroid resistant now and there's no point taking pred if it's not going to help so I'm fine with not having it. I try using my ventolin every 4 hours then on top as needed which helps a bit, but not useful with the sudden flares. I try to rest/work from home when I can afterwards or if things are dragging on.
Does anyone else have this? What do you do if so? Maybe I just need to put up with it and do as suggested as nothing more I can do. The 'couple of nebs' which I suspect would be hugely helpful, based on times I have had access to this, is not an option. I do not have good experiences with OOH, same day GP etc - they either tell me I'm fine or panic and send me to A&E when I'm not quite at that level yet).
A couple of specialist asthma nurses have suggested home nebs which I suspect would help - I don't agree with spacers being just as good in this situation and have spoken to someone who actually knows about the technicalities of the devices who agrees on that. However, one of these nurses was AUK helpline and the other has now left my clinic and didn't have the authority to give them to me anyway - my consultant is massively against them for anyone. As mentioned above pred often doesn't help me.
Just wondered if I am a total freak or if others have this, and if so what you do? Do I just need to put up and shut up unless it gets worse, since I don't have access to nebs/steroids?