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How do you go back from amber to green phase on your asthma plan

I could use some pointers on how you decide when you are safe to go back to the green phase of your asthma plan. I have just been on my amber phase (sounds like an exotic trip...) after my first attack at the weekend. With oral steroids, inhalers and a lot of help from this forum, I think I have brought the cough under control. I have been back to the gym on Tuesday, took the last (7th day) pred on Wednesday and made the 'judgement call' to go back onto the green phase. Wednesday was good, and yesterday not bad either.

Last night I started coughing in the night again, waking myself up with coughs. Today I have a constant (low intensity) cough. It is like having to clear your throat with a sharp, barking cough. Repeatedly. Today is starting to feel like I am walking through treacle with a flat battery for a brain too.

Should I increase the preventer again (when - this evening or now)? Use the reliever whenever I feel the cough coming on? Is it ok to use the normal 2 puffs of preventer but needing the reliever more during the day? I just don't know!

I am aware that I am not gifted in the ability to make naturally sound decisions as far as medical stuff is concerned, and this inability is making me second guess every judgement call/decision.

(PF is better than personal best most times I take it, twice a day since Sunday, but the cough is still with me...)

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Hi

I’d get another appt with your asthma nurse - if you’ve hit a new PB on your PF then all your percentages will have changed so you need a new action plan regardless.

For me, I wait a couple of days after finishing pred to change my inhaler dosage. Pred can give you a false high and make you think you’re in the clear, but a day or 2 after finishing you may be starting to struggle.

Usually if I can stay in green zone with no issues 2 days after a steroid boost, I know I’m good to go back to green zone plan.

I’d definitely use the reliever when you feel a cough is building, tho not sure about the preventer - maybe up it this evening for the weekend then get a Monday appt? I’m not sure everyone has personal plans so???

Usually if you’re having to use you reliever more/regularly throughout the day it’s a sign that you’re not controlled so make a GP/asthma nurse appt - if you ignore it you do have the potential to spiral down to needing hospital, hence the reason for the asthma plan.

When you meet with whoever also ask what to do next time if you get bad again after finishing steroids, alternatively speak to the asthma UK nurses - they’re very good and experienced!

Hope that helps and that you can sleep through tonight! X

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Thanks for the advice, Emma. I upped the meds last night and had a relatively peaceful night's sleep. I shall monitor and treat symptomatically over the weekend and pop in to the surgery on Mon to see if I can move my appointment forward.

If my personal best PF is higher while on steroids, does that count as my permanent new pb? Now that I've been off the steroids for a couple of days, it is consistently back to "normal" and even a tiny tad below...

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👍 - glad you had a better night

Yes you best PF measures your lung capacity and their ability to exhale as fast as possible. If you’ve hit it at some point in the last 6 months (no matter what drugs you’re on), then that’s your maximum, and the level you should be aiming to get.

You may find you don’t always hit it, for example my best is 630, which I’ll hit usually around mid afternoon, however I know that when I’m well I’ll always be above 550 no matter the time of day so that’s the number most of my doctors work towards, whilst my ‘boundaries’ are based on my best (if that makes sense). If I’m constantly struggling to hit 500 then I know I’m ‘heading’ for a drop even tho that’s 80% for me.

I hope that explains things a bit x

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Ps when you’re ‘starting out’ it’s normal for your ‘best’ to keep getting higher - I had about 3 improvements to get to 630 (510, 550, 600 then 630) - the better my control the higher my score got - and usually hit them initially after a hospital trip 😅

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I suppose the right thing to do is to increase the number of puffs. Many preventers nowadays are designed with very high overdose threshold. In my case of symbicort 160/4.5, the physician said the maximun number of puffs can be as high as 12 daily. But I never crosses that limit. 1-3 puffs are already sufficient. On bad days I multiple the puffs for 3-4 days before scaling it down to my normal control. Regardless consult your physician first.

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