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Poorly Controlled Asthma - Help!

I have been an asthmatic since I can remember so from being a baby, and I’m now 36.

Problem is it’s very poorly controlled; has been for a while now, under the chest clinic, tried different inhalers, medication etc - no joy, my peak flow is usually 350ish and I’ve been on 6 prednisolone daily for six weeks constantly,

I’m going to see my consultant next week and would love any input/experience/things tried that I could suggest, it’s getting really tough at the moment.

Here’s what my current asthma med is...

*Ventolin Inhaler

*Ventolin / Ipatrprium nebules for nebuliser

*Fostair

*Braltus (Tiotroprium)

*Montelukast

*Loratidine

*Nasal spray

Thanks in advance :)

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Hi

Sorry to hear that you’re not doing great at the moment 😔

I’m assuming you’ve looked into working out your triggers and trying to avoid them etc.

As grim as it sounds, if you’re getting PND and sinus issues, sinus rinsing can help. Personally I hate doing it so only do it when I really have too but others who do it regularly say it really helps! 😅

Have you tried theophylline/aminophylline tablets? They’re a pain (BTs to get correct levels) however for many they really help! Less long term side effects than pred, but more potential for ‘acute’ side effects. A lot of asthmatics say this is the drug that helped them gain back some control (myself included when I was allowed it!)

Also by chest clinic do you mean you’re at your local hospital or under a specialist centre? The fact you have home nebs and are on maintenance pred from the sounds of it, means you should be eligible to be referred. If you are under a specialist have they discussed biological treatments for you? Do you know what type of asthma you have, or your eligibility for biologicals such as xolair or mepolizumab etc?

If you have any allergies or are atopic I’d suggest asking for an antihistamine (fexofenadine is a good one!)

I’m surprised that you’re on both tiotropium and ipatropium as they are the same drug group, meaning usually the inhaler is put on hold if you’re on the nebulae... something to ask your cons about!

If they’re thinking about keeping you on long term pred I’d also ask about alendronic acid/Adcal-D3 etc to help protect you’re bones (him or your GP). You could also ask him (or your GP 😉) about changing to enteric coated pred (it’s red, tastes nicer and may help to protect your stomach a little better!)

Have you been checked for other issues than ‘just’ your asthma? VCD and breathing dysfunctions are often confused for asthma or can make an asthmatic seem/feel worse than they are with just the asthma. If your finding that the drugs really aren’t helping, it’s definitely worth asking to be checked out if you haven’t already.

Hope that helps with some ideas anyway 😅. Good luck next week and I hope things start to improve for you soon!

Reply

Hi Emma

Thanks so much for the reply, very very helpful and informative.

I had an allergic reaction to theophylline so unfortunately was never able to continue with the treatment.

I am under my local hospital - the chest department who carry out spirometry tests, lung function and change treatments etc, I go regularly to be “checked up” but recently my asthma is so poorly controlled and I feel they are not changing much? Or maybe there isn’t much left for me to try?

I take loratidine as my antihistamine and a nasal spray too.

The pred is meant to be a short term thing but each time I stop them a couple days later my asthma gets really bad and I get put back in them.

The ipatroprium is only used in nebuliser when ventolin nebules give no relief whereas the braltus tiotroprium is a once a day inhaled powder.

I just feel like I’m on soooo much medication but not getting much relief! It’s really getting me down 😞

Reply

Oh no with the theophylline! Mine got stopped due to tachycardia and palpitations 🙈

I’d definitely ask about being referred to a specialist centre! It’s usually a bit of a trek but they have more options drug wise! Biological treatments etc.

If the loratidine doesn’t seem to be helping ask to try something else. Personally I have fexofenadine (and avamys) and ‘top up’ with loratidine or Cetirizine when I come into contact with a known bad allergen (cats etc).

Have you been weaning the pred, or just stopping from 40? May be worth asking about a slow wean and maybe a low maintenance dose (until you get to the specialists anyway).

My brain fog read loratidine and lansoprazole (oops 😅🥴) - have you been checked for reflux etc (can be a cause of worsening asthma). Worth asking about omeprazole or ranitidine if you do get reflux or if you end up on pred long term as a preventative measure.

Makes more sense! I’m on spiriva handihaler, and I’m told not to take it if on atrovent nebs, so just wanted to double check 😅

At 27 I’m in the same situation- shake me and I rattle! Luckily I’m eligible for biologicals (about to stop mepolizumab- brilliant for my asthma, but I get terrible side effects) which have really helped my breathing and getting me off some of my meds so worth pushing for if you can! However it’s completely normal to feel down about things, when basically everyone else our age is med free and don’t have a frequent flyers card to the local a&e/hospital!

Reply

I agree with Emma that it is worth seeing if there is any pattern to the things which trigger your symptoms. Keep a dairy for a couple of weeks and note down when and where you are better and when and where you are worse. It may help you to see if there are some things exacerbating the astham which need dealing with.

Reply

Thanks for your reply, I’ve had allergy testing done and I generally feel my asthma is just poorly controlled from the consultants point of view, I think they need to review my medication as it’s not doing what it should. Hopefully when I go to see them they will have some answers :)

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