What next? Still exacerbating

[hb1977]

Hi Everyone, looking for some help on any other treatment options that might be available.

I'm currently on Seretide 250 (2 puffs twice a day) or whatever generic version I get from the pharmacy

I'm also on Spiriva Respimat (2 puffs once a day)

I don't have any allergies, asthma typed as non-atopic, non eosinophilic. Just recovering from an exacerbation that resulted in an admission, before this my last exacerbation was October 2018. I usually exacerbate about 3-4 times per year although managed a good spell between October 2017 and 2018. My main triggers are infections, all other triggers I can manage without too many problems.

Previously been on Montelukast but it was stopped as I don't have an allergic component; wondering if theophylline would be useful of if anyone else has been in the same position and found something that works.

Thanks

[Lysistrata Administrator Community Ambassador]

Hi, I think I'm quite similar to you in being non-allergic (though have hayfever, oddly) and non-eosinophilic. I am on montelukast and find it does work for me - it was the first thing that did. I have been on and off it since with similar reasons cited and while I think it's less useful than it was, I still like it as I feel it stops me having episodes of 'limbo' (not bad enough for hosp but stuck inside fairly symptomatic) -wondering if that is the exercise element it's meant to also help with? I asked to go back on it and the asthma team said go ahead, it's not one with major side effects in general so we're happy for you to try again. Worth asking?

I'm also on Spiriva and it works well but my combination inhaler is Fostair Nexthaler which seems to help - previously Symbicort, but I found it was hard to get it in when I was struggling and that made me worse. Never been on Seretide but I didn't get anywhere with the Serevent LABA element so suspect it wouldn't help. Wonder if switching that might help? There are a lot of newer ones out now including fine particle (like the Nexthaler) which may work better.

I'm also on aminophylline (Phyllocontin 225mg 2x/twice daily) which seems to help - again worth a try though some drs are reluctant given the potential side effects. I personally haven't had them but some people get bad ones and others are fine. If your dr (cons?) is reluctant you can always remind them about the lack of options with this type of asthma!

I do get triggered by infections but also other things. I know some non-eosinophilic have been helped by azithromycin though the evidence is limited so not all drs may go for it.

Hope this helps - the AUK nurses are good to chat this through with too!

[hb1977 in reply to Lysistrata]

Hi,thanks for your reply! Had a brief trial of Fostair but found I got a lot of cramps on it! Can’t tolerate Synbicort for the same as you - always struggled to get a dose when I was short of breath!

Not currently under a consultant although have been seen by the local severe asthma service previously; think I’m going to be asking to go back and consider other options. Fingers crossed there are some more options in the coming years for those of us who are non-eosinophillic!

Thanks again!

[Lysistrata Administrator Community Ambassador in reply to hb1977]

There seem to be a whole raft of new inhalers including other fine particle, so maybe one of those will suit! Yes I'd ask to go back. There's one for non-eosinophilic in late stage clinical trials and I am keeping an eye on it. My consultant mentioned bronchial thermoplasty but it seems very remote atm (I'm too busy tying my head in knots about being a weird asthmatic and am assuming that if it comes down to it I wouldn't qualify).

Good luck!

[cc00]

Hi I too have been through a period of exacerbation usually from chest infections. Since taking vitamin D for osteopenia I've not had any colds turn into chest infections. May be get for D levels checked. Often low during uk winter's.