At what point do you usually take or... - Asthma UK communi...

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At what point do you usually take oral steroids?

haggisplant profile image

Adult onset asthma 4 years ago. Viruses, cold air, sometimes exercise, some chemicals and smoke. To be honest I’ve always been faintly like this, it just got significantly worse after my first pregnancy. No allergies though some chemicals seem to sometimes make me cough if I’m a bit inflamed.

Never really bad, but I was struggling in the autumn and finally put on Fostair 200/6 which has been amazing. So my best is now 440, usually 420. 400 in the morning.

Recently, viral coughs dropped me down to 330 or 300, though with lots of salbutamol I could hover around 350.

Asthma uk nurses, my asthma nurse and one or 2 gps have said oral steroids fairly quickly - nurse said within 24 hours of below 380.

I’ve just caught a bad virus that’s given baby and older child bad coughs and croup, I really suffer and am prone to a croup like cough. Peak flow plummeted first to 330/300 then hovered around 350. Then the next day the coughing started. Day 3 I decided to start steroids after bad nights and frequent inhalers.

Gp I saw to get a replacement rescue pack felt she wouldn’t have taken the steroids as I wasn’t acute. She felt I was experiencing the sump of the virus. I felt I get so much inflammation I do need them though and was worried about not taking them. However I also really don’t want to take them unnecessarily. I had two courses in the autumn, one unnecessary in hindsight (pre Fostair, I needed a better reliever) so this is the third in almost 5 months.

I’m seeing the nurse tomorrow to go through exactly what I should do next time. Any experiences?

My cough symptoms can be worse than the peak flow, though that’s gradually got worse, they’re the most debilitating aspect. I find I can’t talk as it triggers relentless coughing, more talking seems to make everything worse. Teacher so it’s challenging. I personally feel the steroids have potentially eased this this time. Or do you ride it out for longer and let the virus play out?

16 Replies

I think it's really varied based on individual....for me it's when my peakflow is in the amber zone for a few days plus when I have a cold or something obviously setting my asthma off. You know yourself best- if you are struggling to breathe and do normal things despite preventers and relievers then to me that's when my body needs extra help.

Thanks, so you leave it a few days? Nurse said 24 hours but I’m thinking 24 hours of both struggling to keep peak flow near 380 plus lots of coughing. Also get an itchy neck under my chin.

I know I can manage it with inhalers; when first on clenil, doubling up really nipped it in the bud. I think I’ve either had a bad run of viruses or in post pregnancy I’m extra reactive.

Hi there, I agree with Liam, below. Everyone is different with taking steorids . When I catch a cold and wheezing and coughing, steroids have always cleared it up. I could take a deep breath again, open up my airways and I was free of the cold again. I take Fostair to. Help a lot when I feel my chest is tied. I am now on Mepolizumab once a month had my six injection and have not catched an infection since. So I believe that oral steroids are helpful to open up your airways. 🌹🌹🌹

I think doctors, too, vary a lot. Your situation reminds me of my experience last Christmas and New Year. Like you I am late onset, though I think the problems have existed far longer than that, but I didn’t seek help. My primary symptom is coughing. I got a virus last Christmas and my peakflow started dropping pretty quickly. This was on Christmas Eve. I really couldn’t face out of hours that day, nor on Christmas Day, so it was Boxing Day by the time I saw a gp. My best is 380 and by then I was down to something like 260 or 270, so down by a third of my best. The gp I saw said as there were neither crackles not wheezes I didn’t need anything. Part of me was glad, but I was also rather surprised. Anyway, 2-3 days later I had got worse, coughed like there was no tomorrow and again saw an out of hours gp. By then air was no longer moving through one lobe, so she immediately gave me antibiotics, but at first said I did not need steroids. Weird , I though, as in part it would be the extra mucous that clogged my lobe. Anyway, she gave me a course, and I did get better fairly quickly, except of course for the enormous tiredness that follows.

I wonder if there is some kind of drive to cut back on steroids? I can’t imagine anyone wanting them ‘just for fun’, and thus only seek help if it feels needed, and following the advice for amber zone.

Yes sounds very similar to my experience. I think different gps gave different approaches. One I saw in the autumn with a constant mid chest crackle that steroids hadn’t moved, said he’d give steroids and antibiotics together in case of infection. The antibiotics didn’t work either! It eventually cleared on its own but my peak flow was lower despite by then 3 months of double clenil.

Think I’ll

Follow the nurses I just worry that over time oral steroids won’t work as well?

The Fostair worked brilliantly but I clearly gave a massive over reaction to viruses. I’m a bit better on day 3 but still fighting the bug and peak flow still at 350 at times; it varies. I seem best after the Fostair. My lungs feel very itchy.

I must have needed the oral steroids as I’m onto day 4 now and while I did cough a bit in the night it wasn’t ‘asthmatic,’ more just a bit of phlegm. But morning peak flow is 330/350; has been 400 when well. I imagine it would be worse or I’d be more symptomatic with out them?

I’m just trying to work out my normal but I find asthma very confusing! And I’m clearly not as bad as many people, though I couldn’t have gone to work this week (on maternity leave.)

While its probably sensible, in most cases, not to grab for oral steroids when you’re just 'slightly worse' than average, leaving it too late can, apparently, contribute to increased long-term lung function decline.

Personally, I’m not as committed as I should be to checking my Peak-Flow frequently. Once I find myself starting to use my Blue Reliever Inhaler (Ventolin) 'regularly' over several days, I become more attentive and - if' my 'gut feel' / observations reveal breathing issues are getting 'more' out of hand (and Ventolin use is not beginning to decline) - then I make a 'call' on whether or not to start oral steroids '.

Peak-flow Monitoring is definitely sensible, and can support an oral steroid decision, but you've really got to know your typical Peak-Flow Patterns (that can change / go up and down regularly) which means habitually using a Peak-Flow Meter twice a day, every day, to establish your pattern.

If you're classified as a 'Severe' Asthma Suffer, then Daily Peak Flow is wise - so I suppose I should be doing that (smack-on-the-wrist for me!).

I’ve just had a review with her and she realised my ‘amber’ number was 380, she said it should be 340. The red wasn’t filled in but is very low. So I feel clearer in a way, though it brings the thresholds down a bit.

She did say she thought the steroids were a good idea based on what was happening; it’s a really harsh virus. Salbutamol wasn’t lasting 4 hours. I’ve thought I’d heard the same in the past re long term damage. I pointed out that the Gp wouldn’t have given them which she was confused about, suggested sticking to one Gp who will get to know me.

My big issue is when I start to come down with a virus, talking can exacerbate the progression and asthmatic response much more. I’m a teacher so this is often a big issue. She mentioned montelukast but I’ll have to see how I go over the next year. I’m hoping I’m dealing with post pregnancy hormones too.

I’m going to have a good look at bedding and airing off too in the bedroom in case any dustmite stuff is adding to it; never really noticed it before but can’t hurt.

Lysistrata profile image
LysistrataCommunity Ambassador in reply to haggisplant

Does your plan also have symptoms on it? Plans don't have to be just peak flow based, there is evidence that symptom based, peak flow based or a mix works just as long as it is individualised - but some drs/nurses can get fixated on PF, glad yours hasn't too much it seems.

For me personally it doesn't work to rely too much on peak flow, because while mine does drop it doesn't necessarily correspond to where things actually are - I've had some of my worst hospital admissions with amber peak flow levels and a less bad one with what was for me a very low peak flow! For me the use of peak flow is more in how it's responding to reliever - if it stops responding or doesn't last that is a big red flag more than the number itself, because it normally responds so well.

If you have other things you notice like this such as your cough and Ventolin response, perhaps ask for these to be included in the plan if they aren't already, next time you see the nurse.

I normally have my amber set at about 70-75% of my normal and my red at 50% (so 320 and 230 ish for my best peak flow of 450) so the 340 sounds about right for you!

It sounds like the steroids were needed - viruses can really flare things off and while peak flow is helpful, its important to not totally rely on it! The symptoms you're having and relief you get from salbutamol should be equally important when deciding.

Daily peak flow isn't always needed, but it can be handy to do it twice a day for a while so that you know your numbers and how they vary (I think has been suggested above) and then hopefully that would also give you less issues if you get stuck seeing GPs who don't know you (always possible when you end up needing urgent appointments!).

Looking into bedding etc is always handy, I didn't think mine was making a difference until I changed to anti-allergy stuff and suddenly found I was sleeping better! (It wasn't a total fix but definitely improved things!).

It might also be worth having a chat with work just to see if you can come up with any ideas between you for little changes that might be possible to help you when you have a virus - maybe having a TA in the room or something if you don't already? Or less duties outside (not sure how your school does things like that!).

And given all the changes pregnancy puts your body through there's every chance it is just that still having an effect! Hope you're feeling better now :)

Thank you so much for your reply, very helpful. Until this virus, Fostair 200/6 was great and I was 400 am 420 pm sometimes 440. She wanted to bring me down to 100/6 but I’m staying on 200/6 for the foreseeable future.

I have only had issues sleeping / coughing at night with this virus (and a couple in the autumn.) sleep had been disturbed for a few years but I’d put it down to other issues I had.

However, I can see there could be background dust mite mild allergy stuff adding to general inflammation. This time of year it’s at its worst I think?! If I try to address that it might help longer term I suppose? My son is being tested at the moment too (trialling a brown) so I think we should look at that too. Again, it’s mainly viral coughs but they linger and he seems to cough a lot during exercise in the winter.

hello haggisplant

I see you are a teacher you are probably getting bombarded with viruses and constant coughs and all sorts all the time if you look at supporting your immune system through foods vitamins and minerals and if you can research magnesium deficiency and symptoms of magnesium deficiency also benefits of vitamin d3 and k2 Mk 7 and if you look at Barbara O'Neil on utube she gives some great home remedies goodluck

Hi, thanks, I have hypothyroidism too and am on maternity leave with a baby and a 6 year old. Germ war fare! As I’m breastfeeding I’m on top of what ever I need there and have experienced deficiencies in the past so I do try to keep things covered. I think hormones are also a factor too.

I think it comes with experience and knowing what normally happens for you.

For me, prednisolone doesn't get rid of my symptoms.

Experience has been infections where only take antibiotics or where viral just have to wait it out (no antibiotics) take me longer to recover from that when I have prednisolone.

This last bacterial infection started 05/12/18 and it was only about 3 weeks ago started to feel more human. Rescue Pred given 10/12/18 and nebulised 13/12/18, GP sent to A&E 14/1/18 when sputum results confirmed type of bacterial infection was nebulised chest xray/bloods antibiotics and further 7days course Pred.

All meds completed just before Christmas all infection clear by week 6 it took till circa 3rd/4th Feb before I got voice back and began to feel normality return.

This is longest and scariest ever had.

Despite having 12 days of Pred still lasted that long.

This was scary because I needed to be nebulised and first time ever had to go to hospital for my asthma (despite been diagnosed 29 years).

Result change of inhalers and new plan which has peak flow and symptoms on.

Hi! Sorry to jump in on this thread, but when you have a chest cold, and nothing seems to clear the phlegm, will oral steroids clear it? I got a pretty bad case of a chest cold last week, and my peak flow dropped to (all time low) 53% on Friday evening and all of Saturday. Took ventoline pretty much every hour which got my peak flow up to 60% for a little while, until it fell down again quickly. Sunday it increased to around 60%, and now I’m up to 75%. So is this a case where oral steroids would be the miracle cure, or should I just wait it out? (Please don’t yell at me for not going to the ER this weekend. I would have if I really felt like I was in trouble)

I think it’s dependant on what the cold is; from my understanding a bacterial infection might be cleared with ‘stronger’ lungs but might also not allow the lungs to strengthen no matter how much steroids!

One Gp I saw said he would give steroids and antibiotics together as sometimes the steroids some how weaken immunity to further infection.

I think if peak flow is as low as that and there’s buckets of phlegm a Gp might give both.

I’m slowly getting better now; peak flow is still 350/370 in mornings but higher during the day at times. Didn’t need to take salbutamol till 5 am today which is the first time for 11 nights.

From what i can tell it’s vety dependent on the individual and the infection!

I’m starting to think I have cough variant asthma as I don’t wheeze, do cough endlessly, have coughing fits where I just can’t stop, and perhaps my peak flow never drops as low as with classic asthma?

Hope you feel better soon x

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