Possible Flare up?

[WheezyNanma]

Advice needed. Been diagnosed just over a month and put on blue inhaler reliever (doesn't do much) and Fostair combination preventer (which is a Godsend). Cough and wheeze all but disappeared.

Suddenly the cough came back again tonight. Not as bad as it was but it still came back. Does this mean the Fostair stopped working and if so, do I need to get a different preventer? Why would it suddenly stop working?

It may be I have some sort of cold coming on that is always a trigger, but I don't yet feel I have a cold. I'm puzzled. I thought I'd found a really effective preventer. Anyone else had similar experience?

My peak flow has never been good - started off at 120! My highest has been 400 but I'm usually at 320 - 350. I'm 60 years old and should be doing 395. Now it's a struggle to get above 320.

[Js706]

Hi sorry to hear that you’re struggling a bit at the moment.

It’s great that generally the fostair has been so helpful. Unfortunately with asthma there will still potentially be times when symptoms get worse despite a really effective preventer medication - especially when we get things like a cold.

Having one flare up of symptoms doesn’t necessarily mean you need any change to your preventer medication but might need it temporarily increasing (depending on the dose you’re on, you may be able to double the amount you take when struggling a bit to help settle things) or something like a short course of steroid tablets until everything settles down.

With regards to peak flow I wouldn’t worry too much about predicted amounts, as they’re just a rough guide for when people don’t know their own. Your personal best is much more important (as remember the average will be made up of people your age who had higher peak flows than you, but also a lot who had much lower ones!).

Do you have an asthma action plan based on your peak flow? If not it’s probably worth making an appointment with your GP to fill one out based on your best peak flow of 400 (asthma uk has a link to a great blank one you can use - asthma.org.uk/advice/manage....

It varies a bit from person to person but generally advises you to see your GP for some steroid tablets if your peak flow drops to about 70% of your best - so about 280 for you, and to go to hospital/call 999 if it drops to about 50% - 200 for you.

Also peak flow is only one way of monitoring your asthma, the symptoms you’re having are also important. So if your cough is worse, wheeze is back etc, then that also suggests something isn’t right.

I know asthma is really confusing with lots to learn about! But you’re in the right place to ask questions. 😊 I think it’s probably worth trying to get an appointment with either your GP or asthma nurse so you can let them know what’s going on at the moment and go through things like what to do with your inhaler dose when you’re a bit more symptomatic and fill out a proper action plan for you to follow.

Hope some of this really long waffle was helpful!

[WheezyNanma in reply to Js706]

Many thanks for this, it's really helpful. Thank you so much.

I will certainly monitor the situation and I think I'll wait to see what things are like tomorrow and go from there about whether to see a doctor. One thing that did occur to me, although it doesn't seem to be listed as a trigger on most sites, is that, immediately before this flare up I had an episode of reflux into my throat (regurgitation of stomach contents). That started the cough off initially, which it would do as my reflux problems have caused me to have a stuffy, congested nose and cough.

I'm now wondering whether, in fact, the two things are linked. I did touch on this with my doctor who said that asthma is linked to the nose, and nasal rhinitis. Well I have rhinitis caused by reflux and always sound nasal, like I have a cold.

I thin perhaps the reflux might have triggered the asthma.

Your very eloquent and concise response is much appreciated, particularly in regard to my peak flow.

[Js706 in reply to WheezyNanma]

No problem. Reflux is definitely linked with asthma! As is rhinitis. Both of those conditions are very common in people with asthma and can make asthma symptoms worse (reflux is especially bad for setting off an asthma cough!)

[Chip_y2kuk]

The famous "asthma cough " is generally a sign things are deteriorating... temporarily trough a virus/infection or because of a trigger

It's also possible that fostair has stopped working there is some evidence that suggests that people on combination Inhalers become resistant to the long term bronchodilator used and so the airways narrow and constrict despite the LABA .... however there is little to no research on how often this occurs and how long people should stay on a combination inhaler

The general rule is 24-48 hours on increased medication (that depends on what your gp has said to do) and if it's not settling it's worth getting checked In case it's a bacterial infection or you need oral steroids

[WheezyNanma in reply to Chip_y2kuk]

Many thanks for this advice. It has calmed down now so I am going to just monitor. Helpful to know about increases medication for 24-48 hours. I do think it was the reflux which triggered it (my fault as I ate just before lying down like a silly sod).

I do like the Fostair so I hope we don't gain a resistance to the bronchodilator 🤐 The blue inhaler doesn't work on me at all. I do get slight racing heartbeat if I take 2 puffs of Fostair together so I avoid doing this. I mentioned this to the doctor who said he could change the preventer but it would possibly make the heart racing worse!!! He didn't mention the name of it.

Thanks for your response ☺

[Chip_y2kuk in reply to WheezyNanma]

Seretide/sirdupla? It has salmeterol In it... which is similar in function to formoterol but older fashioned and takes a bit longer to work

As for the blue not working at all have you asked for it to be changed...its of doctors will tell you blue is all you can have but

They do blue In powder instead of liquid form... I found that better

There is also the likes of ipatropium and there is a powder blue twist Inhaler that i forget the name of so if the blue doesnt provide relief then it's always worth a trial of something else

You can also use the fostair in MART (maintenance and reliever therapy)... you basically use fostair instead of the blue as well as using it as a controller