Hi, this is going to be a long one.
I came down with suspected Covid at the end of March. Previous to this my asthma was well controlled on fostair 4 x 100/6, ventolin as needed (once a month or less), dymista and cetirazine. I've been on this lot for about 7 years with the occasional issue after respiratory infections, solved by temporary doubling of fostair.
Peak flow pb is 670 but on this regimen I would have a steady daily measurement of 550 and be essentially symptom free.
I'm still struggling with breathlessness and asthma control 11 weeks since starting with symptoms. I've seen little improvement in the past 6 or so weeks despite adding on extra meds. I'm back at work part time (from home) and whilst I can cope with the lost income I don't want this to go on any longer than necessary.
I appreciate these are unprecedented times and treatment plans are very trial and error. I hope someone can read through where I'm up to with my GP and asthma nurse (see below) and either give me some alternative options, or some reassurance that we're on the right track?
So the background /treatment so far:
My plan advises doubling fostair for any illness which I did as soon as I showed symptoms but after one week my peak flow fell precipitously to 170.
GP gave me pred (30 mg x 5 days) and increased my fostair to 8 x 200/6 a day. This helped, my peak flow increased to 500 on day 1 of pred but was only 325 at the end of the course and I was struggling with breathlessness, which was helped by ventolin, and fatigue but otherwise no longer symptomatic for covid. Peak flow through the day very variable (350-450).
I was concerned how I would react when the pred wore off and spoke to a nurse at 111. After a serious telling off for not shielding (I have never been in the very vulnerable group) she told me my peak flow was really good for my age and height - she wasn't concerned about my symptoms and ignored my pb and my usual measurement, she then told me I didn't need another course of pred but could call an ambulance if I needed help. I was feeling rather frustrated when I got off the phone!
GP and asthma nurse advised to keep going with 8x fostair 200/6 and add 2 puffs (or up to 10 if needed) ventolin 4 times a day with a review every 2 weeks, or sooner if symptoms worsen. (PF 350-500)
Ventolin did help and now at 4 weeks since coming down with covid I was feeling OK when sitting still and only struggling when on my feet for more than 10 mins. I tried to walk around the block, but this set off my asthma really badly, improved by ventolin but lungs were twitchier for the next 4 days and Peak flow dropped back down to 275. Daily range (275-450).
GP added montelukast as I suffer with rhinitis; this had little impact on my asthma and breathlessness but has improved my rhinitis. I was advised that it will take time to recover and that I need to rest, pace myself and that she suspected I probably have lung damage and scaring. Peak flow now more stable during the day (375-450) but only 450 max. I'm less breathless when active but still unable to walk far without asthma symptoms. Reduced ventolin back to as needed.
Very little change. Still getting asthma symptoms when trying to go for a short walk (10 min). Having to use 2-6 puffs of ventolin most days. Peak flow ranges between 350 and 475 during the day.
Asthma nurse and GP agree the lack of progress is worrying, I've had plenty of time for my lungs to heal and they are concerned that whilst the meds are stopping any deterioration, they aren't sufficiently dealing with the inflammation.
So I was sent for a chest xray, referred to chest clinic and started on uniphyllin.
Since starting the uniphyllin I have reduced my ventolin use a little but no overall change in peak flow, it is quite variable - usually 450 when I first wake up, but drops to 350 during the day or if I go for a walk.
No appointment yet for chest clinic or result from the chest xray. Had blood test 5 days after starting the uniphyllin but not had results yet.
My asthma nurse and surgery team have been absolutely fantastic, and I've finally found out which GPs at the surgery specialise in asthma which is brilliant.
Thank you for making it to the end, is there anything you think I should try whilst I'm waiting for the referral?