Thanks very much to those who responded to my post last week about my recent worsening symptoms. I've gone to the doctor and agreed on an upped dose and some steroids short tem. I want to understand something from the community that I have not been able to understand from my asthma nurse.
When I take the blue inhaler, I feel this improves my symptoms ever so slightly but it does not by any means make it so that I feel no shortness of breath or chest tightness. Is this normal? I was speaking to my doctor this week and she was saying "when you take the blue inhaler it should last for four hours" Does that mean that most people, when experiencing symptoms, take a single dose of the blue inhaler which makes the symptoms subside entirely for four hours and then they take another puff? Or is this just meant to restore you to a less compromised state of breathing so that you don't have to go to the hospital? People have advised I can take the blue " as often as I need to" but I just don't understand what the impact should be if I am taking multiple hits in a short span of time... should this make the tightness and shortness of breath go away all together? That has never happened for me so I am wondering if I am doing it wrong?
Also, I have now been put on Prednisolone for a 5 day course. I am currently on day 2. I have not noticed any improvement of the chest tightness or shortness of breath so far. Is this usual? Would it be expected that this steroid does would alltogether manage the symptoms so I should be feeling completely fine? Or am I just expecting this to reduce the inflammation so that I don't need to go to the hospital, but should still be feeling severe tightness and shortness of breath?
I'm just confused at what these remedies are supposed to be providing for me as none of them seem to be able to return me to "normal breathing". I'm also worried about if I'm doing something wrong or if I should be more insistent with my doctors that these aren't helping me so they can look into other problems that are not related to asthma.
Feeling complete lost but grateful for any help or advice you can share!
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CanadianBrit30
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Ok, the steroids should start kicking in now - some people say they feelmtje benefit sooner but I certainly don't, it takes 2-3 days.
The blue inhaler, yes it should last 4 hours but, in your situation given you're having issues, it may well not last that long at the moment.
Some points in my head:
- generally speaking (so perhaps not relevant right now for you, depending on the root cause), if it's not helping then it might not be asthma causing the symptoms at that time (various things feel like asthma but aren't and so don't respond to asthma meds).
- a good way to see if it is helping is to do your peak flow before you use it, use your blue inhaler and then redo your peak flow 15 mins later
- are you using a spacer?
- are you doing 1 puff, breathing it in and then doing the 2nd puff?
This post about what to do and when has a section for seeking further help. It would be a combination of factors given you're already on steroids, so not just "still tight" necessarily but it's difficult to say this is the criteria as different people experience different things. The tightness and shortness of breath will go once the steroids are reducing the inflammation. But they need time to get to that stage.
If you're concerned though, phone 111. Particularly if you can't function properly. But maybe speak to your GP or nurse tomorrow to ask at what point you should seek further help.
Hi Twinkly,So no one has ever told me to do two puffs at a time, but I will try that and the peak flow and see what difference it makes. To be honest after my initial period before I was diagnosed with Asthma last year when I had like 350 most days, I typically see almost no variability with PF. It is almost always 490-500. I'll be interested to see what this trial uncovers. If I get no improvement with the ventolin on peak flow is that unusual? I am using a spacer so I think my technique is okay. Thanks again.
The spacer I wasn't thinking technique as such, more that bit means hopefully all the ventolin gets in that way (which can be harder when struggling) - but that's ok as you are.
So have you only been doing 1 puff as a dose? A dose of ventolin is 2 puffs, so if you're only doing one then that might explain why it's not helping much. Do them separately though, so one into spacer, breathe it in then repeat.
If things are controlled then little variability would make sense (in twice a day am/pm readings before preventer meds). Some people don't see much variation anyway, even in a flare, as for some people peak flow isn't a reliable tool. But the pre/15 mins post ventolin can still be useful. If it increases a decent amount, that would indicate that it is an asthma issue and the ventolin helped. If it doesn't increase (and you also don't feel much better), it suggests that the ventolin isn't helping and so might not be asthma at the root at that time. It's not quite that simple because in very acute issues ventolin not helping can mean seek further help.
Apologies if I shared this link with you the other day (ignore if I did!) but this is my new to asthma post - but it might be useful if you haven't been given useful asthma info (so many people aren't):
Thanks Twinkly. I read through everything on that link the other day. It was helpful. I will try the pre- and post ventolin with two puffs and see what it indicates.
Ah sorry couldn't remember if I'd given it to you or not!
It could well be an allergy thing which may or may not be affecting your asthma (for some it's a trigger, for others it's an additional but separate delight!) im which case antihistamines might well help.
It seems that you haven’t been given the information on increasing your salbutamol when your symptoms start to increase. When you are wheezy, short of breath, tight chested and or coughing you can take up to 10 puffs of your salbutamol. I have attached a photo of a traffic light system that has been made for parents of children with asthma but I think it can be used by adults as well. Hope it help
Traffic light system for increasing asthma symptoms
Hi I sent a, reply but not sure u got it not much to add as you have had, excellent replies in the summer I get very bad with asthma I fibf the blue inhaler doesn't really help nowhere near 4 hours if pretty poorly. You need the, steroids, to help but it's not a, quck fix can take the, whole course before any relief and I sometimes, need another course if it flares up again. You can use the blue inhaker as needed but advice is if you needing it more than usual you prob need extra, help with steroids.. In, a bad attack up to 10 puffs can be used but if no relief with breathing seek help. Tske care hope you feel better soon
Sorry if I've missed this, but I take it you are on a steroid-based inhaler as well as the steroids and the Salbutamol? Has anyone suggested adjusting that too?
Regarding Salbutamol - it is meant to last 4 hours but when my asthma is worse it's more like 2 hours and even then it doesn't take away all of the symptoms - it does help but everyone reacts differently so 4 hours is a general guide as to how long it lasts for most people.
My PF also doesn't move when I'm ill so I don't really use that nowadays as a guide to how I'm feeling - it's still worth doing - but how you feel is most important as I believe it doesn't always pick up how the small airways are reacting (some of the air sacs are 2mm or smaller in the small airways and air can get trapped in them - doesn't always reflect in a PF or a spirometry for that matter, which is very frustrating when you feel poorly but this isn't reflected in the readings!)
Steroids for me usually begin to work the same day or day after but again everyone is different so don't panic if they aren't working yet. That means my symptoms begin to ease but I often need two emergency courses back to back before things settle down. Again, everyone is different, but if you're struggling to sleep or do everyday activities I'd get on to your GP again for some advice. You should also have an asthma action plan - there's info about this on the Asthma UK site - that should guide you and the GP as to what to do when you're feeling worse. Or give the Asthma UK nurses a call as they are brilliant at advising you in situations like this where you aren't sure what to do next.
Hi CanadianBritYour post is very articulate, you’re obviously very good at expressing yourself. As the others have said, at this stage it sounds to me like you need to take more blue all in one go; I often find that 2 puffs (1 dose) isn’t enough. If I take 4 or 6 puffs over the space of 10 mins I normally get some relief that will last the 4 hours. I may then take another 4 puffs at the 4 hour point to aid recovery. Obviously if this is happening often you need to see your gp. If you’re taking more than 10 puffs in one go then you need emergency help but I’m sure you know this already.
Hope the increase in meds helps & that you get some relief soon. X
Hi there. Thanks for your help. I've been trying that today to see if there is any improvement. Yesterday I tried two puffs and then another two and over the course of the day I think I took 8 but they didn't really seem to do anything. Today I tried 4 puffs at noon and then 4 puffs again at around 8 as I needed to get dinner cooked and be moving around. Again I just don't feel like it is helping. If I try six at a time, could I take another six later in the day or is that I need to not exceed 10 per day? Or if I'm having to take 6 puffs just to get any relief could I try that again later on?
I think you need to contact your GP and query if anything else is likely to be causing the symptoms,.as using a lot of ventolin and feeling no better as well as peak flow not really changing indicates it might not be asthma at the root of these symptoms. Maybe ask to try antihistamines as allergies can cause similar symptoms but if the allergies are not affecting your asthma then the asthma meds won't help - but antihamines will. Trying meds is often the way to find the root of the problem.
Oxygen levels are absolutely not reliable in many asthmatics and, for that reason, are not recommended for asthma. SATs often remain good and don't show what's going on. Yes in some people they drop helpfully when there's a problem but, even then, asthma being a variable condition, it doesn't mean it will happen every time and so people could fail to seek help in time because they were waiting for the sats to indicate the problem.
As Twinkly says, it isn't a good idea to rely on sats like that as they are not reliable in asthma - it is entirely possible to need help before they drop.
The same goes for peak flow for some people - you shouldn't wait u til that drops to get help. But your peak flow not being helpful does not mean you should rely on sats instead.
I'm really quite shocked that your asthma nurse said it was ok to just sit at home and chug Ventolin by yourself in that situation. Even though sats aren't reliable, if you do drop to that and/or you are too breathless to speak properly, eat, or sleep you should not be sitting at home trying to sort it regardless of what your peak flow is doing. Perhaps the nurse believes you should go by peak flow alone, which is also wrong, or thinks that oxygen level is fine because it's acceptable for COPD - but it isn't for asthma.
You should absolutely NOT be waiting until you cannot get any puffs in at all before you call 999 - that is dangerous, and your asthma nurse should not be saying that if they did. I'm saying this to you and anyone else reading. Please follow AUK's advice on this:
Just want to reiterate twinkly29 and lysistrata. Asthmatics should NOT be relying on their Sats. It is dangerous. Sats of 92 or lower in asthma indicates that it’s a life threatening asthma attack. Just chugging on ventolin is dangerous (I know someone who died doing this so really, please DON’T do it). The nail al asthma action plan is to go to hospital if you have any ONE of; can’t walk/talk properly (or eat/sleep safely) +/- reliever isn’t helping (10 vent puffs max) or you’re needing it more than every 4 hours +/- you have difficulty breathing +/- wheezing a lot or coughing a lot or a very tight chest +/- PF under 50%. Please look at your red zone asthma plans as it tells you when to seek further help safely.
EVERY a&e doc I’ve seen in the past (even the not good ones) have confirmed they’d rather see an asthmatic a touch too early than a touch too late.
Thanks everyone. I'm not relying on SATS or PF. I'm just relying on how I feel. It seems pretty clear to me that the drugs are not helping in the way they should. I seem to get next to no relief from the ventolin even at these high doses. I actually have a specialist allergy referral appointment on Monday and I can't take antihistamines in advance of that appointment which is part of the problem. This has all just started last year and before that I had no breathing problems and no asthma. If only I had been able to get the allergist appointment earlier then perhaps I wouldn't be in this situation. I will try to persevere and hope for the best. My Asthma Nurse said if I can't speak and have a conversation then I probably don't need A&E so that is what I'm going on at the moment. I don't have an asthma action plan unfortunately. I will try to force my nurse to give me one to follow. Thanks for all of your advice.
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