British Lung Foundation
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Should steroids clear exacerbation symptoms in COPD flare up?

I was diagnosed with COPD seven years ago. I was a heavy smoker and it took me until two years ago to give up, after a collapsed lung and surgical procedure. I've been lucky not to have had extreme symptoms and have managed to exercise regularly, daily walks and three classes of Chi Kung a week. I have never had an exacerbation - never that is, until two weeks ago. For no apparent reason, over several days I developed a tickly cough, which became worse and worse and was there permanently. I was suddenly also frighteningly breathless, and for the first time unable to climb the two flights of stairs to my bedroom. I waited for several days hoping things would improve, but in every respect they just got worse. I finished up going to A&E in a panic, and they did an X-ray which revealed nothing, and blood tests which showed no underlying infection. As I'd calmed down, they sent me home with a seven day course of 40mg of steroids (Prednisolone). I began taking the steroids the following morning. By the end of the course, while my symptoms had eased very slightly, they were still there. Now, a week since finishing the course, I am still coughing badly and much more breathless than I ever was before. I had hoped that by now, the steroids would have addressed the symptoms, but apparently this is not the case. Today I rang on of those NHS help lines, and was informed that it's not uncommon for symptoms to continue for up to three or four weeks after a course of steroids. Can anybody confirm this for me from their own experience? Do most people find that a short course clears an exacerbation?If not, what is the alternative? And is there any point in continuing with another course of steroids? If I'm patient, will these symptoms clear?

Any input would be most valued. Thanking you all in advance.

Every good wish,

Cliff (67 years)

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Hi cliff, you should return to your doctor and tell him how things are now. Are you bringing any mucous up? If so then a sampler could be sent for analysis and maybe antibiotics could be prescribed if there is any sign of infection.

I hope things improve soon. Xxxx

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Thank you Sassy, for your prompt and caring response. In fact I did visit my GP on Friday to check that route. Like the hospital blood tests, he could find no signs of infection, but he did prescribe a course of antibiotics just in case. Now in my third day of the course and they seem to be having no effect either. He also gave me another course of steroids which I havent started because the last course seemed to do no good. I suppose they're there if I am desperate. But basically, what I need to know is whether a short course of steroids can be expected to clear symptoms, or if as the NHS help line suggested, it can take up to three weeks after finishing the course for the symptoms to disappear. I begin to wonder if they will ever disappear. Thanks again Sassy, Cxxx

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Hi

Not all exacerbation are caused by a infection.

Mine are non infection exacerbations, the first and worst one was caused by long exposure to Air Wick automatic air freshener, there are several other triggers, aerosol, strong household cleaning products.

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Thanks. But my real question is whether symptoms should disappear after a course of steroids? The course I've just finished seems to have had no effect on the symptoms. Is this usual?

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Hi I myself have just finished a course of steroids about five days ago, . They eased my symptoms but from my experience it usually takes a few weeks to get back to normal. I can't say this is how everyone finds steroids, but hope it helps. 😊 Bernadette x

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Thanks, Bernadette. That's most encouraging. Cxxx

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Hi burnet I'm the same as Damon steroids didn't get rid straight away took about four weeks to get better hope u get better soon

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Thank you Southp. That's really helpful. C.

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Hi cburnett, steroids almost always work for me , but it takes time and is dependent on the prescribed dosage. My pulmonologist supplies me with medication to have on hand for any incipient exacerbation, basically steroids and a strong antibiotic (if needed). The steroid treatment is 60mg for 4 days, 40 mg for 4 days, 20mg for 4 days, and ending with 10 mg for 4 days. ( a total of 52 10 mg tablets) I do not abuse this privilege , having only undertaken this at home ‘ all out ‘ prednisone treatment once in the last 13 months. While it does work for me , we all need to be aware how easy it is to become dependent on high doses of prednisone and how serious that can be. My mantra on prednisone is by all means to take it when you need it , but when you are better and have tapered off the medication, to then stay off it until , and if , you again have a major exacerbation. Best Wishes, judg69

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Hi judg69. Thank you for taking the time to contact me. The medication regime you outline sounds pretty uncompromising. My steroid course was a first course for a first exacerbation - seven days at 40 mg per day. Have you had frequent exacerbations, and does this explain the much larger doses of prednisone, that you have built up to this level over time? And did you only begin to get results when the dosage was upped to this level? Is it possible that I'm still suffering because the dosage wasn't high enough? So many questions. Thanks, CB.

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Hi again cburnett, I was hospitalized for a week and a half with a very serious exacerbationin April 2017. Ever since , my pulmonologist insists I have medication to take at once if another major flare up occurs. He believes in hitting it quickly and hard, and has also prescribed levofloxacin 500 mg as the ‘on hand antibiotic’ . Again, best wishes and feel better soon, judg69

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Thank you again judg69. It sounds like a sensible strategy. I hope you're presently stable and remain so for the foreseeable future. I send you thanks and my every good wish. CB.

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I have had various treatments with steriods. And they help me. However, my reaction will vary. Sometimes just awake one morning at the end of a steriod treatment time and feel very well. Other times it takes several weeks to regain my strength.

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Thanks Cha. It's so useful having other people's experience to refer to. So good not to feel entirely in the dark. Good wishes, CB

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Hi Cliff at one stage I had to have a 3 week course of prednisolone along with anti biotics to clear a particular nasty exacerbation I got .I don't understand why you weren't given anti biotics as well as when they are taken with steroids they work well .I suggest you go back to your GP and ask his advice , he the may in turn prescribe both .Good luck .

Love Babs xx

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Thanks Babs. I have been back to the GPand he has prescribed both steroids and antibiotics. I've started the antibiotics, to no effect, so it's clearly not a lung infection. Lots of people on here have suggested that it takes a few weeks fo symptoms to disappear after finishing a course of steroids, so I'm willing to suffer for a spell in the hope that this is the case. If after another week I'm still coughing and breathless, I will start the second course. Thanks for your input. Lots of love, CB.

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Well I hope it does the trick but my doctor phoned the hospital after I had steroids etc for 3 weeks and I wasn't getting any better .I had to go in for a day and have loads of tests ,after which they told me it takes many weeks if not months to recover .Sending you healing hugs .

Lots of love

Babs ❤️ xx

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Hi Cburnett, this is a 'horses for courses" type of thing. In some cases a short course of 5-7 days on prednisolone will do the trick, in others a longer decreasing dose regimen (like judg69 mentions) is required. If you have been prescribed any inhalers make sure you are using them as well. Start the prednisolone your GP gave you. If at the end of that course you are not feeling better or if you feel worse beforehand, go back and see the GP and tell them what has been going on.

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Thanks Aussie. This is very much what I had concluded. We're all different. And as I'm so new to all this it will take time to find the right path for me. It's been suggested that it's not uncommon not to get an instant result from a first course, but to see improvement weeks after. This is what I'm hoping for at the moment. I'll then try a second short course. All about suckin it and seeing I suppose. I'm grateful for your input. All good wishes, CB.

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Speaking solely as a patient, your symptoms and their onset sound like a virus. I have bronchiectasis and have just had very similar. The cough and extreme breathlessness was totally different to my usual exacerbations. In spite of taking my abs the dreadful breathlessness has gone on for over 3 weeks. I don’t take steroids. If what you have is a virus, the steroids may help whilst you are taking them but basically, a virus is different to a normal exacerbation and it will have to run its course until it leaves the body. I really feel for you because I have been finding it tedious and frightening.

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Thank you littlepom. I'm sorry you've been suffering like this. At least I know exactly how it feels. My problem may well b viral. So as you say, all I can really do is wait for it to pass. If it becomes too desperate, I have another course of steroids ready and waiting. Hope both of our coughing and breathlessness is relieved soon. Take it easy brother. Sending you good wishes, CB.

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Hi Cliff, I have had an on and off cough for 2 years treated with AB Amox or Dox various inhalers. No real help. I followed this blog site & found a kind person who explained well the treatments that worked for her under similar conditions to my own. I went to GP & asked for AB Azythromicine 250 mg & Relvar one dose inhaler each morning. She prescribed Serevent if have difficulty breathing at night. I live in S of France where the terrain is hilly struggling with the uphills. The AB have helped but still have some clearing. However the improvement in energy from Relvar is a transformation, I tackle well the uphills on my dog walks now. The GP says I should take Relvar daily for the next 3 months. Like you I am a little nervous that I will become dependent on steroids for a “cure/comfortable” life. My breathing is vastly improved before I took shallow breaths & felt constantly tired. I cough still but more infrequently, trying to breathe always through my nose as advised by a specialist in WSH Bury SE, who also helped with techniques to control coughing. I avoid irritants, eat smaller proportions, short telephone calls, to protect throat.

Coughing is really miserable I sympathise. This is my story I hope you find something that helps you soon. My intention after 3m to stop & reassess.

Good luck B

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Bonjour Breester, et merci. I can hardly imagine living in the heat of the Sud with COPD. But I am grateful for the medicine outline you give me and I shall certainly discuss these items with my GP. It's also really encouraging to see that you haven't given up and let the condition rule your life. The Severent sounds especially applicable. Last night I woke every hour with a violent coughing fit which actually put my back out. Thank you so much for your input. Toute a l'heure, CB.

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I agree with Littlepom. I had the RS Virus this past winter and it was brutal.

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Thanks cases. Points noted. All the best. CB.

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Hi Cliff I had a exacerbation COPD flare up in mid February had 3 lots of antibiotics and steroids was unable to return to work till the end of April, 9 weeks I was off I went back and the nest week I was off again and on anther course o Steroids & antibiotics I'm more breathless each day since I gave up smoking January 2017

I feel tired all the time, I seem to be losing my concentration, Some days I feel so useless unable to have fun with the grand kids, I have shaky hands most days that limit me to do everyday tasks.

Hope you have a speedy recovery.

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Oh Cathy, it sounds awful. And I sympathise with the additional struggle of giving up smoking. I started when I was nine, and to be truthful, for me, life was something that happened between cigarettes. It was five years after my COPD diagnosis before I actually gave up. And even then, only after a collapsed lung and surgery. So at times, when I'm feeling down, I have to remind myself that only I am responsible for my condition. It's a tough pill to swallow.

I am also continuously tired, and like yourself, because of the lack of oxygen getting to my brain, my concentration and attention are barely available. I can go blank half way through a sentence as if someone has taken the phone away from my ear.

Because what I did as a job was quite physical, I'm now no longer able to work. I certainly wouldn't be able to cope if I had the additional pressure of external professional demands. Usually, it's as much as I can do take a shower and dress. So, many congratulations for continuing to make the effort.

Hope you're feeling better now.

With every good wish,

CBx

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Thanks Cliff I would have to give up work if it was physical I'm mostly at a desk on computer. I also stop in the middle of a sentence I make remember 5 mins later and then finish the sentence.

We have to be thankful for rescue packs to take at the 1st sign of an infection if we notice lol

Take care x

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I quit smoking back in January and I am worried that this may be my fate as well. I am having breathlessness too....still.....

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Stay strong Ribbon36

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Hi Cliff, I started with a cold in December and was put on abs/steroids, it didnt clear so went back in January and the doctor put me on second course abs/steroids, after third course she said she didnt know what to treat me with and could be virus, after another two weeks of coughing and blowing my nose 24/7 wheezing and breathless, I asked to be referred to the hospital, after seeing the consultant he said this wasnt my bronchiectasis and could be an allergy, he precrescribed steroid nasal spray and fostair, neither did much good, he did bloodtests, which didnt show anything, but I decided to use antihistine which helped alot and cleared alot of the mucus, but even the non drowsy wiped me out so couldnt use them all the time. I am waiting a ct scan and have another appointment to see the consultant. This has left me so confused so not sure what to think. I just know that, I had mild bronchiectasis and now have a serious problem with breathing, mucus and a constant cough. I do hope that you can solve your problems, so many doctors are just not able to deal with the various lung problems, keep pushing so that you get the answers to solve these issues. I wish you all the best. Keep us updated. Irene x

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Meant to say, I also had what I thought was a problem with my heart, this turned out to be h pylori bacteria which i was treated yet again with ab but wonder if this could somehow be connected to the problems I have had. Just wish somebody could connect the dots. X

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Hi Irene. I fully understand how you must feel. It's so frustrating to get tied up the confusion of different opinions. You just want the problem identified and dealt with. But it never seems to be that easy. It's not the best time to be ill. The NHS is under tremendous pressure. Resources are spread too thinly. And there's not enough attention to detail. I'm busy examining some alternative possibilities for treatment if there's no result from the steroids. I'll keep you posted. CBx

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