flare?

[Yellow-dog]

Good morning everyone

I need some advice on steroid dose please.

I have severe asthma as well as pmr . Last December as I was recovering from an asthma flare up I got covid. I have not yet recovered, it feels like one step forward two steps back. So far this year I’ve had two lots of antibiotics for the ensuing chest infection, and steroids ( 5 days at 40 mg). In between these extra doses I have dropped back to the 1 mg dose that I was on before. One week ago I decided to pick up my dsns tapering regime, tapering from 1 to 1/2 mg. My breathing is a bit better but for some reason I now have a hacking cough, productive but does not seem infected,

The fatigue is awful, if I do something extra such as going out for a longer walk, it takes several days to recover. On Sunday I did a fairly challenging ( for me) walk and expected to have to take it easy yesterday , however it’s been worse than I thought. I was awake all night coughing, and on Monday could not get warm, generally feeling ill. I’ve also lost my appetite which is most unusual for me!

This morning I was woken up by intense hip pain on one side. I’m trying to work out whether to increase the steroid dose and if so what to? Sorry this is such a long post, I’ve obviously got a lot going on,

Thanks in advance for any advice,

[DorsetLady PMRGCAuk volunteer]

hi

Sorry to hear you are in such a sorry state…. think you probably need medical input on this … although it might be sensible upping to 5mg for a few days to support your adrenals if nothing else.

The cough, feeling cold and loss of appetite sound like another virus - but not sure about hip… unless you did something on the walk and it’s just materialised.

[SnazzyD]

If this feels like a new set of symptoms on top of the long Covid drag, I think you need medical advice. You have new cough, chills, loss of appetite and deep malaise. Have you had a chest x-ray since Covid? It doesn’t sound like a small increase in Pred will help much but any more needs to be done taking into account the context of what going on in your chest. If your adrenal glands are also suppressed 5mg might help a bit with energy. However, two lots of antibiotics and whacks of Pred and another surge in symptoms later, I think there needs to be a bit more inquiry into what’s going on.

[PMRpro Ambassador]

Reading between the lines - you felt reasonable on 1mg? That is such a low dose I wouldn't be too bothered about getting any lower but bear in mind that the high dose pred, albeit only a for a few days, that you have had over time for asthma, won't have done your adrenal function a lot of good. According to Imperial London, 2mg pred can be plenty as a replacement dose so that 1mg may have been doing a lot more than you thought.

Like the others, I think you need some medical input because whatever was going on is still going on. Of course, it is probably a viral infection so more abx won't do a lot other than prevent a secondary bacterial infection but were they the RIGHT abx first times round? Have they done a sputum culture? Have they done a chest x-ray or are they assuming it is the asthma? Assumptions like that make me very twitchy!

[Yellow-dog in reply to PMRpro]

Yes, I did feel ok on 1 mg. I see what you mean about adrenals, I had not thought of that.

I am taking the advice from this forum, and have submitted an appointment request at my gp practice.

Thanks to all,