Hi everyone. Another (hopefully quick) infomercial post, to (hopefully) clear up any uncertainties people have about when the should be doing certain things. So without further ado;
WHEN DO I TAKE MY RELIEVER?
When you’re symptomatic 😉. If you’re in a coughing fit (that feels asthma-ry), wheezing, have a tight chest or are feeling breathless (SoB- short of breath). It doesn’t matter how ‘mild’ you think it is - if you’re having symptoms you treat it! It doesn’t matter if your peak flow (PF) is in green - if you’re having symptoms you treat it! 😉
WHEN DO I SEE/SPEAK TO MY GP FOR STEROIDS?
If you’re having unusual, sudden and persistent issues (ie regularly having issues and needing your reliever when the day/weeks before you had none) you may need a short course of prednisolone to calm things down. This is typically in your ‘yellow/amber’ zone of your asthma plan. So if you are suddenly waking at night with symptoms (or going to bed late/waking early), or your symptoms are interfering with your usual day-to-day activities (like work or exercise), or your symptoms are coming back (wheeze, tightness, cough, SoB) regularly (every 4 hours or so. If you have needed 10 consecutive puffs of ventolin (and it has lasted over 4 hours) you should also see your GP as you may need steroids. If you are needing 2 puffs of ventolin and it is not lasting 4 hours then you need to see your GP urgently.
WHEN DO I SEE/SPEAK TO MY GP TO CHANGE MAINTENANCE MEDS?
This is usually a more insidious issue. Persistent issues, that you didn’t really notice getting worse. Never something you’d class as an ‘attack’ but regularly needed your reliever three or more times a week. Persistent issues at night, persistent issues that return once your steroid course is finished. These are all signs that you’re probably needed escalation of your reliever drugs. This is your yellow zone, but it’s persisted for 7+ days!
WHEN SHOULD I ASK FOR A REFERRAL?
If you’re not getting controlled (ie not able to get 0 symptoms) and your doc is basically saying they are out of options (having allowed each med time to kick in properly), or you feel like you aren’t getting anywhere you ask for a referral. That may be from your GP practice (primary care) to your local hosp (secondary care) or it may be from your local hosp to an asthma specialist hosp (tertiary care). Sometimes GPs can refer straight to tertiary. But if you’re not getting on top of your asthma, it’s disrupting your life and they have ‘tried everything’ then ask for a referral (if they haven’t already offered!)
WHEN SHOULD I REDUCE MY MAINTENANCE MEDS?
If you have been completely asymptomatic for 3+ months then it may be suggested to you to step down/reduce your meds. This is a normal thing as medics want you on the minimum amount of meds possible. Whilst remaining controlled. If you have been needing the occasional reliever during these 3 months then you should not be reducing meds. If you feel like you have seasonal issues and are worried they may reoccur during that season speak to the medic you’re with and see what they suggest (it’s not uncommon to have a change of regime during known ‘poor control’ season for you - if this is the case and you have been told to restart in certain seasons restart in plenty of time so the meds have a chance to kick in properly). If you have tried (and failed) to reduce before it is also worth mentioning. If you are trying to reduce this is a good thing as it shows you are controlled, however if you then get issues you report straight back and the original regime will be restarted!
WHEN SHOULD I GO TO HOSPITAL/URGENT CARE?
This is your red zone. If your reliever isn’t helping or if it is not lasting 4+ hours, your PF drops to/below 50%, you’re unable to walk/talk/eat normally as it’s very difficult, or if you don’t feel safe to sleep, if you’re struggling to breathe/are wheezing/coughing a lot/have a very tight chest then you call an ambulance or go to hospital. You can take up to 10 puffs of ventolin - if this resolves the issue you see your GP ASAP, if it doesn’t or if you feel worse at any point you call an ambulance.
Best practice is always to call an ambulance if you need hospital as they are able to start treatment immediately and transport you safely. They may also be able to ‘fix’ the issue and leave you at home. It is not silly to call an ambo for asthma! If you decide to take yourself to hospital you DO NOT DRIVE YOURSELF (!) - you will not only be putting yourself at risk, but also other people on the roads/pavements etc. So if you think you need hospital please go preferable by ambo, but definitely don’t drive yourself!
So hope this helps clear up some issues as to what to do when! Please don’t avoid things because you ‘don’t want to make a fuss’ or ‘they are busy with COVID’ - asthma is not to be trifled with and getting the right treatment early can stop things escalating/calm things down a lot quicker. Asthma is not a stubbed toe or a hang nail, it is not to be ignored, it won’t properly sort itself out. Medics would rather see us than not when there are issues, no matter what else is going on!