advice

[Reader100]

Was called in by the asthma nurse for a review this morning. She listened to my chest and said she could hear a couple of crackles and that I had a chest infection and gave me antibiotics - about the 5th course in 8 weeks. What? I saw the doctor only 4 days ago who said it was as clear as a bell! She took me off my two inhalers inhalers , Fostair and genuair and put me on trimbow 2 puffs am and pm and said not to use Ventolin as that was incorporated in it. Well I’ve only used it once so far but my throat and mouth are so dry and stuck together thst I had to take Ventolin as i felt so tight does anyone use trimbow? How do you find it? Does it take a while to kick in? Do you still need Ventolin with it.? I had a bit of a cough before I started it and was bringing up occasional green stuff now I’m coughing a lot and bringing up more. I’m feeling quite panicky over this x

[Katinka46]

It all sounds very difficult. I had a quick read of your profile. I am so sorry that you are struggling so much. Do you feel that you can contact your GP again? Your whole situation needs some attention and these panic attacks should be addresssed.All the best

Kate xxx

[Hidden]

With the caveat that I’m not remotely medically qualified. As I understand things, the information you’ve been given is not accurate. Trimbow is a maintenance inhaler that, in addition to a corticosteroid to reduce inflammation, contains both a long-acting bronchodilator (LABA) and a long/acting muscarinic (LAMA). LABAs and LAMAs are intended to help reduce persistent breathlessness and wheezing, however, ventolin can and should still be taken in the event of sudden or increased breathlessness and wheeze. The patient information leaflet very clearly state this: Trimbow is not a reliever, and if it was such an amazing inhaler that you didn’t need ventolin, then they’d have everybody with COPD and asthma on it. There are a small number of MART - maintenance and reliever therapy - inhalers that contain the same LABA element, which can be used as an alternative reliever inhaler in addition to daily maintenance, so perhaps that’s where the nurse is getting confused, but Trimbow is not one of these, and they still require you to use them when feeling breathless.

With regards to the increased coughing and productivity, if you were tight and your airways narrowed, you would have been struggling to clear, so the fact that you’re bringing up more may well indicate that either the antibiotics and/or the Trimbow are helping in that regard. In the course of killing bacteria, antibiotics may lead to more sputum coming up in the short term as a result of reducing the inflammation associated with infection. Unfortunately, sounding clear doesn’t really mean a great deal: auscultation (listening to someone’s chest) is only useful if there are positive signs, meaning when things are heard. The absence of wheeze or crackles doesn’t mean someone’s chest is ok, and for some people it’s common to have a clear-sounding chest in spite of having an underlying infection.

I would suggest speaking to a GP that you like/trust to confirm what you’ve been told regarding not using ventolin and to discuss the situation more generally. Have you had a sputum sample sent off to see what bacteria you’re growing that’s requiring all these antibiotics? It may be that you need a different type, or that the courses you’re being given are not long enough. My other suggestion is that you do have the right to request referral to a respiratory consultant: if the GP can’t get the situation under control, and it doesn’t seem like they can, then I would suggest firmly asking to be referred. Frequent chest infections is one of several criteria that the British Thoracic Society say indicates referral to a consultant is appropriate, if only to make sure that the COPD diagnosis is correct. There are other conditions that can look like COPD but require slightly different management, and sometimes COPD can require someone to have hospital-led care, at least until their symptoms are under control.