should I take inhaled steroid for asthma as well as pred??

Bones, joints and muscles
1

This is for Eileen really - our knowledgeable saviour!

I have been to see a private GP who is also an experienced homeopath to try to unravel all my issues.

The huge problem I have with chest congestion, mucus, breathing etc has been put down to acid reflux by my GP but this chap thought it is probably asthma. I am not having any of the traditional reflux symptoms, you see.

He asked me to get my GP to prescribe the brown preventative inhaler (which contains steroid), take it for a month then come back.

What do you think?? He said it wouldn't increase my steroid \"load\" as it is inhaled.

Thanks as usual!

Beev

2

Hi beev!

I see where your private GP is coming from with the chest problems - I think I did ask something relevant some time back. He's right that the amount of steroid absorbed at the low normal doses used in asthma is very small and shouldn't make much difference, certainly over the month he's suggested. If anything, of course, you might find reducing the dose easier! (No guarantee though).

Does he/do you think your GP will play ball? The very mention of someone interested in homeopathy is enough to give most medics an attack of the whatsits! :wink: :roll: I can't remember what you said now - were these symptoms less bothersome at the higher doses for the PMR at the start and what dose are you on now? You would have thought the systemic pred would have helped, unless the asthma is bad enough to need a pretty high dose - like used in GCA, which is the sort of level needed in asthmatic exaccerbations but then it is 40mg down to nothing in about 7 to 10 days. I remember what I said before - I had problems with mucus in my throat and a sore tight chesty sensation - as if I had a permanent chest infection for ages before the PMR was diagnosed and it improved steadily after starting on pred. I have put that down to my PMR being more at the GCA end of the continuum and the arteries to the upper respiratory tract being involved to some extent.

What things did he think suggested asthma? Is it worse at night? Did he suggest a chest x-ray? What is your peak flow - did he measure it? All these questions! It certainly seems like a good idea to look beyond simply the reflux idea - it didn't seem entirely convincing to me - but I do wonder how your GP will react! How does HE account for reflax affecting your breathing?

Eileen

3

Thanks Eileen - that was a quick response. smile

I had none of these symptoms before the PMR or during the high doses of Pred. I did have some chest type symptoms towards the beginning of my oesophagitis, which started a few months before the PMR. Once on the Omeprazole, it stopped along with the other more normal acid reflux symptoms.

This latest bout of acid reflux symptoms and then the mucus/cough/breathing problems started after a few days of the uncoated 1mg tablets back in October. So I stopped them but the airway symptoms have continued ever since.

The homeo doc did a something test this morning - I had to blow into a thing - he said it was fairly ok - better than he expected.

I had a chest xray at the beginning of my oesophagitis, about 18 months ago, because of similar symptoms - it was fine.

I have a congested chest all day and night and some mucus comes up in the day, but when I lie down at night especially on my left side (which I've had to use because of the hip bursitis on my right), it feels like the airways are squashed and it all makes a terrific noise (whining, whistling, creaking) and it's progressively hard to breathe.

He thought it might be asthma because of the constant mucus and its colour.

My GP has always said that reflux can irritate your airways.

I have just spoken to my GP on the 'phone - he doesn't know about the private homeo doc. The latter suggested it might be best to just give him the symptoms and ask for the inhaler.

However, my GP said that he wasn't sure giving me more steroids was a good idea because of the Pred and he said the Pred should be helping it anyway if it's asthma. He said he would put out a prescription for a blue inhaler and that I might need antibiotics as the mucus is yellow and brown. He told me to make an appointment for a Spirometry test, followed by an appointment with him. He said it would be unethical to give me a brown inhaler without establishing that it is asthma, especially with the Pred..

So, now I am really confused!! I don't want to go against what my GP has just said as it actually seemed to me to be good reasoning.

I had already told him about the symptoms before though and he hadnt reacted. I think they only listen to half of what you say. This has been going on since before xmas.

Oh dear - maybe I shouldnt have spent that £80 on the private chap!!?? :? :cry:

Beev

4

Don't know if this will help, but I was diagnosed with late-onset asthma a year after being diagnosed with PMR. I had managed at that point to get the initial dose of 20mg down to 2.5 mg (the only other time I have managed to get down that far and it lasted 3 weeks) but it was becoming more and more apparent that I was having respiratory problems, which of course were becoming more obvious as the Pred dose reduced.

I had every test known to man (or woman) because it seemed so unlikely and everyone was as puzzled as I was. All they found was, and I quote \"evidence of untreated pneumonia in childhood\". I was told that it would have become evident sooner had I not had the PMR and the Pred and that it had very likely masked it for some time as the pain/tightness in my chest was being dismissed by me as the PMR and considering the state I was in they are probably right.

I have to say that it is the least bothersome of all my ailments. Once diagnosed and the right meds sorted out I have very little trouble. I have always had a tendency to chest/sinus infections and now I probably know why!

Nefret

5

Right - the thing you blew into would have been a peak flow meter. It is an indicator of how well your airways are performing by measuring the force with which you can blow air out of your lungs. If they are OK you should have a figure of about 400-ish (I think) but it depends on your height and build (which obviously affects the total volume of your lungs etc) and when you have asthma it is usually reduced, sometimes a lot, because asthma narrows the airways.

Don't know what is unethical about trialling a steroid inhaler. I do agree that the systemic steroids should have an effect - but of course, you might just have got down to a dose that isn't enough to keep the inflammation under control and the fact it happened when you changed to non-coated was coincidence. Or it was an allergic-type response to something in the tablets. Or it really is the reflux causing it. None of that alters the fact that the GP needs to do a bit more to find out what makes you unable to breathe properly at night! And you seem to have achieved that at last! :wink:

Don't over-use the bronchdilator but see if it helps you breathe better. It should make it easier to cough up the mucus at least. You might also find having a shower before bed helps that too - or even inhaling steam, or just being in the steamy bathroom. The spirometry the GP has ordered will give lots more info about the state of your lungs. You could also ask if he will do a culture on the sputum to see if there are any bacteria - if there are you will get the right antibiotic straight away, if there aren't, an antibiotic won't do any good at all so there is no point being given one.

The main advantage of using an inhaled steroid would be if the amount of pred you are on isn't enough to keep any inflammation under control - whatever is causing it. Inhaled steroids are applied directly to where you need them in the airways (provided your technique is good) and reduces the amount of oral steroid you need to get the same result without increasing the steroid load on your body because very little is absorbed through the lungs if you are using the usual doses used for asthma so doesn't lead to any increased risk of steroid side-effects.

You're quite right - your GP's reasoning is fine, and he is doing something at last. And yes, 80 quid is a lot - especially of you didn't get any homeopathic remedies out of it :-) - but look at it as a confirmation for you that you need to push your GP a bit more, which you have done and he has reacted. If the other doc didn't think it was something that needed investigating further/doing something about he would have prescribed a remedy and said nothing else. I think a lot of GPs do tend to not listen properly, especially if there is a pre-existing condition that COULD be the cause of the symptoms. That doesn't mean, however, that it IS the cause and a bit more enthusiasm on their part trying to reduce the effect it is having on you would be helpful in any case.

I spent 5 years whinging at the GP about my PMR symptoms to no end! :roll: And spent a fortune on the gym and complementary treatments that kept me mobile! With a bit of luck this will lead to something being done rather quicker than that and the rest will be at the cost of the NHS.

Keep us informed how it goes!

EileenH

6

Thanks Eileen

I've just been to pick up the blue inhaler and he had put out antibiotics too - just as a precaution he said (I bumped into him when I was there!).

Amoxicillin 250mg for a week. Is that a coverall one?? Have booked the Spirometry for 9th May (1st avail appointment cos of bank hols).

Would it not be worthwhile using the blue one before bed and, in fact, 4 times a day, to see if that widens the airways enough to prevent the mucus forming etc.??

I wonder if I could have got a chronic bronchitis (symptoms seem to fit) and the steroids have been masking some of the discomfort normally associated with it??

My son has a brown inhaler here I could use but it was started a few months ago and don't know if it stays fresh. Also, I know I mustn't try several things at once or I won't know what did what.

I dont know what number I had on the peak flow meter but got the impression it was ok. I think he might have muttered \"36\" - I am 5ft 3ins and av build.

Re the unethical thing - he qualified that by (I think) saying that if anything went wrong because of the 2 lots of steroids etc, they wouldnt have a leg to stand on if they hadnt done the correct tests first.

Many thanks Eileen - what would we all have done if you hadnt contracted PMR??!! :? - sorry - not funny. smile

Beev

7

Amoxicillin is a form of penicillin (you aren't allergic are you?) and is the bog standard simple antibiotic. I find it difficult to believe he won't give you a brown inhaler on the grounds he doesn't know it is asthma but is perfectly happy to dish out an antibiotic even though he doesn't know it is a bacterial infection sensitive to that antibiotic - well I don't really :roll: , he obviously doesn't read the latest guidelines (in chest infections it is now recognised that just cos the phlegm is green and yucky doesn't mean it is bacterial not viral and a culture should be done first in the absence of other indications).

How often are you to use the blue inhaler? I don't think it will have any effect on the production of the mucus, there is no reason why it should, it will make the airways dilate which should make the breathing easier simply because there will be more room for the air and the mucus. The medication in it can make you a bit jumpy if you use it a lot - you should see my granddaughter when she has a bad attack! Bounces off the walls - which isn't too helpful when she is meant to be resting after pneumonia! :lol: :roll: If you use it too much you might feel you are back on a high dose of steroids :wink:

Yes - what you have is almost certainly a chronic bronchitis: long lasting inflamed airways. Whilst you were at a higher dose I suspect it was enough to calm the inflammation down but now it is not - that's why I asked if it had been better at the higher doses. What now needs to be done is establish WHY and try to calm it down because irritated airways are not very good for you in the longterm.

Has it got worse with the spring and pollen? Or - and I know it is a while ago so you maybe won't remember - did you change washing powder, paper or paint the bedroom, get a new mattress, pillows, bedding, was anything changed about that time or soon before? New plants in the house, new furniture, anything! Naomi's asthma has got far worse since last December and the last time she was in the new consultant says he thinks it is allergy-related (the other one blamed hormones!). They finally got functional heating just before it started, they'd been in the house for a few months and the previous owners had had multiple cats and dogs (and didn't clean much :roll: :wink: - you have to think of everything to try and identify it!

Hope the blue inhaler helps at night and you start to feel less wheezy! It's most likely the phlegm rattling around but I know it sounds disgusting! There would seem to be an investigation in sight if not an end though,

EileenH

8

And beev - you don't smoke do you? Or anyone you have a lot of contact with? Do you have wood/coal fires? All no-nos with chronic bronchitis and not helpful with asthma! But I'm sure I don't need to tell you that. Try and increase the humidity of your rooms as that should help make the phlegm a bit \"looser\". Oh, and try to avoid dusty situations.

Have a nice weekend! :lol:

Eileen

9

Thanks again Eileen

No I don't smoke - none of our family do and no, no environmental changes I can think of.

No it wasnt there at the high doses of steroid but it wasnt before either. This only kicked in in October when starting to reduce from 5mg to 2.5mg and using the 1mg tablets. It started with the acid reflux returning with a vengeance and I think the tight chest, mucus etc started at the same time or within a few days.

I wonder if it was indeed the acid reflux which initially irritated the bronchial tubes and that set off an infection or inflammation (same thing??).

Im not allergic to penicillin so no worries there.

The fact that it was worse over the New Year weekend and then again over the Easter weekend make me wonder if it is down to richer, fattier food and hence to do with reflux??

Have a good weekend.

Beev

10

beev

I looked up on the 82 side effects listed (yes, we have added, treacle brain and a n other, which would make it 84 but they are not listed in the drugs and medications - Prednisolone Oral)

Listed in Common Side Effects is Condition of Excess Stomach Acid Secretion

MrsO's remedy of lemon juice settled the excess stomach acid. To save you looking for it Juice of one Lemon, divided into three and taken with water three times a day.

Listed in Rare Side Effects - Trouble Breathing.

I had trouble with this, but nothing like you describe, what helped was a three cornered pillow.

Friars Balsam.

Mind, I smoke so it could have been my own fault. But the flow measure taken by GP showed no problem.

It sort of cleared up by itself.

Neither the lemons or the Balsam will interfere with any medication you are given.

Hope to see you get through this patch successfully and quickly.