Just given asthma medication for dd and feeling a little confused any help appreciated !

[Walkingandtalking]

My dd is 17 and has been really breathless and wheezy on and off since having covid last September. We went to the gp today and the gp said it sounds like she has developed asthma.

She has been given steriods for a few days and two inhalors plus a peak flow meter which we are supposed to be doing.

We are sitting her looking at this pile of stuff and really confused about what we are supossed to be doing !

So the steroids say 8 tablets in the morning each day - all at once?

The peak flow meter we have done it her best was 150. But we have no idea what that means !

We know she should be using the brown inhalor morning and night but when should she use the blue? She tried it when she got home as she was very breathless but it didnt really seem to do anything - does it take a while!

None of my kids have had asthma before and i dont know anyone who has so if anyone has any advice that would be great!

Steroids, if it says 8 together then do that. You may notice a change in her temperament.

Peak flow, no idea dh never had one.

Blue as a rescue, so if she still feels wheezy or breathless take it, the brown one should kick in soon but give it a week and ring the pharmacist if it hasn’t.

Thanks the doctor said that she needs to take them early in the day or she wont sleep.

What kind of change in temperament?

Steroids, yes all together. A short fast course works wonders for my asthmatic daughter.

The peak flow you should record the numbers each day (best of three usually) to see any patterns or when she’s struggling.

The blue inhaler is a reliever, use when feeling breathless, you can take several puffs at once which should slowly reduce the breathlessness. This may take a few days until the steroids have started to work.

Have a look on asthma uk, there is so much helpful information on there.

@Walkingandtalking

Thanks the doctor said that she needs to take them early in the day or she wont sleep. What kind of change in temperament?

Steroids can make you angry, irritable, hungry just to name a few things. They are like magic for illnesses but the devil for side effects. You should be ok with a short course but long term use can be terrible.

I would suggest taking the blue inhaler a couple of minutes before the brown one if she is wheezy as it will open up the lungs better.
The steroid tablets may also cause temporary weight gain.

Has she got an asthma action plan? If not call and book an appointment with the gp or asthma nurse to get one. They can go through inhaler technique and peak flow monitoring too.
The steroids are taken all at once. The blue inhaler is for when she’s breathless. It should work straight away but more than one puff may be needed . What are the instructions on the label?

Your GP surgery should have an asthma nurse who can go through all this with you.

Steroids in tablet form (as they're higher dose than the inhalers) make me very agitated.

The brown inhaler needs to be taken religiously, morning and night, even when she's feeling well. It's to prevent asthma worsening rather than to treat it.

The blue inhaler can be used whenever she's feeling short of breath or wheezy. If ever it seems like the blue inhaler doesn't improve things after a few puffs then you'd need to seek further medical attention straight away.

I would ask the pharmacy if you can buy a spacer device. It makes taking inhalers much easier, and means that most of the drug gets into your lungs rather than your mouth and throat. Getting into the habit of having a drink of water after taking the brown inhaler is good - too much residue in your mouth can cause oral thrush.

Take the steroids with food. They're tiny so 8 isn't as bad as it sounds but make sure she has a big drink with them as some have a bitter tasting coating. The first night she might find it difficult to sleep but a short (5 day) course of steroids normally work wonders for asthma and any side effects are worth it in my opinion. She should hopefully start feeling better a day or 2 after taking them but she needs to finish them. A 5 day course will have no long term effects.
Hope she feels better soon.

Brown is a preventer inhaler so use daily, blue is for when feeling tight or wheezy as required. The inhaler drugs can cause tooth decay so best before brushing. Do you have an appointment with asthma nurse to review her technique?

The steroids make me talk very fast and I find it difficult to sleep even if I take them first thing in the morning. They seem to affect different people differently. Some people do just fine on them. Definitely worth it because they do work.

Do contact the asthma nurse even just to talk it all through on the phone

I also developed adult onset asthma, so your daughter has my sympathies. She will be able to get it under control, though, it’s just a matter of finding what works for her in terms of management. She should take the steroids as directed by the GP. If they are Prednisolone, they may cause mood changes.

150 is a very low reading on the peak flow for an adult and it indicates that her asthma is currently uncontrolled. I can blow up to 500when my asthma is under control, but I’m tall & broad chested. A smaller person will get a lower figure.

The brown inhaler is the ‘preventer’. It contains small doses of steroid and should be taken every day without fail, however well she feels The steroid effect is cumulative so will build up over time.

The blue inhaler is the ‘reliever’, it contains a drug called salbutamol which is a bronchodilator. It relaxes the lungs so air can move in & out. Its job is to relieve asthma attacks when they happen, it’s highly effective and should be used as needed. She should carry one with her at ALL times. I always have one in my pocket or my bag. I keep one in my car, one in my desk drawer and a spare one at home. I have even been known to stuff one in my bra on a night out.

Hi @Walkingandtalking , I'm a respiratory nurse. Steroids - yes, all 8 in one go once a day. This will equate to 40mg probably, which should help to settle any inflammation in the airways within a couple of days. Inflammation can cause shortness of breath and wheezing.

As for peak flow - take best of 3 readings morning and evening. Sit up straight, breathe all the way out, deep breath in, and sharp hard blow. Best of 3. You'll probably notice it rapidly increasing in the next few days as the steroids kick in so it's important to get a few readings in now before that happened so they can see a baseline. Mark on the chart when the steroids were started. 150 is low, but this is expected if true asthma as the inflammation in the lungs massively restricts airflow. With peak flow, they are looking for confirmation of diagnosis which isn't just from 1 or 2 readings. It comes in the form of seeing improvement in morning and evening readings after the use of steroids. Either tablet or inhaled steroids. Now because she will be going straight from tablet to inhaled steroids, there may not be a massive amount of data for them to work on, but still do the readings as it will help to confirm things. Normally with asthma, we are quite a difference, and also a difference between morning and evenings.

Inhalers - RIGHTBREATHE website is fantastic for inhaler technique (and peak flow) so check that out. Technique is important because there is no point taking if not done properly, as the drug will just sit in the mouth rather than getting into the lungs.

Hoping the GP have a spacer with the inhalers?? Blue inhaler to be used when required. Usually takes a couple of mins to start working, at its best at 20 mins. If severe asthma, she may need more than just 2 puffs to make a difference. If not using a spacer, I'd suggest buying one from the chemist ASAP. Or getting GP to do a script. With a leak flow of 150, it might be hard to get the drug to the smaller airways which is probably why she didn't feel much difference.

Brown inhaler - probably 2 puffs twice a day? She won't feel much of a difference with this one, but it's very important to keep it up as this is the thing that will actually treat the asthma. It usually takes 2 ish weeks to get into the system but because she's got tablet steroids, by the time she ends them, the inhaler will take over.

Really hope this helps, look at the website. Let me know if you need any more info. And worth feeding back to the GP surgery that patients that are given inhalers for the first time need better explanations! X

On the peak flow - do it a few times a day and keep note of the readings just to build up a picture of what is normal for her and whether things are improving. They may have given you an asthma diary booklet to do this as a graph.

Expect the reading to change a bit over the day - you'll notice that e.g. evening may be lower than morning.

Knowing your normal expectation is helpful - you won't need to track so much for ever, but it will help you check that if she feels a bit 'off' you can verify whether peak flow has dropped. E.g. mine drops if I've got a cold or been near my allergens.

I think you can look up 'normal ranges' by sex/height/age, but useful to know your own normal too. 150 sounds pretty low to me - my normal is above 450.

Take the blue whenever you feel tight chested. Also before exercise IF that is a trigger. It takes a few minutes to work. If nothing happens, take more. The blue inhaler can make you feel a bit 'caffeinated' (for want of a better description). There is a certain skill to taking it - you have to trigger & inhale in a co-ordinated way. She should not be feeling it spray on to her tongue (it's freezing if you do!). It's usually prescribed to take a couple of puffs at a time, wait 10 mins then some more if still needed. You should have a 'call for help' threshold in mind - X number of doses in Y minutes with no improvement. Ask your practice nurse about this.

Thanks!

Mightbe- So we should wait until tomorrow to take the first set of steroids? we’ve only just picked them up. And start using the brown inhalor tonight?

Ok we will try the blue inhalor again now as see if that helps a bit more she is breathing really loud and rattling in not sure if thats normal!

She wasnt given an asthma nurse i dont think? The gp didnt mention it. She is supposed to be getting an appointment for a chest xray but i dont know how long that will be.

The gp prescribed a spacer but the pharmacy had run out so i have to go pick that part up tomorrow.

Ltgregs - i tried it because i thought there was something wrong with it because it was barely moving but mine came out as 450. Dd is bigger than me i am only 5 foot 2 and she is 5 5 so i assume when this is under control hers should be higher?

Start using the brown inhaler immediately, the sooner she starts the sooner it will start working.

You should really gargle and spit with water or mouthwash after using a steroid inhaler, rather than swallowing water you’ve used to rinse your mouth.

@Walkingandtalking I would take the steroids now. Correct that they can sometimes disturb sleep, but not always. And her asthma is 100% more important right now to get under control - especially if her breathing. Is noisy. Often asthma can be worse at night so def get a dose in now.

Tomorrow she could take next dose a couple of hours earlier than today, day after a couple of hours earlier again to bring it as early in the day as pos if you like. But 2:30pm is fine to start then.

As for blue inhaler, she can take up to 10 puffs if things are really bad. This might give her a headache / make her feel shaky / racing heart. It works on adrenaline receptors so the same feeling as adrenaline rush. Take 2 now, 2 more in a bit if still bad.

Def pick up spacer tomorrow. In the meantime look at rightbreathe for how best to use it without a spacer.

Make sure you get the spacer. The pharmacist should be able to ensure the technique is correct too.

When Ds has steroids (it’s a regular thing!) we give one dose immediately and then the remaining doses first thing in the mornings on advice of respiratory team. Otherwise we can say goodbye to any chance of sleep!

My DS had to take 6 steroids at once but is younger so yes probably all 8 at once.

They made him hyper & hungry! But can also make you feel angry, stressed & wired.

Definitely get a spacer, much easier to inhale it properly. Start the brown inhaler straight away but don't expect any obvious results from that, it's slow & steady progress usually.

The blue one she can use whenever breathless, look out for continuous coughing & yawning (sign of asthma attack for my DS) not just wheezing.

Keep a record of the peak flow as the doctors will probably need to see it.

Hopefully it'll be a temporary thing for your DD.

@mikeyboo

You should really gargle and spit with water or mouthwash after using a steroid inhaler, rather than swallowing water you’ve used to rinse your mouth.

This! I get a really sore throat and irritation in my mouth if I don't do this!

@Walkingandtalking how's things going?

This is mumsnet at its best in my opinion - so much helpful advice and useful tips on here
@Walkingandtalking I hope your DD improves and gets the asthma under control soon.