Asthma - on oral steroids but still coughing up phlegm and not well

[Indole]

Hello, can anyone give me an idea of what I should be doing about this? I'm very concerned as I am mainly alone with my daughter as DH works away a lot freelance, and I feel quite ill.

What has happened is that we had some parts of our house redecorated over the summer while we were away. I think the plaster dust this generated has set off my normally well-controlled asthma. I usually take a couple of puffs of standard strength becotide twice a day and rarely use my ventolin - I don't normally have any symptoms at all, unlike when I was younger.

As soon as we got home after the decoration, I started to feel like I had a bad cold and cough. This got worse and worse over a couple of weeks until over the weekend I was coughing so badly that we went to a minor injuries unit (yes, I know, we should have gone to A&E but I was very seriously ill and I don't think I was really in my right mind). I was unable to sleep because of coughing and wheezing and was sitting up on the side of the bed most of the night just coughing and coughing and coughing (my stomach and all my rib muscles still really hurt). Fortunately my husband was here and he drove us to the closest place where I was nebulised and my symptoms completely went (tbh he did not really know what to do as I have not had bad asthma since before I knew him, I probably should have called an ambulance). When I arrived I had a peak flow of about 120 (usually more like 450) so it was very bad. I don't think I realised how bad it was, partly because it is well over twenty years since I had an asthma attack requiring a hospital. I had sort of forgotten what to do and what it was like. My ventolin was not doing anything at all.

My symptoms immediately stabilised and the doctor prescribed me 30 mg of oral prednisolone per day for 6 days and discharged me. I'm on day 4. While I'm not anywhere near as bad as I was when we went to hospital, I am still coughing up clear phlegm all the time and taking a lot of ventolin (approx 5 puffs every four hours is enough to keep it under control enough to sleep but it's still not quite right). The doctor said up to ten puffs at a time was OK, but I'm worried about taking so much.

Husband is away, though back tomorrow for a few days. I'm really concerned about what will happen when I come off the steroids in a couple of days. Obviously we've cleaned everything as much as possible but I am still clearly reacting to the dust. My shoulders and neck feel tight.

I know this sounds stupid but what's my best course of action? Clearly I can't continue like this as I have a daughter to take care of and I feel immensely weak and feeble. I am going to call the doctor tomorrow and get an emergency appointment, I think - would that be sensible? I'm just worried as I absolutely cannot go into hospital as there is really nobody at all to take care of my daughter. Husband cannot take time off work, though he is here from tomorrow night until Sunday. I know I'm going to need more meds. I am trying to balance it so I can be out of hospital when he has to go away again. And DD has anxiety so it's been really tough on her. She thinks I am going to die and I am spending a lot of time reassuring her. She is 9.

I suppose what I'm really asking is, how bad is it that I am still having symptoms despite the oral steroids? What happens if I have to go to hospital and have nobody else here?

Sorry, so long. I'm just feeling very alone and a bit scared.

I think you should ring your local OOH service for advice.
Then consider if there is anyone you could call to be on stand-by if you did need to go to hospital.

Anxiety makes things worse and doing both of the above should help to reduce that.

Have you been given any antihistamines?

No, but I am already on high strength antihistamines due to urticaria (I am a veritable smorgasbord of allergies etc). I take fexofenadine but that isn't helping with this. I am currently OK and breathing well, tbh, the mornings are my worst time. But I'm definitely still not right. I don't think my current condition is dangerous hence thinking I would wait until the morning as my doctor is good and I am likely to get an appointment before 10am.

The anxiety is not mine but my daughter's. She is a bit fragile about this kind of thing. I am scared but not more than is reasonable, I don't think.

I am trying to control the asthma until DH is home tomorrow evening as I genuinely have nobody nearby to call. My parents are an hour's flight away. I have siblings but they can't take time off work to look after my child unless it's really necessary. I could get someone if it was life or death but really not otherwise. I am thinking who I could call out of her school friends parents if it was a real emergency. I think I do have someone who might help if they had to. But it would be appalling for DD - she would be distraught.

I will call the OOH doc if I worsen in the night. Thank you.

I suppose I just wanted to know how bad it is that the steroids haven't totally knocked it on the head. What's going to happen when I come off them? I am OK on them, despite weakness, but I can't help feeling that something bad will happen when I stop taking them. Or will the next two days sort it out? How fast are they meant to work? I can't remember from when I was younger.

You definitely need to see go or nurse tomorrow (if they question your need for an urgent appt tell them how much ventolin you're needing, and that you at least need to have a phone call back from Dr/nurse).

Your preventer medication needs to be stepped right up prob to combination high dose steroid +/- oral meds. Ask about getting a peak flow + diary so you can monitor how things are going. Also might be worth asking for a spacer (if you are v short of breath its difficult to take a deep enough breath for inhaler to be effective).

Have a look at the British thoracic society/sign guidelines on asthma for what you should expect. Asthma UK might also be worth a look.

You should have regular follow up and not step down your treatment too quickly.

If you feel you get worse overnight don't delay in getting treatment (ooh or 999), yes it may be a bit frightening for your daughter but getting too ill to get help would be infinitely worse. Asthma can be fatal even if its been well controlled for years.

Take care + hope you feel better soon.

The steroids are like a sticking plaster if you like, they will reduce the inflammation whilst you're taking them, but you need prolonged treatment to get it well under control, which is better achieved with other drugs (without as many side effects as oral steroids), please get a treatment plan in place asap x

Sorry to hear you're still feeling grotty.

A couple of things based on my very asthmatic ds.

You're coughing up the secretions caused by the asthma - if it's clear it isn't infected. It's a real nuisance and can drag on.

That dose of prednisolone isn't high, my 11 yo ds has 40mg for 4 days. You should be feeling a greater level of improvement by now. The fact you're struggling at night when your natural steroid levels are at their lowest would suggest you may need a longer/stronger course.

As said by others up thread, get back to a gp/asthma nurse asap.

Hope you feel better soon

Thank you.

Doctor I saw at the weekend said don't bother with stepping up my becotide until I come off the steroids. Is that wrong?

I have a spacer, thank you, though I have mostly been well enough to take my inhaler without it, apart from very early mornings. The amount of ventolin needed has stayed pretty much constant since the nebuliser on Saturday so at least it's not getting worse - mostly the five puffs is lasting almost four hours. The cough/phlegm is constant, though better in the afternoon/evening.

My GP is really good and I am absolutely sure they won't be arsey about emergency appointment so I will definitely do that tomorrow.

I am definitely going to ask for a peak flow meter. I had one years ago but I chucked it because I'd been so well for, well, decades.

Do you have a spacer? If not get one as it will help get more of the ventolin into your lungs. Don't be afraid to take more. Worst that will happen is that you feel a bit shaky.

I have a feeling that 30mcg is a Standard, but lowish dose of steroids. They may give you another course or add another type of inhaler.

The last time I had an asthma flare up I found that the chest pain caused by the coughing etc made things feel worse. GP advised to take paracetamol so it was less painful to take a full breath. Lots of hot baths also helped.

I hope you feel better soon.

The becotide won't make much of a difference until the current inflammation has died down.

Oh and as Bernice says, use the spacer anyway - ds's consultant recommends everyone should use them as a matter of routine, not just children.

Thanks, Maladicta, you posted when I was writing.

I have had higher doses in the past. I was just expecting more of an improvement as they are so miraculous when you're ill.

I will definitely go to my GP tomorrow morning and thanks so much for everyone reassuring me that this is the right thing to do.

Look after yourself x

Yes, I have a spacer, thanks so much everyone. This has really made me feel not so alone. And reassured that I'm doing the right thing. I will use the spacer for every dose from now on until I am better.

The doctor said I could take up to 10 puffs in one go as that is the dose in the nebuliser.

Paracetamol also great tip! Will take some now.

I could have written this post a few years ago. I'd had long term, but just about controlled asthma, but it flared up when I was pregnant. My lungs finally succumbed when we had some plasterwork done. It sounds as though you've got onto the prednisolone quickly enough to avoid my fate of pneumonia.

I'd call OOH as a precaution to check you don't need any emergency treatment, particularly if your chest gets very tight. I was told the prednisolone isn't a quick cure. The aim is to calm your lungs down so that the Ventolin, and in time beclametasone, can get things under better control. I wouldn't worry about taking large doses of Ventolin if that's what you've been advised whilst you're trying to treat this flare up. IIRC, a nebuliser delivers the equivalent of a 20-puff dose and the worst side effects you might get in the short term is to get a bit jittery.

It may make you twitchy and bit tachycardic but that's better than not being able to breathe!

I found a spacer from years ago so am OK.

And thank you so much, everyone. I really appreciate your help. I just feel so alone and it's really helpful to hear everyone's tips and know that I am not actually totally alone with my crappy lungs.

How are you feeling today?

Hello. Much MUCH better, thank you. I have an appointment later today to discuss medication once the steroids have finished but the tightness in my neck and shoulders which seemed like a real warning sign has totally gone! I'm also not coughing nearly as much and the ventolin is lasting more than four hours at each dose.

Hope you got on OK with your GP today.

I'm currently on my first ever course of steroids and was told that nowadays it's 40mg for 5 days. I've also been told to step up my Clenil preventer (which normally I don't use at all as I don't usually have any symptoms) to 8 puffs twice a day from 2 and to stick with this for a month.

So if you are dragging on with symptoms at the end of your steroid course you prob need a higher dose of preventer for a while. It's also good to get some appointments with your own GP when possible rather than bouncing between out of ours doctors. When I rang my surgery for an emergency appointment and said it was asthma I was seen within an hour- they were fabulous.

Yes, I got on fine, thank you. Hope you are feeling OK. I'm going to be on 2 puffs four times a day of my preventer and also have six more days of steroids plus a further five days stepping them down gradually. I also now have a whizzy new peak flow meter and a spacer plus more antihistamines. That was expensive!

Glad it went well. I'm prob going to need to go back soon as not really getting better.

I luffs my spacer - despite being 40 and a highly trained medical professional I cannot for the life of me co-ordinate the inhaler with my breaths. Spacer is much much better.

Glad you're feeling better.

If you need more than two prescriptions a month it will be cheaper to get a pre payment certificate. It's about £10 a month on direct debit, not sure about the cost of the pre pay in full ones. Shame the pharmacist didn't tell you that.