Managing asthma - high reliever usage

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I booked my own check with the nurse they didn’t call me in. I know myself I am using too much reliever - 4 times ish a day, every day. It’s driving me mad. And they don’t know how to really help me.

I have a good peak flow overall, good oxygen levels etc etc but lying down at night feels like my lungs stick together. It’s worse in summer but I have tried Monkelukast (singulair) and it gave me bad stomach issues so I stopped. I take generic hay fever tablets and sleep half sitting up because it feels better. Sometimes I don’t sleep well because it’s wheezy and tight. I do not ever cough unless I am having a proper ‘attack’ or have a viral infection. The warning signs I get is a feeling of tightness and physically recognisable bronchi-spasms in the right lung area, sometimes a little light flutter sometimes big repeated fluttering.

I close the bedroom windows now. My room isn’t dusty. I take my preventer every day.

I’ve been referred to pulmonary rehab now because no one knows what to do with me anymore, but they might not accept me as I don’t have COPD. I am feeling frustrated and worried. I don’t know what I can do to help the situation either. Any asthma sufferers got any advice?

I don't have huge experience with adult asthma, but I do some work in a paeds asthma clinic - I'm a Physio.
You really shouldn't be using your reliever every day, never mind 4 times a day. It will become less effective over time. It's a sure sign that your preventer really isn't working and it might be worth speaking to your consultant/GP about changing it round.
Do you have an Asthma Action Plan? You should use this to guide your reliever use. It's based on your predicted peak flow.
In the longer term, many asthmatics have gotten great benefits from learning and practicing the Buteko method. Have a look online. Plenty of information. Look for Patrick McKeown - an international expert on the method.

Also, our consultant also preaches ICE - Inhaler technique, compliance with meds and Eliminating your triggers. Inhaler technique is really important and many adults don't use a volumatic which really helps with technique and getting the correct amt of medication to the airways. Worth looking at. Is there a respiratory nurse that works at your clinic/hospital?

What about spiriva?

There's loads more STUFF they can do/try

Back to basics and work from the start first thiughbstarting with technique. Showering pollen off you every night. Windows shut etc.

My house is so hot, I have to have some windows open for the kids too. Also I like fresh air! It is miserable not having any air

I have powder inhalers and good technique IMO and nurse agrees ie you pull the powder in by yourself. I used to have aerosol and I don’t like them. I agree it could be the reliever that’s the issue (symbicort) but I cant see the respiratory GP until next week

I don’t have a plan
I tend to take the reliever once the spasms start because I am being cautious as I don’t know if I should ignore them. And nurse didn’t know either!

You should have a written asthma plan. If your asthma nurse hasn't given you one, this is a problem.

It sounds like you have worked through different types of inhalers and done the basic things like inhaler technique and taking antihistamines.

Have you been to a respiratory consultant for asthma clinic in hospital?

And how often do you have a course of steroids?

It honestly sounds like you might need steroids now and the next step being seen in a consultant clinic - there is still a lot that can be done that you haven't tried.

Ive been referred to pulmonary rehab - don’t know if I will get to see a consultant or a nurse

Steroids - maybe once a year? Usually when I get a winter virus that goes to my chest

Right now I feel like I have mucous production higher up (back of throat) but it doesn’t affect my nose or eyes in the way of hay fever, it’s dripping down the back and irritating my lungs. Then I feel like I am trying to clear my upper part of lungs a lot and it’s all spasm and irritated. It doesn’t feel like it’s deeper in. Taking the reliever opens it all and feels better.

Do you have silent reflux? That's a huge trigger for me. The asthma sets off reflux, the reflux sets off asthma. Very common according to my consultant

I've had asthma since I was a baby and unfortunately never grew out of it like so many do.

I suffered very badly between the ages 14-22 and worked through a variety of inhalers, medicines and techniques. My asthma is the best it's ever been and I'm currently using:

Busesonide 2 puffs twice a day (more times per day if necessary)
Ventolin whenever necessary
Steroid nose spray which helps with allergy symptoms 2 squirts twice a day

I have a dyson filter fan in my bedroom too which helps at this time of year with both the cool breeze and allergen prevention

Not sure... I have suffered from it in the past but don’t feel like I am now. I just feel like it’s whatever is dripping down and basically the outside air is annoying my chest

Really User?
I'm really interested in that as I'm sure my asthma and my stomach are related somehow, or as least one affects the other.
Could you tell me more?

I'm type 2 brittle asthmatic, diagnosed 8 years ago, take every med in existence and frequent hospital admissions too.

How do you know what type you are?

www.healthline.com/health/gerd/asthma

I am nearly 40, I was diagnosed as a child but can’t really remember it... my sister was worse but grew out of it and I grew into mine more and more. I did used to smoke but gave up 3 years ago because of my asthma. I’ve had a lot of infections but never in hospital and I don’t really know enough about my own condition as I think I should - not through not asking, as I do!

This sounds very strange. Have you actually been seen by a respiratory consultant? I don't understand why a GP would be referring you for pulmonary rehab if you don't have COPD, bronchiectasis or pulmonary fibrosis and haven't tried all treatment options.

Are you on a long-acting beta agonist (LABA) such as salmeterol (Serevent® or generic equivalent) or combined LABA/steroid such as salmeterol/fluticasone (Seretide® or generic equivalent)? These would usually be tried before a leukotriene receptor antagonist like montelukast. Have you been tried on higher doses of inhaled steroids? Has anyone suggested a trial of omalizumab (Xolair®; this might depend on where in the country you are)?

Agree with @iwouldliketoknow
Buteyko is life changing, i highly recommend. You can also get hypnotherapy, as the mind-body connection is so important.

I get/ had severe post nasal drip that irritates my throat. I've found a few things have helped my asthma, sinus and allergies.

I always use a volumiser when taking inhalers, apparently you can get up to 30 % more drug into your system this way.

I use steroid nasal drops that I lay with my head tilted off the bed for 10 mins. Once the irritation has settled I continue with a steroid nasal spray (Flixonaise) This has helped hugely with allergies.

I take a daily antihistamine.

I'm now well controlled and using a Fostair inhaler. I'm needing my reliever once or twice a year now! It was once or twice a day.

Sounds like you might possibly need advice from ENT and an asthma specialist.

I hope you get it sorted soon, it's miserable.

I haven’t seen the GP yet - next week so this may change things for me

I saw the asthma nurse today

One issue I have is that i have a long history of the relievers sending me into me anxiety attacks, and this seems to make them assume I am using it because I am anxious. I do not, but it happens when I have used them. I finally got removed from salbutamol a few years ago because the palpitations were ridiculous and now I use terbutaline as a reliever and symbicort dry powder inhalers - you cannot use spacers with them

I get put on double dose symbicort then taken down from it to 1 inhale twice a day then now I am in this situation and have not been given new preventers to even try - so I don’t know what does or doesn’t work!

I am tired of them being rubbish

Pulmonary rehab is not the same as seeing a respiratory consultant in a hospital asthma clinic. it's usually run by asthma nurses or physios.

you need to see your GP and ask for a referral.

Because I have good PF and o2 they clearly think this is all in my head and pulmonary rehab would give me breathing exercises. I wish I had never mentioned getting anxiety attacks!

I've had asthma since I was a child (I'm
30 now). I find this weather triggers all the symptoms and makes my chest really tight. I normally take 2 puffs of my steroid powder inhaler (seretide) every night, but in this weather I double it and find it really helps. I've asked my asthma nurse about it and apparently it's fine to double the dose in extreme weather conditions. Since doing that I haven't really had to use my salbutamol inhaler.

Your PF is your PF. Mine is always good, I never ever wheeze but I feel dreadful if I drop by 20.

And yes it is difficult to separate anxiety from feeling anxious because your lungs are awful. And feeling anxious because you have symptoms from the inhalers.

I'd really push for a secondary care assessment.

Yes they see my 450 as good because apparently I am supposed to be blowing 465, but I know I can blow 500 when I am 100% and yesterday I couldn’t

My plan is to get a new preventer and something for the nasal drip, then at least monitor me for a couple weeks and if no change then surely I need to see a consultant

As a long term sufferer and parent to asthmatics too I also highly recommend not reaching TOO quickly for the inhaler and investigating researched breathing techniques. The Alexander technique literally changed my life.
Some of us “over breathe” which feels exactly like the early onset of an attack, hence we take our inhaler but because we didn’t really need it the side effects make us experience more “symptoms “ and we end up in a vicious circle

Please understand that I am NOT saying DON’T take your inhaler. I am however encouraging you to do some research and to use your inhaler really mindfully rather than habitually when you feel a really really early sign of a symptom

I hope that helps, it made a massive difference for me. Best of luck