Asthma plan and calling doctor

[Dilbertian]

I recently came across my mislaid Asthma Plan. It states that I should call the GP or Asthma Nurse if my PF drops below 400 or I have to take more than 12 puffs in one day.

I can feel myself coming down with a cold, and colds are my main trigger.

Last time I had a cold my PF dropped to 340, and was below 400 for ten days. During that time I needed 8-12 puffs per day. It did not occur to me to call anybody about it (I had forgotten what the Asthma Plan says).

Should I have called, given that I knew the flare-up was caused by the cold? What would they have done, anyway? You can’t treat a cold, you just have to wait it out.

Are you asking what to do this time or what you should have done last time? It sounds like you were sensible last time you had a cold and rightly treated yourself with increased salbutamol during that time, as your PF reduced. However (and I am not an asthma nurse but do have a medical background), had you called the asthma nurse they may have started you on a short course of steroids to reduce the inflammation in your chest and this may have lessened the time during which you needed 8-12 puffs daily. This would not have treated the cold but treated the asthma which was triggered by the cold virus. As you said, colds are a trigger for worsening asthma so it is good to know when your asthma is not being adequately treated by simply increasing your salbutamol dosage. (Salbutamol is a very short acting medication, which means that alone is not always the best way to treat an inflammed/wheezy chest and that is why if you are taking it 12 times a day, it's time to add in something else during that period- normally prednisolone for 3-5 days low dose)

It is also useful for asthma nurses to know how often you have worsening periods so as they can step up treatment if needed (i.e add in another asthma medication ((a longer acting inhaler mediciation) if your asthma is not controlled on salbutamol alone).
So while it was good you dealt with your last cold alone, it is also good to follow the advice of the asthma plan and keep in contact with the asthma nurse in case things do worsen. The medication for asthma will not treat the cold, but will help your breathing and make you feel better faster.
Hope some of this helps.

Thanks, harri, that does clarify things. I was only diagnosed in 2020, after decades of having these symptoms, so the way I felt is fairly normal for me when I have a bad cold. I don't know any different, really.

I take Symbicort, plus a puff of Salbutamol when I'm about to do something I know is a trigger, eg exercise in cold weather.

If there is something I can take that will help my breathing, then I'm definitely phoning the GP if my PF plummets this time.

My DP has horrible severe asthma and when he gets a cold or covid it goes straight to his chest.

He's been admitted a few times into ICU and the hospital because of it. We find it helps to have an oximeter at home. He's on so many different daily medications to help with his asthma. There is quite a lot available so make sure to speak to your GP or asthma nurse.

DP was on steroids for 5 years because it was just so bad for him. The hospital finally weaned him off with the help of the asthma clinic over the course of 1.5 years.

Oh he's also on about 3/4 different inhalers daily

I can't reach more than 350 haven't since my first test years ago. I use seretide morning and night. The blue one is rarely needed. Hayfever sets me off. Have a word with the asthma you really need an up to date assessment. Steroids are a good idea if colds Knock you sideways like this

So how do I get this medication? My PF is now 360 despite increasing Symbicort (took 8 yesterday, usually 3). Couldn't get through to GP practice by phone so filled out their online form - to be told that if they don't get back to me by tomorrow evening I should try again!

I'd be pushing for the nurse to do an assessment. 360 isn't life threatening as such but to drop as you have is concerning. eMail the surgery now would be my advice

Do you have access to GP out of hours? It would be good to have someone check your oxygen sats and listen to you chest. People with COPD (another similar breathing issue which can be worsened by colds) sometimes get given rescue packs which contains medicines (like steroids) which can be taken when you feel a flare up. This might be useful if you find you have more than a certain number of flares per year and can't easily get hold of your GP.

Are you using symbicort as maintenance and reliever? The idea of that is that you treat minor exacerbation as with increased symbicort. Peak flow is influenced by lots of things, including technique and whether you sit or stand to do it. It’s useful for seeing variations but not an absolute you’d usually be monitoring for specific symptoms as well. I think you need to go over the plan with your nurse so that it’s clear when to get help.

I've had a telephone consultation and 5 days of prednisolone @ 40mg/day has been prescribed.

I have an oximeter and have never dropped below 97%. I am careful to be consistent with my technique using the peak flow meter, and the drops in my PF are consistent with the way I feel when I have a cold. The dip actually begins before the asthma symptoms begin.

Since being diagnosed with asthma, and having inhalers available, I have seen a huge difference in how I recover from colds. Not that I caught colds very often. But since having Covid 6m ago I seem to catch every cold available. And each cold has caused more chest discomfort and breathlessness than the previous one. Yet I did not really understand that these were not symptoms of the cold, but of the asthma.

Maybe a review would be a good idea.

Yes, I am using symbicort as maintenance and reliever. I only use Salbutamol as prophylactic when I am about to do something that I know triggers me.