Asthma as an adult and what to expect/experiences

[asthma1230]

Hi all,

I had asthma as a child but now as an adult it has resurfaced after not needing inhalers for a long while. I'm 31 now.

Currently on Fostair and then obviously the blue inhaler. I have had 2 courses of steroids in the past year. I finished the last course about 2 weeks ago and yet, I was in hospital last night needing a nebulizer. The hospital weren't that great, they treated me and said my sats were normal now and that they needed the space, which is fine, but I wasn't given any directions on what next - they did tell me to go back if it happens again though.

So since last night I've been wondering what do I do now? Because surely after steroids etc I should be feeling better - not then needing to go to hospital? (happy to be told I am wrong here!) Also, I am wondering how likely is it that my asthma will just go back to not needing inhalers again.

I rang my GP this morning and they told me the asthma nurse doesn't work on a Friday so to call in the week, which is OK as I don't feel too bad now.

I suppose this all feels very new to navigate and to be honest last night scared me.
Does anyone have any experiences or words of wisdom?

I can give you advice form being a mum of a child with asthma. My sister also has asthma and hers like yours has got better then got worse over the years. She was bad as a teenager, well in her 20's not needing anything then needed inhalers again in her 30's. She's now hit 50.and said she hasn't need an inhaler for a couple of years. I don't think it's that it goes away it's that it goes dormant.

DS has had symptoms since he was 3 and is now 13. What you really want is to be taking a preventative inhaler and not need to take the blue inhaler at all or maybe only need it if doing exercise. We were always told that if DS needs oral steroids then his asthma isn't under control properly. It took months of back and forth to the consultant when he was little to get his treatment plan right. He takes Seretide 50, twice a day, montelukast tablets and antihistamine. His is quite allergic so the antihistamine really helps, my sister was/is the same oddly enough and has always has bad hay-fever to.

But what your looking for is to increase your preventative medication until your more stable and don't need to take the blue inhaler. Seretide is actually a combination inhaler so contains both a steroid and a slow release of the blue inhaler as some people need it continuously.

You can feel a bit unwell for a few days after having steroids DS often does, he will sometimes need them if he has a really bad viral infection. But if you start to feel worse again don't wait till next week go back to out of hours doctors or A&E as some times you may need more steroids, especially until you get your preventative medication increased.

I have asthma and to be honest I rarely think about it. I use the equivalent of a Fostair inhaler twice daily and will take this for the rest of my life. I never miss a dose and I don't ever expect to stop it. The treatment of asthma is usually managed in a step wise manner so if you are poorly controlled on the inhalers you are on now, the asthma nurse will step you up to either the stronger inhaler or the next step of treatment.
It is important you get an appointment with the nurse so even if you still feel better next week make sure you get to see the nurse soon.
They will check your peak flow measurement and advise from there. You should also have an asthma action plan (I think. Thinking about it I don't have one so maybe that's just children??)

Get yourself a pulseox monitor for at home so you can check your oxygen levels, this is always good have. They aren't expensive.

OP, I've had asthma since age 7, now 46.
Heres my tips.

Leave your preventative inhalers where you will take them. I leave mine next to my vitamins in the kitchen which I alternative morning and evening, so everrytime I take my vitamins/magnesium, I take the inhalers.

I can't use the spacer thing, drives me mad. So I just use the spray inhaler.

Get more than one blue inhaler. I have one in my handbag, makeup bag and bedside table. That way if you lose one you know where there is an alternative.

If I've ever had steroids it still takes a few weeks to feel better. I always need steroids after a chest infection, so I'm usually still ill from that and antibiotics.

So don't expect to be skipping around. Also I'd ask for another course of steroids to get you back on track if you are still so low you need nebulising.

Know your peak flow. Mine is 600 all the time. If I drop to 520 I need steroids generally. 480 and I need steroids and antibiotics. Everyone's peak flow is different. You can buy a peak flow meter.

I hope you feel better soon.

If you were in A&E last night then you need an urgent follow up at the GPs so push hard when you call them Monday morning, say you were told to get seen when you were discharged (which you should have been).

It might also be worth finding out the escalation procedure at your GP for asthma - I don't mean complaints but at what point you need to see a respiratory doctor instead of an asthma nurse.

If asthma uk are open between now & then, you can also try their helpline for advice.

And absolutely don't hesitate to retrlurn to A&E this weekend should your lungs get bad again!

Ditto pp that you need to be tracking your peak flow. I'd track it twice daily, before taking preventers.

Not medically trained, just a fellow asthma sufferer.

Keep going with the Fostair, it's likely you'll need it indefinitely.
Look up MART (maintenance and reliever) regime and ask your asthma nurse about it - using a steroid inhaler as a reliever too instead of a blue is the big thing in asthma now. The blue may relieve symptoms but not treat the inflammation, the Fostair does both and works as quickly.

You need to be very careful using pulse oximeters in asthma - they are often falsely reassuring. Symptoms and peak flow are more important.

Hi OP, I developed asthma in my 40s, having never had it before. Asthma needs to be taken seriously but the good news is that is a manageable chronic condition and, managed properly, I lead a completely normal life. So can you.

I was struggling badly when I first developed asthma, and it took 5 months of trial & error to stabilise it. You will need to identify your triggers (everyone’s are different) and avoid them as much as possible. Obviously, if you smoke or vape you need to quit immediately. If you have pets which are a trigger, they may have to be re-homed.

You will also need to work out which medication works for you. Asthma & allergies are a very individual thing, and what works for me (a budesonide / formeterol preventer inhaler) may not work for you. And vice-versa, obv.

If you haven’t got a peak flow meter, get one and test yourself frequently until you find out what is ‘normal for you’. This will help you manage your asthma. Make sure you take your preventer every single day, and always keep a reliever with you. I keep one in my bag, one in my office desk, one in the car, one beside my bed etc etc. Antihistamines may help if some of your triggers are seasonal, eg a certain pollen is one of mine, so I always keep some in my bag, the car etc etc.

The best of luck with getting your asthma under control. Work with your GP & asthma nurse and you will get there.

You should have a post exacerbation review with your asthma nurse ASAP. Like PP mentioned, I'd be looking at MART (which Fostair is licensed for) and they should be able to tell you when to increase your Fostair and how long for, so hopefully it doesn't get this bad again.

Interesting, that's one thing they always check with DS when he's ill, but the nurse has become more interested in his peak flow as he's got a bit older. Maybe it's because it's not as easy to get young children to do a peak flow reading. He's still not that good at it.

@StripedPiggy
My 17 year old DS has asthma and I would like him to have more than one blue inhaler so he's always got access to one (school bag, bedside table, part-time workplace, car).
Will the GP prescribe this many for this purpose- I've always been reluctant to ask as it seems you're supposed to manage with one.

Always use the spacer. When you feel a bad attack coming on, how many puffs of the blue inhaler are you taking?

Always use the spacer. When you feel a bad attack coming on, how many puffs of the blue inhaler are you taking?

Assuming you mean Ventolin (salbutamol) reliever inhalers, I agree that he should have more than one . The GP certainly should be helpful if he explains that he needs a back-up in case he loses his inhaler. If he needs inhalers regularly he should be able to get a repeat prescription which he can order online himself every few weeks (that’s what I do) or, failing that, they can be purchased from pharmacies online for about the same cost as a prescription. Google ‘Buy Ventolin’.

I am not a medical professional, so please take advice from someone who is.

Do you know why your asthma got bad enough to need steroids? (For me the answer would nearly always be a cold that went to my chest). You need to tackle whatever that trigger is.

What I've gradually learnt over the years is I'm quite sensitive to air pollution. It doesn't give me asthma attacks but it does make me much more prone to being badly hit by chest infections etc. So also think about root causes of your asthma. If you burn wood inside your house, live with a smoker, have a busy road outside, or have mould in your house it will make your underlying asthma worse even if it doesn't seem to affect you immediately.

You need to get seen as soon as possible after this attack. You might need more steroids or antibiotics for a chest infection, and they should review your medication to adjust the dose or change the steroid if you are still having exacerbations. Switching to budesonide instead of beclamethasone improved things greatly for me. But in retrospect it coincided with the local coal fired power station being switched off, so it could have been at least partly down to that.

There was a major clinical trial several years back that demonstrated use of a regular inhaled corticosteroid significantly improves outcomes for all with asthma so the advice will be to take one in the long term. Not necessarily Fostair (as this contains two ingredients) - you could be downgraded to a corticosteroid alone.

As PP have said, there is also an element of establishing what works for you in reducing your symptoms. DB finds exercising regularly keeps his asthma under control and is very particular about this

You have had good advice from many experienced posters here. I will just add my bit.

My asthma is usually well controlled on a regime of Seretide, with Cetirizine and Montelukast. It tends to kick off during high pollen times , at which point I may need Salbutamol, Flixonase and Piriton,

Always carry your blue inhaler - have them readily available. If your recent attack was not triggered by an infection, discuss allergy triggers with your Asthma nurse and perhaps try an antihistamine.

I am an adult with "sort of asthma" for want of a better description. I was diagnosed with mild hay fever induced asthma as a teen, given a blue inhaler and managed with the odd occurrence of breathlessness once or twice a year when the pollen levels were really high.

Then as an adult (around 27 or so) I had a bad cold and my breathing never recovered. It was honestly a bit of a frustrating experience as no one was ever able to adequately explain what level of wheezing was acceptable. I can (almost always) stop, concentrate really really hard on breathing very slowly and calmly and then over the course of 15 or so minutes the wheeze and cough will subside and my breathing will return to normal. I also had phases where I would be wheezy but it wasn't particularly bad - as I used to say there's a lot of difficulty between fine and dead 😅

They used to praise me for not using my inhaler if I could manage to calm my breathing through concentration alone but then this wasn't something that had happened to me before then so I didn't really see why it happened then but not before.

I kept going up the asthma ladder in terms of inhalers until I got to I think 4 puffs of Fostair a day. Eventually I went on holiday and it just vanished overnight one day. I stopped the steroid inhalers (to much consternation I must say) and have been basically fine ever since. I get a slight wheeziness/asthma cough once every couple of months but no need for steroid inhalers.

Goodness only knows what caused the flare up but I am very grateful it then unflared again!

I have always assumed that if you get diagnosed as a child you get a lot more and better explanations and help to improve your understanding because it was not that way as an adult and I assumed they must just work on the assumption that adults with asthma know what they're doing.

They also point blank refused to allow me a second blue inhaler which was a right pain in the neck frankly. I hadn't realised you can buy online - when I looked the supermarket trials where you could buy a spare had ended I think.

I still carry a blue inhaler in case of a wheeze I can't get under control easily but I reckon I use it maybe once every 6?months or so.

@Sh1neAL1ght I'm a prescriber (pharmacist so not a doctor) and I would be slightly concerned if a patient was asking for more blue salbutamol inhalers. If you need to use this inhaler more than 3 times per week it is a sign of poor asthma control.
For example when I was on a steroid inhaler twice daily plus a blue inhaler when required I used my blue inhaler multiple times daily. I was then switched to a Fostair inhaler which is a steroid inhaler plus a long acting reliever inhaler and I never use my blue inhaler at all now.
If your DS is needing his blue inhaler often I would advise him to get an asthma review and a tweak to his current treatment.
However I'm sure his GP could give him an extra supply until then.

Yes I've had this issue as well as they will often refuse to issue DS more then one at a time. Which was especially a pain at primary school as they insisted on having one stored at school full time that was his own inhaler. My issue with DS has always been that if he needs one he can empty one in a day as his asthma is quite unusual, he won't just need a couple of puffs but the full 10 puffs and as they only hold 100 he can go through a full blue inhaler rather quickly if ill. So I'm never happy just having one anyway. Anyhow I just tell the doctors he's lost his old one to get another, which is even easier now he's at high school and has it on him as it is possible for him to lose it. 🤔

I believe you can buy blue inhaler yourself as well now, they maybe cheaper then the prescription charge. That maybe an option for an adult.

If you respond to Montelukast tablets they are an absolute gamechanger.

Fostair as a MART is also so so much better than having multiple inhalers. Make sure you have a Fostair everywhere: at home, by your bed, in your handbag, in the car....

Also antihistamine every day.

I expect to need steroids with every cold now so don't leave it a week trying to get better and then struggling. Get them prescribed asap.

Hi OP. I've had asthma since I was two years old (now 53!). Fostair didn't work for me so I switched to Flutiform and that has really kept my asthma at bay. I hardly use the Ventolin and can exercise without getting wheezy - worth a try.

I tried fostair and another single use one, but was told I couldn't use the ventolin with it. I really struggled to limit myself to 4 sucks a day, it didn't relieve my tightness like ventolin, so I asked to go back to serevent, qvar and ventolin (well salamol, they don't give ventolin anymore).

But it sounds like people are also using ventolin alongside the fostair...is that right?

My asthma is triggered by laughing, stress, sometimes after a meal I get tight. Often need to use the ventolin after lunch.

I have Fostair on a MART regime.

Basically I flex how many puffs up to a max of 8 a day. I do have a Salamol for if I go over the 8 but basically if I'm up to 8, then I need steroids and so the Salamol is just there to keep the asthma nurse happy.

It's so much better for me not to be faffing with multiple inhalers.

Fostair doesn't give you the instant hit of Salamol though, I have one puff and then think about it for 30 minutes to decide if I need another one.

@AnnaMagnani that's it exactly, you don't get an instant hit!

I've been told by many doctors that I'm addicted to the salamol, on the basis I need the hit, I probably am!

Thing is, I don't have the time to wait 30mins to get it to work. I would feel totally naked if I left the house without an inhaler in my pocket, even if I didn't think I'd need to use it.