asthma and oral steroids - am I expecting too much?

[mrsgboring]

Sorry this is a bit of a ramble as I don't know my own mind properly on the subject.

I'm an asthmatic of longstanding - it's well controlled with Seretide, but sometimes goes pearshaped if I have a virus, and then I usually get oral steroids which get it back under control. I'm currently pregnant. This time round, I've been ill for five weeks, first off with a chest infection and then with the angry, inflamed chest it left behind (I shook off the infection without antibs) I've had two appts with the GP about the asthma, and both times he's said that air is getting to the lungs okay, they're not particularly wheezy and so I'm not bad enough for steroids, though they would be safe for me to take during pregnancy if I needed them.

At first I was inclined to go with this, as I don't want to take unnecessary drugs in pregnancy, but my chest is still sore feeling, the asthma is only under control because I've increased all my drugs and am taking enough ventolin to make me feel rotten and chest is not good enough to do any more than potter quietly through my days.

I'm being induced in 3.5 weeks' time and I'd like to be able to get my body a bit prepared before that - for this I need to be able to breathe enough to go for walks and do a bit of swimming. Is it unreasonable to ask for the drugs that will improve my asthma beyond the day-to-day survival? I am also utterly exhausted with this constant low level bad chest and want it knocked on the head.

I have rung up again today to pester the GP (who I have to say is normally marvellous) but am feeling slightly guilty about it. What do you think?

That breathless exhaustion is rotten, isn't it? I've been an asthmatic since I was small, so really feel for you. Particularly lousy in pregnancy.

There's also some really nasty chest infections doing the rounds here, and I'm recovering from one myself.

Oral steroids, because they're taken in through the stomach, rather than directly into the lungs, are much higher doses than you would take through your inhalers. So, while they're safe and have a good track record, I can understand your GP's reluctance to give them to you unless absolutely necessary.

Have they increased your Seretide dose too? As that's smaller quantities direct to your lungs, I would have thought that would be first port of call (although, be aware - that can take up to a couple of weeks to kick in properly, which is why I'm told to increase Seretide at first signs of a cold and probably why you've been told to increase Ventolin in the meantime).

Can you definitely not go for walks etc in your current state? I ask this because I've been avoiding exercise while I've had this chesty cough, then discovered a couple of days ago (as I was itching to get moving) that while still not great, the exercise wasn't worsening my chesty symptoms so I've restarted gradually with care.

That said, it does sound like the changes they've suggested aren't managing your symptoms well, so it's worth going back to see what improvements can be made. When did you last see them? If more than a couple of days ago, then I'd go back.

My general rule of thumb is that if I have to ask the question whether it is appropriate to see the doc over asthma related problems, then I probably should.

Thanks RubberDuck. I've been on double the Seretide dose for ever. GP's advice, which was yesterday was to space the doses out through the day instead of taking them morning and night, and see if that made a difference. He also said to ring today if it hadn't made a difference (no it hasn't, basically. I need the full dose in the morning to get me going so effectively cutting it down to allow me a lunchtime dose isn't going to cut it.)

You're right that very very gentle exercise doesn't make it worse, but I actually tried swimming this morning and while I can sort of sploosh about in the water, I can't take my normal swimming strokes with face in the water because I can't breathe out for long enough without coughing and hacking.

I'm maxed out with Seretide. I've added in a couple of Becotides left over from when I was on separate Serevent and Becotide, to increase the steroid dose further. I know from experience that the oral steroids will have me totally cured within 24 hours, and while it makes me feel guilty because I could just struggle on for a bit longer, I'm not really inclined to. I don't actually have that much longer before I must face labour again.

I am so fed up.

I would have thought a short-course of steroids was by far preferable to your condition gradually worsening, for both you and the baby. Very little of an oral dose or prednisolone that you take reaches the foetus, and a short course of 5 days or so should pose very little risk to the baby. The only potential problems might come if you had any risk of PE or if you've had any fluid retention, but again this shouldn't be a major problem with a short-course.

Thank you Juwesm. Doc agreed that there was no serious risk from me having it, just that I wasn't ill enough to merit it. Just feels a bit self-indulgent to take the drugs rather than wait it out. But then I'm 34 weeks into a very hard pregnancy so maybe I'm entitled to be self-indulgent? Am on the list to get a phone call from doc this afternoon, so we'll see what he says this time.

I don't think it sounds self-indulgent to want to be able to breathe properly again I hope that the phone call goes well.

Yup, I reckon after maybe 32 weeks, there is no self-indulgent! It's impossible!

I have the drugs and have taken first dose. Hallelujah.

Thanks for the hand holding you two.

Brilliant - I hope recovery is quick for you

Hooray for drugs!

Have you tried the Symbicort inhaler? I didn't get on with Seretide and seem to find the Symbicort a lot more effective.

Thanks for that, tiredsville. Most of the time my meds work fantastically - have had perfect control of asthma for years unless I get ill and then all bets are off. But it's worth a look if my current pregnancy turns out to have changed my asthma for good.