Asthma advice - re work and prednisalone WWUD

[magso]

I am currantly on (high dose) prednisolone after a flair up. It is day 4 of the tablets so I actually slept last night and am probably well enough to work although rushing about is still out (I am due to work this afternoon - I have to commute etc). PF now 200 - was 140 should be 350+. I had a long hospital admission (pneumonia) some months back but prior to that was considered a mild astmatic so do not have a clinic/nurse /specialist.
This is not my first course of prednisolone (I was on it for weeks in hospital and then again over Christmas holidays) but the first time I have not been signed off or otherwise not expected at work!
What would you do? Thanks!

mag how old are you.Your PF should be moe than that even at 350. go to the docs and tell them you are not fit to go to work with that level of PF. Get yourself fit before you go back. Most employers dont care about your health...they just care about their business. You wont get any thanks for being a hero and you could make yourself worse

Thanks Alypaly. I left for work before your reply so did go to work but felt exhausted and was rather slow. I have a good employer (hospital) - I am not working my full hours due to not being fully recovered from summers pneumonia/ lung haemorhage etc. I am on the wrong side of 40 and petite/50kg, but have not managed a PF above 350 since my hospital admission. It was higher than that last year although checked so infrequently I cannot be sure.
I forgot to ask the GP if a 5 day course causes immunosuppression and if I should work!
I am currantly charting my pf in readiness to request referral. Gp said she could not refer till at least 2 weeks charting. Do you think a low PF could cause fainting/ collasping in a breathless semiconscious state ? I ask because a locum gp suggested panic attacks (it does not feel like panic - just illness/exhaustion/lack of puff?

your PF is very low at 200. Even though you are petite. You should be looking at a comfortable PF of 400 +

No wonder you feel faint and lethargic.

A 5 day course of prednisolone causes minimal immunosuppressance. The benefits outway the side effects. It is only a very short course and as such doesnt normally cause any problems.

You dont sound panicky....Lack of breath is awful and can obviously cause panic attacks by the sheer fact you cant get enough oxygen in.

Personally i would say you had quite bad asthma,not mild and I reckon you should be on a seperate steroid inhaler and salbutamol inhaler, with results like that. If you feel that unwell i would go back to GP,not the locum.
I dont think you should be at work...everything must feel like an effort

Thanks Alypaly for your advice and kindness in replying. I am lucky in having an understanding employer - and am still working reduced hours as I have not been able to manage full days since my pneumonia and collaspe in late spring. I may also get help with my caring commitments (SN child).
I will chase the asthma clinic referral as soon as I have 2 weeks PF charting under my belt. It was charted in hosptal (140 on admission) but only 1 hour after meds - I am doing both before and after meds now. I certainly faint/ keel over more easily in the mornings when my pf (and also my o2 sats - I have a basic monitor from mountaineering days) are lowest. The good news is that today my PF on waking was over 200 (and O2 95%) at last and climbed up to nearly 280/96% by midday (I have doubled my steroid inhalor in the last 5 days as well as oral prednisalone).
Again thank you for replying. My gut feeling is that keeling over is due to physical illhealth and I was beginning to loose faith in myself when my mental health was questioned.

ita horrible once doctors say 'you are causing it ,or its panic attacks or psychosmatic. You know your body better than they do....stick to your guns..i had to when gp said same thing to me. 3 years later i found out i was quite poorly and i felt like thumping the GP

Hi - I would definitely request a referral to a respiratory specialist.

I always thought I was a mild asthmatic, but due to an immune disease was referred to a respiratory specialist, who did tests etc and I realised that my usual peak flow of 250-300 is not normal! So I got prescribed different inhalers, prednisolone is prescribed when needed - and I had pneumonia this autumn and returned to work too early and have suffered for weeks since. And I work part-time!!

Having a resp consultant I see twice a year has made a big difference when I seen gp/had infections/been to hospital with breathing difficulties!!

All the best

Thanks Keziahopes. I will ask for referral. Oddly I was supposed to be reviewed by the respiratory specialist after discharge from hospital (I have some markers for immune disorder too - but the picture is confusing) but it now seems I have to start again. Sorry you have had pneumonia. I am really struggling to recover- and have to pace everthing I do -I run out of energy so fast.
Do you chart your PF both before and 30 mins after inhalors - or just before? How long does prednisolone go on working after you stop the short course- my PF has started to fall after stopping.

Magso - I would definitely ask for that referral. Mine changed my inhalers, which helped immensely - something an asthma check at a gp practice didn't pick up on! I now have the purple inhaler , instead of the green and brown one.

It might be worth asking gp for immunological blood testing - I have selective immunoglobulin A deficiency (quite common, most people not ill with it - I am in the less common category) - which means no immune protection in lungs, sinus,ears etc.

Yes, energy has to be banked and used carefully!

I must admit I only check PF once a day as I can tell when it is worse thesedays! I find prednisolone works when take it. Do check there is no underlying chest infection - I get hidden ones (ie no coughing up green stuff!). Antibiotics help me (I have such a huge dose prescribed that when inhospital no nurse believed me, but immunologist works with respiritory consultant (see them at same time).

Respiratory clinics go much more on their own hospital tests than peak flow I have found... hope you get that referral!

I am convinced my health started to go downhill when the old inhalors were replaced by the CFC free ones about 2 years ago. The new ones make me cough!! Maybe I just have the wrong replacement one for me. How do the purple ones work?

magso try and get the breathe easi ones .They dont make you cough so much. I found the ordinary salbutamol one made me cough too

magso - are you using an MDI (a traditional 'puffer' inhaler where you press the canister and inhale)?

If so I would definately follow alypaly's advice and ask for a breath-actuated inhaler (called an easibreathe or autohaler depending on your medication) or a dry powder inhaler (such as an accuhaler or turbohaler, again depending on medication).

You don't have to co-ordinate your inhalation and they don't trigger the cough reflex anywhere near as much as an MDI does. Most standard preventer and reliever meds come in breath-actuated or dry powder form, so there shouldn't be any hassle changing you over if needs be.

Thank you both!
I am using MDIs - now with a shiny new spacer. Still using the blue ( salbutamol) inhalor many times a day which I'm trying to avoid ( also tachicardic since admission). - So it might be as simple as changing the inhalor type. I chased up my post discharge (pneumonia) appointment today - incase that comes quicker than the GP referring me to a asthma clinic.

Hi - yes eashbreathe inhalers can be great, though I suffered with the inhaler that had dry powder, maybe just me.

I used to have salbutamol (blue) and for preventer the brown inhaler (twice a day), as ashtma worsened they put me on the green inhaler and brown together. My consultant prescribed my purple one which is SERETIDE,a mix of green and brown one I think!, which I have found superb for my own condition and I hardly use salbutamol now.

Do you have lots of infections generally? I only ask because after 10yrs of suffering infections I got quite ill and eventually I was diagnosed with a mild immune system illness. Not saying it to scare you - it just explained my chest infections, ear infections, pneumonia's, sinus infection, stomach issues ... if you have lots of infections in those areas an Immunologist is a good referral to ask for after blood tests by Gp as sometimes there is a reason for a mix of infections. If asthma then respiritory is the way to go.

Yes I have had lots of chest sinus and ear infections ( and labyrinthitis) and joint/ muscle stomach and back problems. Falling apart really! I seem a bit oversensitive!! Saw rhematologist who repeated some blood tests (ANA and ESR were + when I had pneumonia) but they were ok on retest.

Hi - why not ask the Gp (if they haven't already) to test your Immunoglobulin levels (one blood test) - IgA, IgG, IgE, IgM and one other - as a basic test. The website PIA (Primary Immune) has lots of information but it can be scary as it can focus more on the more extreme Immune illnesses. Just a random idea - but might be worth a check along with rheumatology, who are meant to be good at looking at the whole body rather than just a part (eg asthma clinic).

I have no IgA, hence I need a different regime of antibiotics - and 2 years later I have less infections! Not likely you the same as me, but wish I had known about a simple blood test (and then if an issue, a referal to immunology - who ask your entire medical history,as immunology is like that!!) years ago and kept my hearing etc!

Thanks. I am sorry about your hearing - mine is not too wonderful too. I had a bronchoscopy whilst in hospital and washout showed very high IgE in my lungs but I do not know if others were checked.
Thanks for the website info. My gp is in a group (and it is very hard to get appointments) so it is difficult to make progress!