Chest infection with asthma

[sciencepotato]

Hi, I was wondering if anyone of you with asthma manages to go through sinusitis/chest infection without taking oral steroids, just on the max dose of inhalers? Currently pregnant and been through covid and now again some asthma flare up after sinusitis that worsened my asthma. My Peak flow of 400 is not representative of how breathless I feel but gp doesn't want me to take oral steroids just yet as peak flow should apparently go down to 270 for me to do that (my normal is 450). Took steroids for a week already with covid three months ago.
Thank you for sharing your experiences!

Anyone?

Was pregnant, had COVID and went to GP. He listened to my lungs and asked me to please try it without steroids as he couldn't prescribe. O2 saturation was still ok and I was already ill for a week so he wasn't worried that I would become more ill. Indeed I recovered albeit slowly.

Went for something pregnancy related to the gynaecologist, who said steroids were no big deal if needed but it was better that I managed without... so GP had been overly cautious. He had said he wasn't allowed to prescribe...

I use a combi inhaler, when ill during pregnancy I took the max dosis. But as my lungs felt constricted and my meds didn't seem to work as normal I started with salbutamol to open my lungs up before taking my normal medication. That improved it a bit.

It's been a long time since i was PG but did want to warn you about postnatal asthma.
I've had two babies, and both times ended up in A&E with breathing issues at about 6 weeks postnatal. Apparently hormonal changes can cause asthma symptoms, but it's not widely known.
Just remember that breathing is fairly important 😉😂

Hey, thank you so much for your replies. Quick update - took a 5 day course of steroids. was very little improvement and I still puffed fostair 7 times a day for breathlessness. Today is the 5th day without and it's got worse again - fostair 8 times, nose congested again (improves after fostair and steroid nasal spray but not for long) and waking up as fostair isn't enough and need to take salbutamol now. I'm going in for VQ scan at the emergency care unit today to check for pulmonary emb.but doubt they find anything as I think it's asthma. The emergency doctor says oral steroids will probably do little as my bloods show no inflammation. Check heart - normal too. Basically I think it's asthma that exacerbated due to me waiting to start oral steroids for longer than couple of weeks into my cold. My asthma doesn't have much wheeze either.
Please share your experiences. Maybe you went through a similar nightmare??

Thanks BronnauMawrio, I thought about hormonal changes making it worse but it all started as a normal cold and sinusitis. Whatever the underlying reason for asthma right now - what did you get prescribed and advised when your meds weren't helping?
I'm waiting for the respiratory doc to get back to me but I need to breathe until then 😅

Thanks Stars and Stones for the idea to use salbutamol before fostair to help open up the airways a little more than fostair can do on its own! I'll try that. Gps really are little help when it comes to asthma. The problem is that I already took a course of steroids for 5 days that I got someone else to prescribe but it improved asthma very little. And now I'm off them, I'm struggling again and it's back to square one and even worse as even 8 puffs of fostair isn't enough per day! I mean what do you even do when something like this happens, it's not a full asthma attack yet and my peak flow is still around 400 but I can't talk or move much so breathless I get. I am using my inhaler correctly top, the pharmacist checked.
Any thoughts, did you have similar experience? How long does it take to improve?

I was on a nebuliser for a couple of hours and then 10 days of Pred.

Btw I would absolutely go on another course of steroids, not afraid of them, but they do raise my blood pressure and headaches and when taken for long periods can raise blood sugar levels too. They make me hungry and moody too so the benefit of that plus getting off them causes nausea and headaches for me so I don't want to take them unless they will improve my breathing by a lot. So far they only have improved by a bit. Temporarily. But who knows maybe I should have taken them for longer like other asthmatics do...

Quick update : vq scan didn't show any abnormalities. The doctor said there's nothing else they can do and discharged me. The advice was to "ride it out" and go to a&e when my inhalers won't provide me with any relief at all (so far they do just have to puff every couple of hours) And no more Pred for now. Frustrated to no end.

My sympathies. How bad roughly was your peak flow when you went for a nebuliser?

How are you doing OP? Appalled at how little you've been helped.

Very early in pregnancy for me but I am also on Fostair and have had similar (when not PG) in that my peak flow is often good even when my asthma is really bad.

Do you take anything else, like Montelukast?

Oh hey, I've been wondering how you're doing! Congrats on your pregnancy!!!
I thought I was going mad about peak flow : they keep saying to me if peak flow is OK or a little reduction then nothing to worry about and keep taking inhalers. Mine is 450 normally but I was absolutely breathless at 400 this time after cold and started on steroids because I thought I need to and I think it was a right decision even though they improved little, at least they kept it at bay.
I'm on 4 times fostair daily usually plus montelukast plus antihistamine and dymista.
I'm now taking 8 puffs fostair a day and still at night struggling so take ventolin on top then. The doc from the emergency care said 8 puffs fostair a day is too much and should be substituting it with ventolin instead. I was like : why? It's also a reliever and can be taken up to 8 times a day! He mumbled something it's too much of steroid and should be only taken under docs supervision. 🙈 basically I'm astonished by how much they know about asthma inhalers unless I'm going mad and I cannot take 8 puffs of fostair a day while I'm struggling with post cold asthma exacerbation for weeks??

I'm about 6 weeks gone now. Must self refer to midwives! Seeing GP on Tues.

I was told by the respiratory consultant (pre pregnancy tbf) to always up the Fostair when needed and that 8 puffs of Fostair is the first step then ventolin if needed. She said only go to ventolin when I need to reserve the last two Fostair puffs for bedtime.

Surely the most important thing is to bring your asthma back under control, for both you and baby so surprised doctors aren't trying to do more. You could try asking asthma UK nurses for advice?

Thank you so much, FeedMeSantiag, that's exactly how I've been doing it and told the emergency care doc that I take 8 puffs at the moment but even that isn't enough and I wake up needing to take ventolin. He's like wow 8 puffs that's a lot aren't you supposed to take only two or four and then ventolin. I went no, that's exactly what fostair is four it's a preventer and a reliever. The idea is that ventolin doesn't have the therapy component (steroid) and if you are congested then you need to tackle that by puffing fostair as much as you can and only then ventolin, as you are saying / your consultant is saying. So yeah, point is, not every doc knows that apparently. Btw, when you say "need" a puff, FeedMeSantiag, do you rely more on how congested / breathless you feel or your peak flow? For example,.now I've come back home from walking I feel short of breath but peak flow is okay and I'm wondering if I should still take my 6th puff today just for therapy as clearly my chest will benefit even though peak flow is around my normal?.. If you see what I mean?
With regards to asthma UK, I'm not ringing them ever again. I had an awful experience with them in the summer when I was having covid. What happened was,.I rang a week into covid being on oral steroids to be reassured that it's OK for my asthma to be still flaring and not controlled even after 5 days on oral steroids. What the nurse said was actually a bit self righteous and patronising. She went why are you puffing fostair so much while you need to be taking it only morning and night and ventolin in between (because my consultant advised it so and it works for me!). Then she went it's strange you're not feeling better after steroids, something is wrong here you need to prepare yourself to go to the hospital to get seen tonight as your baby might probably be not enjoying your coughing so much etc. It was so unprofessional!!! So yeah, I stressed myself to no end, went to the emergency care only to be told it's all OK and things take a while to settle after covid and gave me more oral steroids as I was wheezing! Will never ring asthma UK again.

I'm really appalled at how you've been treated.

I had an asthma attack when I was pregnant. I aspirated some saliva which caused it. I took ventolin but two days later I was still out of breath sitting in a chair so I took myself to A&E. They gave me an x-ray and a ECG before deciding that I needed a VQ scan as the risk factors being pregnant meant they had to check for pulmonary embolism. VQ scan was clear. They refused to give me a nebuliser or steroids in A&E which I really pushed for as I wanted the relief.

However the hospital did refer me to a specialist team in the hospital that specialises in managing asthma during pregnancy. I was monitored for my symptoms and medication until I was a few months post partum. They wrote regularly to my GP. Might be worth seeing if your hospital has the same?

Oh, Angela, I wish the Lincoln hospital was anywhere near as good! I was referred to a lung consultant a year (!!!) ago and still not heard anything from them. Not even the stage of my referral, that I'm in the queue etc. I had to go private in Sheffield and thankfully at least now on nhs in sheff. They don't even have a respiratory consultant available for advice at Lincoln emergency unit, let alone specialing in pregnancy. The doc that discharged me literally said go to A&E when your meds aren't working, so I was like ah okay as long as I'm breathless but meds are working i shouldn't be going to the A&E then? Lol. She backtracked but yeah, I'm still feeling rotten by how she communicated these things to me. Basically said we are not here to treat you for asthma - we ruled out pulmonary embolism and heart problems, the rest is up to your gp how you're going to get a treatment. The second doc from the same emergency unit was more emphatic and helpful but said you need a respiratory consultant but we can't give you an urgent referal so there'll be a very long wait so my advice is sadly you need to go private probably. Great hospital this one!

Angela, if you don't mind me asking how did they treat your asthma exacerbation that time? I'm still new to asthma and in the absence of a consultant, it really helps to know about how everyone else manages in the acute situations!

I've had asthma since childhood. It used to be awful - particularly in my 20s. I know certain things trigger it so I try to avoid those where I can. I take qvar and ventolin, and have an annual check at my GP surgery. I usually get a chest infection once a year which usually requires a course of steroids after. My asthma hasn't been too bad the last few years, and 100% I put that down to working from home during the pandemic and not having to commute. I've had two big asthma attacks in my life prior to the one when I was pregnant. Both times I went to a&e, received a nebuliser and was sent home immediately after.

I had a look at my notes from when I was pregnant. I was told to expect a worsening of asthma symptoms up to 30 weeks which is due to the baby growing and pressing against the diaphragm. This apparently settles after 30 weeks. They gave me a daily regime for taking my inhalers, and tried to encourage me to use a spacer (which I didn't). I was monitored monthly with the usual peak flow readings. After that attack I was OK generally. I needed my inhaler a bit in the summer as I was in late pregnancy then and it was hot, but otherwise it was OK. One thing I do remember about the monitoring I had was that kept an eye on my well-being / anxiety in case thay triggered anything.

While you are waiting for the referral is their an asthma nurse in your GP surgery you could see for help? In mine the GP will not prescribe inhalers unless you're up to date with seeing the asthma nurse. It does sound like you've been pushed from pillar to post and I hope it all gets resolved for you x

Oh wow, I'm so sorry you had to go through the asthma attack in your pregnancy. It's so horrible isn't it. When you say you were having an attack and went to the A&E, what did it feel like? The peak flow was low and you were struggling to take a breath and complete sentences? I'm still trying to understand when to know it's time to go to the hospital.
At the moment I'm having episodes of breathlessness. Like when you sit down watching something or eating and then out of the blue you get whoozy and out of breath as if you've been running and need to lie down and catch your breath. That leaves me extremely fatigued too. Inhaler usually helps with that. I'm not sure it's a panick attack as it started 6 days into my respiratory infection onset. But of course in theory it could be.
Anyhow, there's no asthma nurse at my gp practice but they did check my inhaler technique with spacer and said it was correct.
I'm just wondering if those episodes of breathlessness could be counted as asthma attacks too?

I'll add I live with two pets that my bloods showed I'm sensitive too but since I started taking the antihistamine and dymista and my husband feeds them with special food and puts anti allergen liquid on them things improved and I never really felt any additional asthma symptoms from them. It's never been like I'm having asthma symptoms when I'm near them anyway. Only when pollen is out and about. So I'm genuinely at a loss.
I guess like I say in theory in may be a panick attack or silent acid reflux, of course I'll consider these things too but they seem less likely than asthma to me at the moment m..

I'm 31 weeks at the moment, so will see maybe things will settle in a few weeks? Of course I worry about my asthma not being fully controlled as I need to be fit to push in a few weeks time and I'm just not :(

This thread has been really helpful for me to read. Really sorry everyone's struggling so much.

I've had severe asthma since I was 15, along with allergic rhinitis. Usually take a steroid inhaler, montelukast, fexofenadine, lansoprazole and nasonex daily but was told to stop ALL when pregnant. Absolutely ridiculous as my asthma is still not under control at 32. Been taking my steroid inhaler twice daily but struggling, especially after my covid jab a couple of weeks ago.

Only 12 weeks right now so worried on how I'll cope for the rest of the pregnancy but makes me feel better to see that people are still taking montelulast. I may start taking one every couple of days as they usually really help me

Risk of having an asthma attack is so much worse than taking our usual meds!! I confirmed by my lung consultant right at the start that I'm taking all my meds as normal - montelukast, fostair 4 times daily, claritin, dymista steroid spray. Dymista was later approved by my ENT too M I would be in the hospital without these meds in a couple of weeks!

Hey, your suggestion to use ventolin prior to using my normal fostair proves really helpful as it just stopped working for me the way it usually does as a reliever to open up the lungs. I took two puffs of ventolin yesterday and nearly cried I was so happy I could finally breathe again. How long before do you take it before your combined inhaler puff? What combined inhaler were you on?

Thanks so much StarsandStones!!

Hi OP, i’ve had pretty severe asthma since I was 6 and had chest infections in both my pregnancies. It’s really hard! If I were you I would be looking at changing your inhaler to one with a different inhaled steroid. Beclomethesane (it was becotide when I was on it) never did anything much for me. I switched to seretide (combo of fluticasone and salmeterol) and it changed my life. I took the lowest dose once or twice a day and the rest of the time it was like I wasn’t asthmatic anymore. I still got chest infections with colds and so on but I’ve never needed oral steroids since. (On becotide I was hospitalised several times and took a good few courses of oral steroid). The efficacy diminished after about 10 yrs so I’m now on a budesonide/formererol combo and that’s doing a great job. The other thing to consider is silent reflux. I’ve had this occasionally and its only real symptom is that I get a stuffy nose and awful, non-wheezy breathlessness that my inhalers don’t shift. Tell tale signs are that it’s better when moving around and just after eating. Good luck!