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DUKE MEDICINE

Reply: Prednisone every day no thanks

Dear ledzep0521, I'm sorry to hear that you've had such trouble getting your...

Posted by Michael H Land, MD

Dear ledzep0521,

I'm sorry to hear that you've had such trouble getting your asthma under control. This is certainly frustrating and with all of the prednisone use, you are right, there are side effects to worry about.

I would make sure that you discuss a few important things with your doctor. Firstly, are you seeing a board certified pulmonologist or allergist? Your severity and need for oral steroids should be managed by a specialist in lung disease. I would ask them if they feel confident that your diagnosis is indeed asthma. There are sometimes other conditions that may appear to be like asthma but in reality, they are other types of lung disorders or even vocal cord disorders. Often times these other lung diseases may be treated as severe asthma but when the response is not adequate, more therapy is added on until you are at maximal therapy. With this much difficulty controlling you, it may be helpful to re-assess the underlying disease again. That being said, Asthma is very common and it quite possibly is asthma all along.

In addition to systemic steroids, there are other therapies that may help asthmatics. You should discuss with your doctor the other options that may help decrease steroid need. If you have allergic disease, immunotherapy may be an option. In patients who have allergy-induced asthma symptoms, a monoclonal antibody medication called Omalixumab (Xolair) is sometimes used in patients. The medical therapy for inhaled medications may be optimized to include combination inhaled medications (an inhaled steroid and a long-acting beta-agonist) and sometimes patients may take an anti-leukotriene medication as well.

A relatively new procedure called Bronchial Thermoplasty has also been recently developed to help treat severe asthma patients and is something done primarily at referral centers. If your doctor has had this much difficulty controlling your symptoms, a referral to consider this may also be something to discuss with them.

I hope you can get relief soon and have an open discussion with your specialist about your treatment options.

Good Luck,
MLView Thread

Posted byMichael H Land, MD

4 Replies | Reply | Watch This DiscussionReport This| Share this:Prednisone every day no thanks Dear ledzep0521, I'm sorry to hear that you've had such trouble getting your...

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Reply: What do I do?

Dear Casmere624, I'm sorry to hear about your situation and the difficulty...

Posted by Michael H Land, MD

2 Replies | Reply | Watch This DiscussionReport This| Share this:What do I do? Dear Casmere624, I'm sorry to hear about your situation and the difficulty...

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Reply: I Don't Want To Die

Dear Ted, I'm so sorry to hear about your insurance situation. If you have a...

Posted by Michael H Land, MD

2 Replies | Reply | Watch This DiscussionReport This| Share this:I Don't Want To Die Dear Ted, I'm so sorry to hear about your insurance situation. If you have a...

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Reply: Asthma reactions to dogs

Dear floridamom5, Judy, and Sonya, Thanks for your excellent input Judy and...

Posted by Michael H Land, MD

9 Replies | Reply | Watch This DiscussionReport This| Share this:Asthma reactions to dogs Dear floridamom5, Judy, and Sonya, Thanks for your excellent input Judy and...

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Reply: Xolair and Donating Blood?

Hi Anan, Sonya, and Mattie, I contacted the American Red Cross yesterday and...

Posted by Michael H Land, MD

5 Replies | Reply | Watch This DiscussionReport This| Share this:Xolair and Donating Blood? Hi Anan, Sonya, and Mattie, I contacted the American Red Cross yesterday and...

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Reply: Asthma is trying to come back...

Unfortunately, asthma is a chronic disease and does not easily improve in many...

Posted by Michael H Land, MD

3 Replies | Reply | Watch This DiscussionReport This| Share this:Asthma is trying to come back... Unfortunately, asthma is a chronic disease and does not easily improve in many...

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Reply: Symbicort and acid reflux

Hi Kirkmc2 and Mathchickie, I agree with Matchiickie's responses--it is often...

Posted by Michael H Land, MD

7 Replies | Reply | Watch This DiscussionReport This| Share this:Symbicort and acid reflux Hi Kirkmc2 and Mathchickie, I agree with Matchiickie's responses--it is often...

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Reply: Hospital ER question

Hi pljohns and bresky, This is a great question and I agree with Bre...

Posted by Michael H Land, MD

Hi pljohns and bresky,

This is a great question and I agree with Bre completely. Most of my patients with severe asthma who have had to go to the ER will be closely monitored to make sure the attack is not getting worse, to possibly get steroids on board, to make sure there is not an infection like pneumonia that they think is their asthma, and to evaluate for other causes of their symptoms. I don't know how old you are pljohns, but when my older patients who have heart disease develop chest tightness and trouble breathing, sometimes it is a heart attack and not their asthma (or it's both), so this can be checked for with an EKG and labs.

Sometimes, you might need a nebulized treatment of something other than Albuterol if your asthma attack is very bad (i.e. Ipratropium, Heliox, or regular Oxygen can be given).

If you're having these types of attacks fairly frequently, you should bring this up with your regular doctor to get your symptoms under control so that this type of attack won't occur in the future.

Everyone knows that the ER is a place to go when you have an emergency like a trauma or car accident or a heart attack, but there's sort of a "grey zone" for other conditions where oftentimes people are worried about (1) how long the wait is going to be, (2) are they going to do anything more than what I can do at home, (3) how much is it going to cost, (4) could I just wait until the next morning and go to my doctor? (5) is my problem serious enough to need ER care? and others.

I think the best thing the ER can do (for any condition) is to make sure if you have a life threatening disease (i.e. asthma), that it does not kill you. Asthma is one of those types of problems and my recommendation to my patients is that if the symptoms are not controlled enough that you don't get enough relief from your rescue inhaler, you should get it checked out.

If you work with an asthma specialist, they can develop something called an Asthma Action Plan which is a detailed protocol on what to do if your asthma gets out of control--you can check your peak flows, use rescue doses, possibly take steroids, and if it is still not better, then you'd know when you should go to the ER. I develop asthma action plans with many of my patients who have severe asthma so they know what to do in severe situations.

HERE is a link for more information about this from WebMD. I hope this helps!
Good luck,
MichaelView Thread

Posted byMichael H Land, MD

7 Replies | Reply | Watch This DiscussionReport This| Share this:Hospital ER question Hi pljohns and bresky, This is a great question and I agree with Bre...

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Reply: chest pain

Dear katiedevall1 and abbymay16, Having many pediatric patients with asthma, I...

Posted by Michael H Land, MD

2 Replies | Reply | Watch This DiscussionReport This| Share this:chest pain Dear katiedevall1 and abbymay16, Having many pediatric patients with asthma, I...

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Reply: Physicians, MY NIECE NEEDS YOUR HELP!!!

Hi Tokarra9696, Thanks for your update on your Niece's condition. I am so glad...

Posted by Michael H Land, MD

3 Replies | Reply | Watch This DiscussionReport This| Share this:Physicians, MY NIECE NEEDS YOUR HELP!!! Hi Tokarra9696, Thanks for your update on your Niece's condition. I am so glad...

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