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.
I'm sorry to hear about your situation and the difficulty you're having with controlling your asthma. You've already started on the right path by identifying possible triggers to your symptoms. Unfortunately, smoke exposure is very likely to continue to affect your asthma negatively, and any chance you can take to avoid the smoke exposure would be great. Regarding your allergens, it might be helpful to discuss with your doctor if allergy shots (immunotherapy) may be a reasonable treatment to consider. This can help to lower your sensitivity to cats such that you can tolerate being around them and not have such bad symptoms. Other things to consider might be that your asthma is not optimally controlled if you are on too low of a dose of inhaled steroids or need other medications such as a combination inhaler (steroid plus a medication called a LABA), Omalizumab (which is an injected medicaiton), or a medication like montelukast. I would recommend having a discussion with your specialist about how to optimize your asthma management with medical therapy in addition to allergy shots if possible. This would be necessary if you cannot avoid your triggers.
Of course, if you can get out of that house and into a cleaner environment, this might make your symptoms improve a lot.
I'm so sorry to hear about your insurance situation. If you have a prescription from your doctor for refills, there are some pharmacies that offer $4 medications for a 1 month supply (i.e. Walmart, Target, etc.), and nebulized Albuterol is on their list of medications. You'll need to transfer your prescription to a pharmacy that has the discount. I'd highly recomend that you get back on your daily "controller" inhaler pronto, because that is the best way to get your asthma symptoms under control so you won't be so symptomatic.
As soon as you can, you should also try to get new insurance or Medicaid if you qualify as this can help support your medical costs. The sooner you get qualified and have insurance back, the faster you can get your medications, see your doctor, and get to feeling better. Please take care of yourself ASAP and don't let this run out.
Thanks for your excellent input Judy and Sonya. I completely agree that there is no such thing as a hypoallergenic pet. Unfortunately, for a lot of folks like floridamom, they will have significant symptoms when exposed to (or living with) a pet. Avoiding the allergic cause is the single BEST way to reduce allergen triggered symptoms. However, the possibility of benefit from allergy shots (allergen immunotherapy) is real and if you are committed to this, you could potentially be able to one day tolerate the exposure. It is always difficult to face the possibility that a family member (pet) could be the cause of significant health problems, but this therapy could help a lot. I'm sorry you had to return your pet, but at least you can breathe now. I'd discuss this possible option with your allergist. I'm sure they'd work with you on developing a good plan.
I contacted the American Red Cross yesterday and specifically asked if Xolair (Omalizumab) was a contraindication for blood donation. Here is the reply I received, below. It looks like you are clear to go. I think it's a great thing to be a blood donor, as so many folks can receive benefit from your donation.
Have a great week! Michael
Dear Michael Land
Thank you for contacting the American Red Cross. We appreciate your time and willingness to keep our blood supply at a safe level by wanting to donate at one of our collection sites. In regards to your question about eligibility the donor will be not be deferred based on this information you have given us as well as by our guidelines and regulations. As long as the donor is feeling healthy and well at the time of donation.
Thank you so much for your willingness to donate. If you have any other questions or concerns please feel free to contact us by replying back to this email or calling 1-866-236-3276. Have a great day and once again thank you for taking the time to contact us.
Cheronda Battle DCSC Eligibility
American Red Cross, DCSC 9013 J-Perimeter Woods Drive Charlotte, NC 28216View Thread
Unfortunately, asthma is a chronic disease and does not easily improve in many patients. Sandy, if you have not had a diagnosis of asthma for very long, then it is possible that you might not know what all of your triggers are. Sometimes it is temperature related (Cold air) or sometimes it is illness, allergen exposure, smoke exposure, exercise, etc.
I would suggest talking to your allergy or pulmonary specialist to come up with a list of likely triggers for you, so that you can "be prepared" and take the necessary precautions to avoid triggers or know when they are coming (like the cool weather).
Here is a nice resource at Uptodate.com on avoiding asthma triggers: LINK and one here at WebMD: LINK
I agree with Matchiickie's responses--it is often not typical to hear someone go from Intermittent albuterol use as a Rescue medication--to a combination inhaler like Symbicort. Often, physicians would want to "Step up" to a combination therapy if an inhaled steroid alone is insufficient to get asthma under control. There is also the difference between intermittent and persistent asthma that should be more clearly defined by your doctor.
I would have a good discussion with your main Primary care doctor about what is the best choice for you. Having samples is nice, but sometimes the best choice of medication is not the one where samples are available.
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
Having many pediatric patients with asthma, I have heard a lot of different symptoms that children can describe for asthma--coughing, tightness, shortness of breath, wheezing are certainly the "classic" symptoms, but I completely agree with you Abbymay16 that tightness of the chest can be described as soreness or "heart hurting" for a 6 year old. I've had kids complain that their stomach hurts (and it turns out that it is from coughing all the time). If the asthma symptoms are fully controlled (i.e. he is otherwise fine) and these symptoms are persistent, I would certainly question it being due to asthma and it warrants further evaluation. However, it is also important to look at how he initially presented and how he was diagnosed with the asthma--were his initial symptoms also chest tightness and shortness of breath? Does he appear to be breathing fast/working hard to breathe or wheezing when he complains? Does it get better if you give him his rescue inhaler?
Some kids who have GE Reflux actually can be misdiagnosed with asthma, particularly if they have a chronic cough as a major symptom. If they have heartburn or reflux symptoms, this may also be called "heart hurting" or "cramping." I would trust your instincts (true, sometimes mom does know best) and if this does not seem to be improved with your asthma care plan, then question it. Maybe he is undertreated? You could always get a second opinion or go back to your pediatrician if it was the allergist/pulmonologist who made the diagnosis.
Thanks for your update on your Niece's condition. I am so glad to hear that she is breathing on her own and improving.
I am not sure what they mean about brainstorming--unless they are trying to come up with ideas on what could be causing an issue or problem. Sometimes there may be an issue (like a clotted IV line or some other nursing-related issue) and a nurse may say to the family that they are "brainstorming" ideas on how to clear it or something else to fix it with (like taping it a certain way if it is bent).
If she does have a true seizure disorder, this may be their way to explain something relating to her condition to the family.
I hope she continues to have a good recovery.View Thread