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When is it important to use daily steroids?
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Lily_91 posted:
Hello all,

I have a question regarding when it's important to take daily steroids for asthma. I'm 19 years old and have had very mild asthma since I was 12 or so. I was initially diagnosed because I was coughing and wheezing slightly essentially all the time, with severe shortness of breath occasionally (particularly at night or after exercise), but never for a prolonged period of time or anywhere close to being hospitalized. I was prescribed two puffs of Flovent twice daily to take when symptoms started getting worse, which for me is mostly limited to summer and winter (not the intermediate seasons).

When I was living at home, I would take the Flovent regularly whenever I started coughing more, because my parents forced me to, but now that I'm living alone I can make my own decisions. For the past few weeks, I've definitely noticed an exacerbation of my asthma symptoms - short episodes of shortness of breath/coughing (enough that I can't finish sentences and feel dizzy) at night, after exercise, whenever I go outside, and occasionally for none of these reasons - but within 15 minutes the symptoms usually subside enough that I can function reasonably (i.e. still coughing a lot but not feeling too faint), and within 2 hours are virtually gone altogether unless triggered again. It makes me tired, my chest hurts sometimes, and I can't breathe really deeply without coughing, but it doesn't interfere too much with normal activities. I've only used albuterol at night, and even then only if I didn't want to lose an hour of sleep while the symptoms went away sufficiently. I generally like to minimize the use of any kind of medication, so my question is - under these circumstances does it make sense to take medication regularly, or to deal with the symptoms? Thanks for the input!
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Aqua14 responded:
You need to see a doctor specializing in asthma, and pronto. Not being able to talk and feeling dizzy is pretty serious. The asthma specialist and you can figure out what's making your asthma worse right now and take steps to address that. Then, after you're better, your asthma doctor can advise you what medications are best to keep your asthma under control.

No one on the board, including our medical experts, can advise you whether you need a daily asthma controller medication (such as Flovent). You really need to be examined, and quickly, based on what you are telling us your symptoms are. It sounds like you are trying to tough it out, but when you have asthma that's not a very wise plan as things can get bad, very quickly.

We all want to take the least amount of asthma medication necessary, because let's face it, no one likes to take meds daily. Sometimes, however, we have to take a daily controller med and that's just the way the cookie crumbles. Only your own doctor can advise you on that.

Take care and good luck. Judy
 
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Mathchickie responded:
Why would you want to endure these symptoms? It's one thing to just put up with a headache or a sore elbow, but we're talking about your lungs here. It sounds like it's really impairing your quality of life, and it's putting you at risk of a serious attack.

The Flovent is probably safer than the rescue inhaler, in the long run, because it treats the underlying problem, which is lung inflammation. Definitely do talk to a specialist and get a precise plan worked out, but I say take it.
 
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Lily_91 replied to Mathchickie's response:
Thanks for the advice I guess I was confused because most of the symptoms go away after some time without any medication, so I wasn't sure whether medication was really necessary. But I am tired of not being able to sleep well and generally feeling sick all the time... not to mention reacting badly whenever I have to go outside, which is unavoidably often since I'm a student. I'll try Flovent for a week or so and maybe see the doctor if it doesn't help enough after then.

In addition to starting the Flovent again, I tried using albuterol before I went to bed last night in the hope that I would be able to sleep more comfortably. I wasn't feeling particularly bad at the time, but there was a slight "background" wheeze with deep breaths that I thought would get worse after lying down and reduce the quality of sleep. But for whatever reason, the albuterol didn't help at all - if anything made it worse. In this case it wasn't a serious issue, but I thought it was kind of strange since usually albuterol has at least some positive effect for me. Does this happen often?
 
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Aqua14 replied to Lily_91's response:
You really do need to see a physician promptly - I can't stress this enough. If you were my kid I'd be super worried at this point, knowing what I know about asthma and getting in trouble with it.

When we have an asthma flare, our physician may advise us to take additional doses of our current asthma medications and/or add additional asthma medications in order to get the asthma under control quickly. So if you are just going to take the 2 puffs of Flovent per day, it's very likely that that is not going to do much if anything to get you out of the flare, particularly since it would take about a month to reach full effect if you weren't in a flare. It's a lot like trying to put out a house fire by throwing a few glasses of water on it.

As for your experience with the albuterol, some people are bothered by the new propellant in the inhaler. Since your lungs are so inflamed you might be more sensitive to the propellant than you otherwise would be, or it may be just that anything inhaled is going to bother you a lot right now. That's also a clue that you're doing worse than you think you are.

I'd also recommend that, if you haven't already, you call your parents and let them know what's going on with you and how badly you're doing right now.

Take care and good luck. Judy
 
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Lily_91 replied to Aqua14's response:
Well, less than 48 hours after starting Flovent I already feel much, much better. I'm barely reacting to the cold air at all, a bit of coughing and wheezing occasionally but sporadically and much less severe. The only time I really didn't feel well was after exercising moderately for 30 min - I did take albuterol preemptively, but as before it didn't seem to work very well, or as well as normal. I also started having some strange on-and-off chest pain with breathing that I don't normally associate with asthma yesterday, but it seems to have gotten much better today. I did go to the doctor this morning just in case, but my peak flow was high and my chest was clear (especially so at the time I went, I had a bit of trouble earlier) so she didn't understand why I had come... kind of made me feel stupid, but I'm glad that I've responded to Flovent so quickly and well. Thanks for the help!
 
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Mathchickie replied to Lily_91's response:
Glad to hear it's working for you.

In the future, just keep in mind: While it's not necessary to obsess over every tiny twinge in your chest, any time asthma symptoms start to interfere with your sleep or activities, it's a sign you are losing control and may need to take action to get things back UNDER control.
 
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amcate replied to Lily_91's response:
This is a reply to the whole thread.
1. Glad you are better.
2. Be sure the doctor who said you were fine has experience with asthma. Sometimes a person can sound normal between acute attacks, and doctors without much experience with the diagnosis might think nothing is wrong if it is.
3. What you are asking about is stepping down treatment. As previously mentioned, getting set up with an asthma specialist and developing an action plan is a good way to do this. Every person differs, but in my case, I can step down the treatment if I have symptoms or decreased peak flows two times a week or less. Once I step it down, if the symptoms or decreased peak flows are more than two times a week, I have to step it back up. If you do see an asthma specialist, maybe you could go on a lower dosage of Flovent.
4. Yes, it is good to minimalize the amount of medicines as much as possible. However, all risk is relative. On the one hand, there is the risk of an uncontrolled attack. Even if the symptoms subside on their own, there probably is uncontrolled low grade inflammation. On the other hand, there is risk of the long term effects of the medicines. Even if the symptoms subside on their own, if a person is having them several times a week, there might be uncontrolled inflammation. The problem with uncontrolled inflammation in the lungs is that it can lead to fibrotic changes and airway remodeling. If that happens, this is permanent lung damage. The obstruction to breathing is not as reversible and responsive to medications in that event.
5. I try to minimalize reliance on medicines as well, mostly by trying to ensuring the environment is good. But I still take Advair 500/50 (similar to Flovent, but with an added drug) twice a day. I have to. If I don't, I end up taking much stronger corticosteroids to get things controlled. FloVent or Advair 500/50 have risks associated with the medicine itself, especially Advair with the salmeterol, but not taking it is even riskier as I end up taking prednisone, which is very hard on the body.
6. I hope this helps. You sound like you want to learn things. That's good, and I would get my hands on as much information as you can. Good luck.


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