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Prednisone every day no thanks
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ledzep0521 posted:
how can i better control my asthma? i am 23 years old, and since i was about 12 or 13 i have had severe poorly controlled asthma. The only way i have been able to keep it contained is with 30mg of prednisone every day for the last 10 years, as a result i have suffered horrible side effects, because of the prednisone i have cataracts i weigh 300 pounds and many other horrible side effects in this case the cure is almost certainly worse than the disease itself so how can i better maintain my asthma or possibly replace the steroids?
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DUKE MEDICINE
Michael H Land, MD responded:
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,
ML
 
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ledzep0521 replied to Michael H Land, MD's response:
thank you for your suggestions i DO see an asthma specialist and he has tested me for just about everything under the sun, i just recently learned about bronchial thermoplasty and am making an appointment to discuss it with him, as for Xolair i was on that when it was in trial stages and it just seemed to make my condition worse i also had osteomyelitis just before my asthma took a turn for the worst in my child hood and im wondering if that is some how connected and on top of the prednisone im also on the highest dose of advair with out teh combination of advair prednisone and claratin D i dont stand much of a change in breathing normally through the day
 
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amcate replied to Michael H Land, MD's response:
Dr. Land:

Thank you for the information on accurate diagnosis of asthma. It covers some of what I've run across. The allergist's interventions have helped, but not as much as expected. I've been to a lot of other folks. So, now off to pulmonology doctors, and they want to do specific imaging of the lungs.

Some people in the pulmonary support group I've been going to have had a hard time with diagnosis. One of them said that each doctor is trained in a specialty and tends to have blinders on if there is a problem that another specialty normally deals with. She said that they did CAT scans of her lungs, but the pulmonologist failed to recognize an infection. Finally, she went to National Jewish. The allergist and the pulmonoligst at National Jewish looked at the CAT scans and could not see anything wrong. Then, an infectious disease doctor looked at them, and saw a rare bacterial infection. He pointed it out to her, and said it was all over the images. They treated the infectious disease, and after that, things got better.
 
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amcate replied to ledzep0521's response:
I have also considered bronchothermoplasty, but doctors here said that it is an extreme procedure and the primary care doctor (I have an HMO, so have to get referals from him) said that since I've only seen an allergist and not a pulmonologist or infectious disease doctor, he wants me to get a workup from a pulmonologist first to be sure the diagnosis was correct in the first place. Also, the primary care doctor I have also said that even if the diagnosis of asthma is correct, it does not mean I don't also have another pulmonology disease that has not been diagnosed. He just wants to be sure that they don't go in and do something that destroys tissues without first having a very clear picture of what is actually going on in the lungs and ensuring the diagnosis was correct and that there is nothing else going on in the lungs that has been missed.

I don't know if this is applicable to your situation or not, though. Best of luck to you.