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Asthma Pre Flare? Increase Breo?

Adult on-set asthma, here. Started June 2018 and as far as we can tell triggered by allergies to mold, dust mites and ragweed (which we don’t have here in Oregon, yet) and air quality, smoke, cold, exercise and viruses. 

Saw my new asthma doctor- yay! He gave me a new and much improved asthma plan 2 weeks ago. A couple of things happened over the last week or so. 1. I decided to try not taking xyzal (he had not listed it as one of my meds, it was from the previous doc) because I suspected that was why I have been so tired and unmotivated. It felt great to stop… but I think after a few days I could tell my breathing and coughing was getting worse. I started back taking 1/2 a xyzal. Then on sunday I thought a virus was starting- straight to the chest. I stayed home on Monday. 

Now on Thursday, I don’t feel better. My peak flow is just below 350 (regular high is 400), I feel like my breathing is tight, I’ve been coughing quite a bit and will wheeze a little at the end of coughing, I cough when I lay down. I’ve used my albuterol which helps some. 

That puts me at level 2, which says: “use albuterol as needed, Breo 200 1 puff twice a day”

This my question- everything I read says you only take one dose of Breo per day. Has anyone taken two doses a day? Does that have a lot of side effects? I go skiing again on Saturday and I don’t want to have weird side effects on the mountain. 

I do plan on calling the doctor’s office tomorrow, but I wanted to hear other people’s opinions, too. 

Thank you!! Hope everyone is doing well and breathing well. 

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  • Kathy P

    Sorry to hear you aren't feeling well. I'm glad your doc gave you a comprehensive action plan to follow. Usually, that yellow zone / level 2 is a temporary thing. Would your second dose for the day be this evening? Or do you normally take your daily dose in the evening?

    Calling the office to clarify is always a good idea. I take Breo as well and I know mine is a 30 dose inhaler – 1 dose/day for a month. If I was to double up, I'd run out before I could get a refill. So that might be a good question to ask as well.

    Hope you feel better so you can go skiing this weekend!

  • LK

    I am also on Breo Ellipta and take one puff once a day.  I agree that double checking with your doctor is the best course of action.  Like Kathy, I would run out if I took it more often.  

  • K8sMom2002

    Shadowcat, ugh on feeling worse, but yay on the more comprehensive plan! When you call your doc, could you ask about the Xyzal as well? Sometimes it's easy to forget OTC meds. And could you ask about the side effects you were having? Your doc may have a different daily antihistamine for you to try.

    Let us know what your doc suggests!

  • Pljohns

    I was on an inhaled steroid like that once and the ins couldn't understand that I needed 2 per month becuase there wasn't enough in one for the entire month.  Finally gave up and changed  meds.

  • Shadowcat04

    I got ahold of one of the nurses at my new asthma doctor’s office. We ended up changing level 2 of my asthma plan (yellow zone). Instead of increasing the Breo 200 to twice a day, I am to start taking Qvar 4 puffs a day for 2weeks and continue albuterol as needed. Also asked about Xyzal.  She said keep taking the 1/2 tab and add nasacort if needed for allergies.

    It’s nice to have a doctor’s office answer my questions and take my concerns seriously.

  • LK

    Shadowcat,  So glad you called your doctor's office and were able to have your concerns addressed!  Hope the new medicine helps soon!  

    It is really nice when your doctors are available!  

  • Deborah Bartlett

    That's great! I agree that you should always ask your doctor before making any change to medications. Hopefully, this will make everything better! 😀

  • Shadowcat04

    Unfortunately, this doesn’t seem to be making a difference. My peakflow is staying at 350 and below. 400 is my normal. I get triggered constantly and then I’m coughing and SOB- which are my main symptoms. I’ll wheeze after coughing if I cough long enough. I’m tired. Cold air triggers me, talking a lot triggers me, stairs trigger me, laying down triggers me, going to bed REALLY triggers me. I cough and cough and rasp and cough. I’ve been using the qvar 4 times a day, albuterol 2-4 times a day, taking the xyzal, staying calm. It has only gotten near full on attack twice- just stays icky most of the time. Do I call and say, I think I need tat prednisone now or keep on at level 2 that doesn’t seem to be working?! Ideas? I’m getting tired and frustrated and confused. Thanks for help!!!

  • LK

    Shadowcat,  For me, I would definitely call my doctor.  When I get to the point of "I am stuck at this level and worn out from all of it and taking my meds as prescribed" then it is time to call the doctor.  I usually end up not making as big a deal of it as it really is when I call so I have to make myself be completely honest with them and tell it like it is with no sugar coating.

    Please call your doctor!  Let us know how you are doing!

  • Melissa G

    Oh my Shadowcat! I agree with Lisa, it's time to check in with the dr. Please let us know how you are doing later. 

  • Luna
    Shadowcat04 posted:

    Unfortunately, this doesn’t seem to be making a difference. My peakflow is staying at 350 and below. 400 is my normal. I get triggered constantly and then I’m coughing and SOB- which are my main symptoms. I’ll wheeze after coughing if I cough long enough. I’m tired. Cold air triggers me, talking a lot triggers me, stairs trigger me, laying down triggers me, going to bed REALLY triggers me. I cough and cough and rasp and cough. I’ve been using the qvar 4 times a day, albuterol 2-4 times a day, taking the xyzal, staying calm. It has only gotten near full on attack twice- just stays icky most of the time. Do I call and say, I think I need tat prednisone now or keep on at level 2 that doesn’t seem to be working?! Ideas? I’m getting tired and frustrated and confused. Thanks for help!!!

    The only med that stopped my coughing is Arnuity Ellipta. Breo did nothing. I remember the coughing attacks. Horrible. Call your doc or ask and/or research another doctor in your area who may be able to take a fresh look at your situation.

  • Shadowcat04

    Didn’t have time to call today, I’ll try to call tomorrow. No better, no worse today. Cough in bed last night was awful also on the way home. I was coughing so much I almost vomited. Then, of course, I’m out of breath and trying to calm down and take some breaths. Need to drink more tea. 

  • Kathy P

    Do you think there is something about your bed/bedroom that is a trigger? For me, just laying down will start me coughing. It's the post nasal drip. But I also have to keep up with dust mite control on my bed and pillows. And keep the dust bunnies cleaned out from under my bed. Otherwise, all that triggers my allergies. 

  • Shadowcat04

    Got ahold of the doctor. It took awhile to explain myself to the nurse.  My situation, as usual, is not cut and dry. It’s not that I’m urgent and need to go to the ER (thank goodness), but after 2 weeks of being easily triggered and coughing and coughing and not feeling better. It’s hard to feel like there’s no end in sight. This time when I called and finally got them to understand (I think at first they wanted to wait another week to see if the qvar would work), they finally gave me a step up in treatment.  Now I’m doing Breo 200 (my main maintenance inhaler that they’d told me to stop last week) once a day and qvar 80, 4 times a day. Continue xyzal and add 20 mg. Prilosec. The nurse also told me to start the prednisone pack if I feel worse over weekend. I have an appointment on Monday. I’m nervous. It’s so hard to tell when to say this is definitely asthma and it’s been going on too long. 

     

  • LK

    Shadowcat,  Good that you called your doctor, were able to get across to the nurse what is going on and get a change in your treatment.  Hope it helps!! 

    I had that same problem when I spoke with a new nurse at my pumlo's office a few weeks ago.  She kept wanting to say if I am that bad then go to the ER.  No I am not that bad but just really tired of dealing with the tightness, shortness of breath and coughing.  Finally she understood after speaking with my pulmo.  It does get very frustrating wondering when it will get better.  Feels like the improvement increments are wiped away by any tiny trigger and you are left starting at the bottom or nearly at the bottom again.  You will get through this!!  

  • Melissa G

    Sending you lots of hugs Shadowcat! I hope the new treatment plans works and you feel better soon! 

  • Shadowcat04

    LK, thank you so much. It really helps to hear someone else’s similar experience. Before asthma, deciding to go to the doctor was usually a matter of counting days. How many days have I had a fever? Usually not enough to go in. Frankly, before asthma (over the last 6 months) it was how much pain will I endure before calling the gyn and saying we need to try something else. And, Melissa, thank you for the support!!!!!!!!

    i do not feel much better today, but at least listened to and there’s a plan and I know what it is. So, I guess I feel better mentally!

  • LK
    Shadowcat04 posted:

    i do not feel much better today, but at least listened to and there’s a plan and I know what it is. So, I guess I feel better mentally!

    Shadowcat,  Agreed!  Along with taking our meds and doing what we can sometimes just talking to my doctor to add/change something and have a plan for new developments really does help!  Hope you feel better!  

  • Shadowcat04

    Hi Melissa, thanks for checking on me. I saw the Nurse Practitioner on Monday. My spirometry and breathing tests were normal, though I was still coughing and short of breath. When she listened to my lungs, she said they sounded fine. That’s what they usually say. She could hear me coughing though and was very attentive to my problems. She gave me a duoneb treatment with albuterol and “something” bromide. I coughed a little at first and then the coughing stopped. I felt better for awhile. So, she mentioned cough variant asthma and wanted me to start Spiriva. I got a sample and that has been added onto everything else. 

    The coughing and SOB and exhaustion from coughing is no better. The coughing now seems more chesty and I sound a bit like a smoker (I’ve never smoked), sometimes I feel like I’m choking. So I’m not sure that this is the answer. 

    Im pretty frustrated- how can I feel so bad and my tests are almost always normal? Maybe they should give me the prednisone and see if that knocks it out like it usually does and start fresh? 

    Maybe I need different tests? CT scan? I don’t even know what else there is. 

    Sorry for the rant. Good news, we are traveling to Australia this summer for 3 weeks! Need to be well enough for that to be fun!

  • Melissa G

    Oh, that is incredibly frustrating! We go through this with my youngest dd. What testing have you had done so far?

    Could you call and talk with your dr about starting pred and see what happens? 

    Oohh, three weeks in Australia! That is so exciting!