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Friday, 31 October 2014

My Latest Doctor's Appointment

Ventolin, the inhaler above, is the one that I use for quick relief. It contains Salbutamol and is the first inhaler prescribed for basically everyone with asthma. And for basically everyone with asthma, it works.

But for a tiny fraction of people, it doesn't. And that includes me.

And of course it includes me! I'm not exactly normal, am I? Eh well..

Back to the point. So I went to see the doctor, and I also got a chance to ask what they were treating me for, and what would happen next.

I told him about my concerns regarding Ventolin's inefficacy, and mentioned Xopenex (Levosalbutamol) to him. He checked it out and sadly, it would appear it isn't approved or prescribed in the UK, and in fact the only others that are for asthma are in dry powder form, which would mean me having to breathe in hard, fast and deep (oi, no innuendoes please!) and then holding my breath for at least 5 seconds, none of which I can do, least of all when I'm having an attack. He's told me to ask the nurse about this at spirometry, and she'll show me the different kinds of dry powder inhaler, how they all work, and we can see if there's anything that requires less of the above, which may just work for me.

He said that my treatment was currently for suspected asthma, and that diagnosis would be clinched if the steroid inhaler, Clenil Modulite (Beclometasone Diproprionate), was working i.e. if my lung function has improved, then I have asthma. He told me that at my next spirometry, should that be the case, I would get a combination inhaler. Combination inhalers include:

  • Seretide (UK)/Advair (US) - a purple inhaler containing Flixotide (Flovent, Fluticasone) and Serevent (Vertine, Salmeterol)
  • Fostair - a pink inhaler containing Beclometasone Diproprionate and Formoterol
  • Symbicort - a red and white inhaler containing Budesonide and Formoterol
  • Dulera - a green and blue inhaler containing Mometasone and Formoterol

Combination inhalers contain a mixture of a certain dose of a steroid (these aren't the kinds of steroids athletes use, nor the type that cause specifically bad side effects) as well as something called a 'long-acting beta-2 agonist' or 'long-acting bronchodilator', which does the same job as quick relief medications, but they keep your airways open over a longer period of time. These should never ever ever be used on their own i.e. without a steroid inhaler, and they equally should not be used for quick relief.

I guess I will probably get Fostair, because that contains the steroid I am already on, but hey, who knows?

He also did a peak flow on me, which hit a beautifully crap 200. That's great. Not. The first time I tried, I thought I could do better. The second time I tried and got the same result, the doctor remarked that it was a "very lady-like blow". The third time, I got the same result, so we figured it was probably the right one. I think I'll ask to do a PEF (peak flow) at my spirometry in..less than two weeks' time, to see if it has changed. I might ask for a peak flow meter to see if I'm better when I think I am and worse when I think I am.

The last thing the doctor told me is that I need to work out an Asthma Action Plan with my nurse. There's something like 85% of asthma patients in the USA who don't have an AAP (sorry about my USA figures, I just read a lot of American asthma blogs!) and this is really bad, because these people don't know when to up their dose or how, or when to go to the ER/ED/A&E vs. when to call their mum. So I need to sort that!

He ordered an eosinophil count to check I haven't inherited my mum's Eosinophilic Bronchitis (that's even harder to type that it is to understand!) and also a Specific IgE test which looks for allergies to dust mites, cats, dogs, pollen, the top 12 food allergens, and some other stuff I could be allergic to/triggered by.

Well, I'll keep you in the loop!