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Old 11-11-2012, 03:54 AM   #1
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Asthma increasing as prednisone tapers?

I'm tapering off the prednisone now. I didn't have a trace of asthma on 40 or 30mg, but now I've dropped back to 20mg... and I'm noticing that the early morning wheeze is starting to reappear. I seem to be fine during the daytime when I'm up and around, but about 4-6am I wake up coughing and wheezing. This morning I was wheezing enough to take a hit of ventolin. Is this to be expected? I'm also clearing my throat a lot today.

Current asthma meds are prednisone, advair, singulair, prilosec, ventolin if needed, and tessalon perles for the cough. I started them a week and a half ago.
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Last edited by Kaji; 11-11-2012 at 03:55 AM. Reason: adding meds

 
Old 11-11-2012, 09:22 AM   #2
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Re: Asthma increasing as prednisone tapers?

That is not usually a problem for me. It really depends on how bad the flare is though.

In the last 9 weeks, I've had problems with asthma and a chronic cough. I went from Dexilant once a day and no asthma meds to taking Dulera (switched from Advair 500 after a month), Singulair, Ventolin, Dexilant twice a day, tessalon perle, rounds of 2 types of antibiotics--in case there is a hidden bug, and a round of Prenisone. It seems like I'm on a very simlar track as you.

What time of day are you taking your Singulair and Prilosec? If you have problems in the a.m., you might want to discuss evening dosages with your do if you aren't already taking them then. Even though I feel no symptoms at all, multiple rounds of testing have shown I have had some pretty severe acid reflux happening between 2-4 a.m. I'd wake up coughing like crazy from that. Because my reflux and asthma symptoms are the same, it is always hard for me to figure out totally what is triggering my flares. Usually it is a combination of things.

Also, do you have a nebulizer. When I get really bad, I find it helps me more than just my puffers.

Hope you feel better.
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Old 11-11-2012, 10:35 AM   #3
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Re: Asthma increasing as prednisone tapers?

I take the singulair and advair at eight in the evening, but the prilosec instructions said to have it an hour before dinner, so that's about five in the afternoon. I'm going to try switching my prilosec to bedtime and see if that makes a difference. I don't have any notable acid symptoms after I eat unless it's something REALLY greasy. The only time I've ever used a nebuliser was in the hospital. It gave me enough ventolin to make me shake like a leaf (just using the puffer doesn't bother me unless I have to have it like six times in the day), but it was wonderful for my breathing. If I have any more problems I'll talk to the pulmonologist about it. But I'm really HOPING that this is going to improve. I've also started writing down my occasional meds etc in a little diary to keep track.
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Old 11-11-2012, 02:54 PM   #4
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Re: Asthma increasing as prednisone tapers?

So you aren't take the advair in the morning as well They usually start people on 2 puffs AM and 2 PM. I'd ask my doc about upping the meds. That very well may be your whole issue.

 
Old 11-11-2012, 02:58 PM   #5
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Re: Asthma increasing as prednisone tapers?

Oh yes I am... I just forgot to put it. But apparantly it's not the strongest one either? It's 250/50, one puff morning and night. If this doesn't improve I'll definitely be addressing it on Friday.
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Old 11-11-2012, 06:56 PM   #6
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Re: Asthma increasing as prednisone tapers?

Definitely ask about that. They usually, no matter the med, start you on 2 puffs AM and 2 puffs PM. Then once under control you drop one puff AM and see if you can tolerate that. Then one puff PM and then the AM puff to get down to one puff in the PM. That can take a couple of years. It did for me but I am down to the one in the evening. Am surpised with all the trouble you are having that you are one 1 puff twice a day.

 
Old 11-11-2012, 07:00 PM   #7
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Re: Asthma increasing as prednisone tapers?

DEfinitely ask about that. I am very surprised that you are down to 1 puff twice a day. Doesn't your asthma action plan tell you to go back to 2 puffs twice a day when you have a flare? I'm down to 1 puff a day ( it took 2 years to get to this level) but I have instructions to go to 1 puff twice a day if sick and as many as 2 twice day.

 
Old 11-11-2012, 07:21 PM   #8
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Re: Asthma increasing as prednisone tapers?

I don't have an action plan other than my own 'if you need ventolin less than 4 hours after you took it (or more than four times in 24 hours), don't be an idiot - go straight to the ER so they can handle it.' It's the first time I've had to use it after my last self-care debacle. Remember, the last pulmonologists verdict after a couple of months of symbicort was that I 'didn't have asthma' and didn't need to do anything long-term. I wrote it off as a once-off, so I was NOT impressed to have it rear its head again not even four months later, and for no discernable reason. I spent a week waiting for the respiratory infection to show up, and I didn't even sniffle.
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Old 11-11-2012, 08:02 PM   #9
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Re: Asthma increasing as prednisone tapers?

Maybe you need to change pulmonologists!

 
Old 11-12-2012, 04:11 AM   #10
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Re: Asthma increasing as prednisone tapers?

I already have! The old pulmonologist was nice and very thorough (he wanted to do all sorts of expensive tests that I decided weren't necessary at the time because I was sooooo much better), and I'm sure if I went back to him now he'd be pushing for them again... but all my other docs are with a different hospital network so it's easier to change.

BTW, one night isn't a statistical sample, but I did NOT wake up during the night last night and I don't seem to be wheezy this morning. Strongly suspecting reflux now.
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Old 11-12-2012, 05:24 AM   #11
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Re: Asthma increasing as prednisone tapers?

Reflux could certainly cause it. You could also up your advair to 2 puffs twice a day and see if that helps.

 
Old 11-24-2012, 02:54 PM   #12
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Re: Asthma increasing as prednisone tapers?

Five years ago I had to be put on prednisone about every 2-3 months because of my asthma. I made a decision one day to clear out my home of cleaning chemicals and replace them with some better, safer products I found. I haven't been placed on prednisone since then.

 
Old 11-24-2012, 03:34 PM   #13
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Re: Asthma increasing as prednisone tapers?

I just wanted to second that an action plan can be really helpful, ask your dr for one, and add that normally you aren't supposed to take any more than one puff of advair twice a day, instead you would need to go to the higher dose. Because while you want to up the inhaled steroid part (flovent) you don't want to double the bronchodialator (servant) dose. If needed, you could ask the dr to change you to advair 500/50. Also I didn't see you mention how long your prednisone taper was? My old allergist used to have me on a long gradual taper, and when he retired, the new dr put me on 60 for 2 days, 40 for 2 days, 20 for 2 days and off. That was awful, I was not ready to taper by 20 mg after 4 days, so I just called the office, described what was going on, and she changed the taper to a slower more gradual one. I normally start at 60 or 40 and then decrease by 5 mg every other day. I really think that everyone is different, and you just need to find out what works for you.

 
Old 11-24-2012, 03:56 PM   #14
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Re: Asthma increasing as prednisone tapers?

I was a bit worried that I'd keep getting worse, but I haven't had any major problems. The specialist said my lungs were perfect when I had my followup. I just need a puff of ventolin here or there, a couple of times a week. And the regular medicines. He wants me on them for three months and then I'll see him again.
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