Doctor doctor doctor. Specifically a pulmonologist. If he’s having trouble breathing, he is not on the right treatment regimen, and it’s possible he’s doing some damage to his lungs in the meantime. My pulmonologist always loves to go on about how GP’s undertreat asthma because they’re used to giving the smallest effective dose of whatever they prescribe, but just because someone’s breathing is better it doesn’t mean it’s as good as it should be – or could be. And asthma patients who are used to living with constant wheezing and respiratory distress feel things must be working because they have only frequent wheezing and occasional respiratory distress, but they could have practically none if their meds were right.
Short answer – yes, the doc can help. There are more meds, there are higher dosages, these come with mild side effects for most, and if someone’s breathing limits their activity in a serious way, they’re not on the right medicine. (For one thing, it’s going to lead to weight gain, which will make everything worse.)
Also, you don’t mention what “several years ago” is, but the drugs have improved greatly in the last couple decades, and asthma is a cash crop for pharma companies (increasing incidence, lifelong condition, dire consequences for those who are untreated, etc.), so they’re coming up with new drugs all the time.
The post you quoted was one where I mentioned taking a slightly increased dose of the steroid inhaler, not prednisone. Both are corticosteroids of course but prednisone is usually systemic (pills, syrup or whatever). Hard to say how quickly an increased dose of a steroid inhaler would start to help; a quick search suggests within a few days. The time or two I’ve done that, it’s been with caution (because worsening asthma symptoms are kind of a big Red Flag!!) - and it either helped within a few hours, or I wasn’t gonna get much worse anyway.
Prednisone will start working relatively quickly. I don’t know what the official expectation is but in my case I’ll start to feel a bit better within a few hours. Certainly less than 24 hours.
Antibiotics…standard disclaimer: antibiotics are NOT indicated for most asthma flares. Only when there is a known or strongly suspected secondary infection going on. Obviously, when you’ve got the airways narrowed and inflamed, and increased mucus due to a respiratory infection and the inflammation, it makes a nice cozy spot for those bacteria to thrive, but it’s not usually a first-line treatment. My own history has shown that sometimes I’ll improve just on antibiotics, sometimes just on steroids, and sometimes I need both. When I was younger, and the asthma was being triggered by cats at home, steroids would knock the cycle out and I’d feel better for a while, no antibiotics required (ultimately we rehomed the cats, I got on better controller meds, and I’ve generally been much better). As an older adult, my flares are virtually always tied to a bad cold that seems to turn into bronchitis. I’ve had it treated a number of times by just throwing antibiotics at it and those usually help within 48 hours, but sometimes I’ll get worse again (because the inflammation is still going in) and we’ll have to throw prednisone at it. Or they’ll put me on prednisone and I’ll get a little better then go downhill again, because there are apparently still bacteria playing around.
Getting back to the specific question (what antibiotics): Biaxin (clarithromycin) is one I’ve taken a few times. Most recently I think I had Avelox (moxifloxacin) because I’d had Biaxin just a couple months beforehand. Zithromax (azithromycin) is also used; last time I had it was 5ish years ago and it didn’t help much (I wound up switched to Biaxin + prednisone) but I have a friend who is on a long-term low dose of the stuff for lung issues.
Back to the OP (and other asthmatics): you really really need to develop a plan for how to handle your asthma on a daily basis, and what steps to take if you get worse.
OK I have yet another question: how are you affected by other irritants that you are not allergic to?
I think cigarette smoke really affects him (frankly, it affects me too, stinky smokers), but also for example, downstairs there is a small garage. Sometimes when a car is broken it’s really smoky and stinky and that affects him too. I’m thinking I should probably call the council or something, because it seems strange to me that that would allowed, otoh it’s their business so there’s probably not much we can do. It doesn’t come in the house or anything, it only affects him if he walks past.
Avoiding cigarette smoke is not too difficult, and walking past the garage while they work on a stinky car is not a frequent thing. But I’m wondering how these things affect others and what you do to avoid situations?
Again, we have an appointment on Thursday and I’m writing down all your helpful comments to discuss. I’ll ask if we can see the pulmonologist, I see what you mean, Cliffy, that GPs tend to prescribe low dosages. Also, “several years ago” is about four years ago he was diagnosed. His meds have been checked since then, the last time being about a year ago. I can’t thank you all enough!
The absolute best way to deal with environmental triggers is to be on the right daily meds, and then hit that rescue inhaler early if you feel a wheeze coming on. Beyond that, avoid what you can, but sometimes you can’t. (And sometimes things will come out of nowhere – about a year and a half ago I stayed in a perfectly clean, not overly perfumed hotel for one night and it brought on the worst asthma I’d had in years.) If you know you’re going to visit a place that has triggered you, or if they have a cat or shag carpet or whatever, it’s not a bad idea to take a prophylactic hit of the rescue inhaler before you go. Better yet, invite them to your place.
Obviously some things can be avoided, e.g. not letting people smoke in your house if that’s a trigger (or, well, if you just find it gross beyond belief like I do). Mold remediation if appropriate. Make sure furnace / air conditioning filters are changed reasonably regularly - when we were newlyweds, our a/c was a window unit in the bedroom, and my husband heard that you could just wash those filters vs. replacing them. Every damn time that thing kicked on, I started a violent sneezing attack. But I’m not bitter (and now that he has allergies too, he changes that furnace filter monthly).
HEPA filters may (or may not) help. Certainly they will remove particulates from the air, but whether they do enough is up for some debate.
And if you’re around a place where you’re exposed to a lot of allergens, a shower may help to wash them off so they don’t continue to bother you beyond the immediate exposure. That’s what I do when I’m somewhere and get a dose of fur therapy (I am violently allergic to cats… but I looooooove cats :().
Thanks again all! Mama Zappa, you need to find a hypoallergenic cat!
And Cliffy, after what I posted in post 19, you saying “shag carpet” had me in hysterics. This may not be funny if you’re not English, but I have tummy ache from laughter. Yeah ok, we won’t be getting a shag carpet then.
Oh, I do so wish I could. The Siberians are supposed to be fairly good but there’s no guarantee and I’d hate like hell to get one and find it made the family miserable and me dangerously sick :(.
and course no shag carpet - you don’t want your faces and lungs to be near a dust-mite mine like that! A yoga mat with a replaceable fabric cover would be much better
