Prednisone/Asthma/Chronic Bronchitis

Two years ago, I contracted a bug (virus or bacteria) at age 49. Up until then, I had no history of asthma, allergies, or significant illness. I've always been an athlete running 4-6 miles everyday. The illness (what initially appeared to be a cold with dry cough) turned into pneumonia or severe bronchitis.  I almost died on several occasions from mucous plugs.  Initial diagnosis by the hospital doctor was asthma (intrinsic).  Allergy tests were negative. A second opinion from a university pulmonologist rediagonosed as chronic eosinophilic pnuemonia (pneumonia) (CEP) following one blood test that showed above-normal levels of eosinophils and the general effectiveness of steroids.

Several months ago, I was rediagnosed by yet another university pulmonologist as having intrinsic asthma as subsequent blood tests showed no elevated levels of eosinophils and lung scans showed no infiltrates.  Lung scans appear normal...I specifically asked about bronchiectstasis and I'm told it is not significant. So it now appears I have asthma combined with perpetual bronchial infections (chronic bronchitis).  The recurring bronchial infections are severe and dangerous because of mucous and spasms.  The day/night variation in my peak flows are a problem...I hit 550 PEF during the day but at night, I can drop into the danger zone around 300-350.

The combination of Prednisone and albuterol keep me alive but life is not pleasant.  When the bronchial infection clears somewhat, I can get down to about 15mg of Prednisone for a few days.  But the infection cycle begins again and I have to ramp up the Prednisone dosage.

I would be interested in learning if there are others with the combination of asthma and chronic bronchitis that are on Prednisone and what your dosage is.  I attempt to take the minimum Prednisone necessary to keep the air passages open but I continue to worry about the trade-offs.  Is it better to stay on high dosage and greater breathing comfort or "live on the dosage edge" (taking the minimum to breath) and suffer from the symptoms of asthma and chronic bronchitis.  I wonder about the bronchial damage from each bronchial infection compared to the long-term damage from steroids.  Not a great choice.

[treebranches]

I do not have chronic bronchitis but I've had bronchitis and only took prednisone for a small amount of time.  The best treatment for me turned out to be switching from Flovent 110, my normal dosage, to 220 whenever I felt a cold coming on.  If it did progress to get worse, then I would take Foradil (which really helped improve my night time lung function but typically isn't for a short-term treatment) in addition to whatever bronch medication they gave me and lot's of heavy duty cough syrup.

I used to also have a knack for getting pneumonia every year, so now I happily get a shot to prevent that and it's worked for me so far.

I have asthma that worsens when I do not exercise; perhaps you do too?  When I was still able to run (knee condition prevents it now) I'd do 4-10 miles a day and if I skipped a day, I'd notice.  The same applied for my dancing (was a professional ballet dancer before the knee condition) 40-60 hours a week: without it, my asthma worstened until I got it under control with a different medication.

The same principle applies to every one on this forum currently taking asthma medications and I'm saying it all the time now:

If your medicine isn't working, it's not working; talk to you doctor about changing something to make it work for you.  You shouldn't have to change your lifestyle to accomodate your asthma, you should be able to control the asthma to accomodate your lifestyle.

The trade-offs between chronic bronchitis and long-term steroids are a good thing to talk to a pulminologist about.  I honestly couldn't suggest any kind of answer with so many factors.

[Glynn_1963]

Hi Greg
    I’m in a similar position to yourself regards the worry about the long term side effects of Prednisolone.
    I remember reading somewhere on the net that to help minimise some of the side effects of Prednisolone it is a good idea to take calcium supplements when taking the Prednisolone, I ran this past my G.P yesterday and she agreed that it perhaps would be a good idea to take the calcium supplements.

    I have also been in touch with Asthma U.K regards what medication is the RIGHT medication regards Prednisolone intake. I was advised that it is best to take a large dose of Predisolone e.g. 40 – 50 mg for a few days to quickly bring the attack under control rather than a low dose that drags on and possible results in taking more Predisolone.

    I went to see my G.P yesterday armed with the information written above and unfortunately the answer I got was “ we don’t give prednisolone of that strength here” she did however allow me to take 40 mg for the first two days then reduce by one tablet a day until the course is finished.

Best of luck

[Glynn_1963]

P.S
I also have a chest infection on top of Asthma at the moment so I can sympathise with how you feel.

[muddypawz]

I have the exact same problem and have had it or several years.  Initially my asthma was triggered by colds - now it is also triggered by allergies.  My asthma is not the typical throat constriction per se - I get a persistent cough that seems to get worse as the day progresses.  What usually works for me is to immediately go on predisone (60mg) as soon as I get sick - and stay at that dose  for at least a week.  As I start to ween down if the symptoms start to come back I go back up a dose.  I goes this way for about a month until I can wean down with no symptoms.  When I'm triggered by allergies - a lower dosage of prednisone works (about 40mg) with other allergy meds (nasoqart cq, and Symbocort are my lifesavers!).  Hope that helps!

[jdrtwin1]

i've had the same problem with prednisone, as soon as I go lower than 20mg its all downhill again, i've been hospitalized 2 times in the last few months for my asthma/broncitis.

As of now to "control" the symptoms are accolate,advair 500/50,prednisone 40mg and fast acting inhalor proAir and albuterol nebulizer as well as oxygen support therapy at night time as needed.

The mucus plugs have seemed to calm down but the cough isn't completely gone, same with the wheezing.

[lara15]

I am writing from the hospital bed. I was admitted for a bronc to rid the plugs. Labored breathing and coughing/wheezing. This is the third year I have been hopitalized for the same thing. I got asthma 3 years ago and every February get bronchitis/asthma.
I have had 2 broncs in 4 days and have had solumedral IV and 4 different antibiotics, advair 500, previced, claritan and mucelex. Nothing is helping this time. The back pain is gone with the solumedral though.
The last time I was sent home I was weaned off to 60 mg of predisone to go home with and Advair and fluctnase. You should always take an acid reflux pill with prednizone. My souse didn't and ruptured his stomach! Gradually over 3 months the dr said to wean off but i cut back after 3 weeks. My face and feet just blew up.
Hope we find some good advice on here.

[lara15]

Dr says one more day in hospital. Doubed solumendral again and maybe tomorrow, 7th day I can go home. he is sending me home with Advai 250, symbacort and flonase. Wants 3 month checkups and breathing test so this should not happen in the future.
Yeah, prdenizone!
Hope this has helped someone.

[TheCrow]

Before I spout off, I wonder if you could say where you are living.
There is no use recommending places that are too far away from you.

TheCrow

[heartfluttersflyawayplz]

what is a musc plug i just got asthmas in oct  and seem to have a lot in my through, i clear it but it comes back i do not have a cough. thanks

[lara15]

How do you know you have mucilage plugs? It is when the bronchia fill up with phlegm like, sticky substance. I have it "washed out" usually every year. it makes breathing labored and you have a contant lump in your throat of phlegm.
I just stayed one week in the hospital and still have infection in lung so "the lump" is still there but the wheezing has stopped.
Hope this helped.

[heartfluttersflyawayplz]

ok thank you i must not have that because mine goes away and i feel ok than i feel musc in there again later but i can breath ok and no coughing . hope you get better and it goes away.

[dschxy]

I got H1N1 in spring 2009 and have had constant mucous ever since. Clear to white, consistancy of raw egg white. I have been treated for asthma for a year but found it difficult to believe that asthma is now a communicable disease. Latest findings showed no bronchial contriction was occuring, just mucous production. Singular provides some relief from my season allergies but nothing for the mucous. Will be moving on to my fourth specialist and still no diagnosis. I am worried that prednisone is all I have left for treatment.