Expert: Marc Rubin, RPh Asthma Educator - 1/14/2010

Question
It won't let me put another follow-up on my other question so I'll let you know what is going on in this new post.  

You asked about nasal steroids:
I have been using Nasacort (2 sprays each nostril, once daily) since November and it helps maybe 70% of the congestion.  Flonase does nothing to the congestion and Avamys helps but only for a couple hours.  I do find it hard to keep it in the right position, when I spray I can tell whether I'm in the right spot or not.  I am getting better and it seems to be working better lately.  I always like tips on how to take inhaler/sprays so if you have any tips I would defintely like to hear them!

For the asthma, symbicort seemed to be helping and then my peak flows dropped to 320-340 (71-76%).  Since she didn't want to increase my Symbicort 200 levels (already 4 puffs a day), she wanted to try a short steroid burst or add oral medication.  My doctor put me on 5 days of 50mg predinosone, to try and knock down the inflammation instead of adding another daily medication.  I'm three days into it and LOVING it!!  I can finally breathe and back up to 410 peak flow.  :D  We are hoping that it will settle it down and I won't need to add anything else.  I have noticed that my lungs are still very twitchy and more reactive than usual.  Tiny amounts of cigarette smoke that I could normally tolerant still are causing a decent coughing fit and sending me for my ventolin.  This is making riding the bus and being at the university lots of fun and hopefully will continue to settle down over the last 2 days of my prednisone.  

Sounds like we finally have the flare-up under control and I can go back to the way I was last year.  Thank you for all your helps so far.  

Answer
Hi Tamara,

Glad to hear that the short course of oral steroids is giving you significant improvement.

Regarding nasal spray technique, here is the guide to use:
1> gently blow your nose,
2> if it is a new unit or one that has not been used for 1 week or more, go through the priming routine to be sure you get a fine, even mist,
3> two options in spraying:
   a) alternate hand technique: use your right hand to spray into the flare of the left nostril, then the left hand to spray into the right nostril, or
   b) tilt your head forward, and while holding the bottle perpendicular to the floor (straight up), insert the tip, aiming at the BACK wall of the nose, and spray. NEVER spray up into the sinuses. This will result in an increased risk of bloody nose, as well as a fungal sinus infection...nasty!
4> gently sniff in, but no nose blowing for 15 minutes.

Your genetics determines which steroid will give you the best benefit, but at present, finding that one is trial and error.

In regards to the smoke on the bus, Canada has a way to go to change the laws respecting the health and welfare of non-smokers. May want to bring this to the attention of the bus company.

Keep in touch! (And happy New Year!)

Sincerely,

Marc