Expert: Marc Rubin, RPh Asthma Educator - 4/17/2011

Question
We live in Edinburgh Scotland. No pets. I have daughter 11. She has number of sever allergies(dairy,seafood,nuts,penicillin).For past 6 years she use seritide 25/50 4 puffs daily .Her asthma was well controlled.But now her asthma starts worsen significantly.For past 5 days she have 40mg of prednisolone,seritide, for past 2 days -10 puffs of salbutamol 4 times per day plus seterizine.Her oxygen level is 98-95%,but she is coughing permanently,has pain in the chest,pick flow is low.10 puffs of sulbutamol does no improve her pick flow at all. It is all come with out any warning.Is it possible she developed adverse reactions to seritide ?. What tests she can have to understand what is going on ? Why oral corticosteroids do not help .
Thank you
Irina

Answer
Hello Irina,

Pollen season has hit your area beginning a few weeks ago. Right now, Alder & Hazel plants predominate, and in the next week, there will be an increase in Birch.

Are there any pets in the home? Anyone smoking in her environment? Has the home been checked for mold?

Is your daughter using a spacer chamber with her Seretide and salbutamol inhalers? If now, has the physician verified that the technique she is using is correct? Up to 75% of patients do not use the devices properly, leading to treatment failure.

I see that you indicated that she is on the antihistamine cetirazine. It doesn't work for everyone. The doctor may want to try fexofenadine instead.

Is your daughter using any nasal steroid sprays? Where the Seretide reduces inflammation in the lungs, the steroid nasal spray (such as fluticasone) reduces the inflammation in teh nose and sinuses. If this is not brought under control, it will trigger the lungs to react.

Another thing to have the doctor to consider, after evaluating her device technique, would be to try adding Montelukast (in the US: Singulair) to her therapy. It is taken at bedtime, and works in conjunction with the Seretide to reduce the inflammation in the lungs.

Is your daughter allergic to corn products? In the US, all the steroid tablets contain corn starch, and if she is allergic to corn, then that is probably the reason for the therapy failure. The way around it is for the doctor to prescribe dexamethasone in the liquid form. The pharmacist should verify that the formulation they dispense is indeed corn free.

Finally, with her level of reactivity, I think the best approach would be to have her started on allergy shots (immunotherapy), to reduce her response to the allergens, It is a long-term process, but results in a significant decrease in the need for meds over time, and is the only therapy known that reduces the risk of tissue damage in the lungs over her lifetime.

Hope this helps!

I'll be unavailable to answer any questions until Wednesday. Looking forward to your responses.

Sincerely,

Marc