Biologic switching
Hello
I have been having a difficult time coping with asthma symptoms during the switch between Nucala and Tezspire. I have severe atypical asthma and suffered a near fatal asthma attack 3 months ago. I have been on steroids since while I await for approval of a biologic change. The plan was to have the first dose of the new biologic around the same time as the as the old biologic was due but instead it was delayed for over 2 weeks. The past two weeks I have had increasing symptoms. I am a nurse in a busy PACU and have been especially symptomatic while I am working. The pulmonologist recommended I stay home til I feel better. Here is the problem, I feel ok as long as I am doing nothing but rest. I begin having chest tightness, coughing and SOB with minimal activity despite increases in steroids. Is this normal? Or just my anxiety?? Has anyone else experienced this ?? Thank you for listening
I'm so sorry you're going through this. After everything you've experienced over the past few months, I can imagine how stressful and frustrating it must be to have your symptoms increasing again, especially while waiting for your new biologic to be approved. I wouldn't automatically attribute what you're describing to anxiety. Chest tightness, coughing, and shortness of breath with minimal activity deserve to be taken seriously, especially given your recent severe attack and the fact that you're still experiencing symptoms despite increased steroids.
I really encourage you to contact your medical team and let them know what you are dealing with. I know it's difficult when you want to get back to work and your normal routine, but please don't feel pressured to push through this. If you're having severe difficulty breathing or struggling to speak, seek emergency care.
I hope you get some answers soon and that your treatment transition brings you the relief you've been waiting for. I also wanted to share a few resources that may be helpful as you navigate this treatment change: https://asthma.net/treatment/biologics // https://asthma.net/living/asthma-action-plans // https://asthma.net/basics/attacks. Sending you so much support. Please keep us posted if you can. -Kimberli (Team Member)
Thank you for your response. I have been in close contact with my pulmonologist during this whole time. They have been guiding all adjustments to the steroids and closely monitoring my symptoms. Thankfully, I have not had any severe symptoms (severe SOB or difficulty speaking) which is probably what is causing confusion in my mind. Luckily, the symptoms have been mild but always relieved by my rescue inhaler or nebulizer. As a nurse, you learn to push through because calling out sick puts a burden on your colleagues to work short ( so I will hear about that when I return to work) Yesterday, I was teaching nursing students in the clinical area and experienced mild chest tightness all day unrelieved by my inhaler and fatigue no SOB, difficulty speaking. When I got home, I did an albuterol nebulizer treatment and the chest tightness was finally relieved. I called out sick for my 12 hour staff nurse shift because it is far more physically demanding than teaching and I was concerned about the symptoms. Today, I have been resting and no symptoms ( thank goodness) but now I am wondering if I called out prematurely. Is it typical to have symptoms like I am experiencing when “washing-out “ from one biologic and transitioning to another? I want to do what is best for my health, but making these decisions is hard for me. I don’t like to be the patient and work has a strict out sick policy 3 days per rolling calendar year and today was my 4th day. The last MyChart message with the pulmonologist regarding the symptoms, she directed me to increase the steroids from 20 mg to 40 mg for a few days and stay home til I feel better. Well, I felt better with the 40 mg prednisone but continue to have breakthrough symptoms at 20 mg. Does this sound reasonable to have symptoms? While I deserve to have some anxiety about the situation, I don’t want my decisions that affect my job to be rooted in anxiety. Thank you for listening to me
I think it's important to give yourself some credit for recognizing when you need to slow down, especially when you're so used to being the person caring for everyone else. I can understand why missing another shift is weighing on you, particularly with the pressure you feel from work, but you didn't make that decision without reason. You were experiencing symptoms, your breathing wasn't responding as expected to your inhaler, and your pulmonologist specifically advised you to stay home until you felt better. I can't say whether these symptoms are expected during a biologic transition, but I think that's a really important question to keep discussing with your pulmonologist, especially since you're noticing symptoms returning when your prednisone dose decreases. I'm glad you're feeling better today, and I hope you can give yourself permission to prioritize your health without feeling guilty about it. You deserve that same care and consideration you give your patients. Always here to listen! -Kimberli (Team Member)
Thank you
