Watch your Step![down]: Part 1
I try to be medically unremarkable. I want to be the boring patient that returns to the office every 6 months to a year and has few medication changes. Take my medications twice a day and play by the rules and know what to expect from life and lungs. I am always emotionally torn when I head into a regular check up with my asthma doctor. I’m relieved to get a clean bill of health and sent along my merry way. There is always the little voice in my head that says what if you’re wrong and you aren’t actually feeling fine. So far this voice has been wrong. I’ve been feeling fine and the spirometry numbers have been good. My lungs have sounded clear.
I first asked about stepping down my asthma treatment while I was still doing allergy shots. At the time I was on an oral antihistamine, oral leukotriene inhibitor, and a combination steroid/ long acting bronchodilator inhaler. In my mind I had been stable for over a year. My medical team felt that keeping me on those medications was best for my long term asthma control and lung health. I felt defeated to be stuck on some pretty strong medications. In my mind I had been stable for what felt like an eternity.
I even as I felt defeated by not getting to decrease my medications, I did not give up on being a compliant patient. I needed to slog through and to my part to keep up with my treatment. That was the only way I had a chance of reducing my medications. No it’s not fun or easy but I tried my best to keep my eyes on the prize of less medications. On that combination of medications I had good asthma control with tolerable side effects. My voice was kind of raspy and frequently disappeared. I have almost no alcohol tolerance. The flip side was that I was finally well enough to work out and enjoy the outdoors.
A few more uneventful years of good asthma control. I walked into my 6 month check up after we had decided that my course of allergy shots was complete. To my surprise after the exam my doctor said it was time to transition to a steroid only inhaler. It almost didn’t feel real that I was in a place where we could step me down to less medication.
Over the next month or so I traded combination inhaler doses for steroid only. Nothing bad happened. Another month went by with no serious asthma troubles. Two months turned into six and before I knew it I was sitting on the exam table at the asthma doctor again. It had been a year without a combination inhaler. My perception of having a good year matched good lung sounds and spirometry numbers.
The long game had paid off! I had stepped down my therapy. I wouldn’t be going back to the raspy voice and the combination inhaler. This was a huge relief that we had made the right call to change my medications. How did it feel to work with your medical team to change your asthma medications?