What should I do if my asthma flare is not settling?

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

From what you have described, you are having an uncontrolled asthma flare, which means your asthma is suddenly acting up, and your usual inhalers are not able to control it.

If you are short of breath even while resting, cannot speak full sentences, feel dizzy, or if your SpO₂ (oxygen level measured by a finger-pulse device) is below 94 %, please do not wait at home.

You should go to the nearest emergency department. There, they can check your oxygen, give nebulizations (a machine that turns medicine into a mist you breathe in), and may start a short course of oral steroids (strong anti-inflammatory tablets that quickly reduce swelling in your airways). These are the proper steps during a serious asthma attack.

Since Budamate 400 (a high-dose inhaler containing a steroid + bronchodilator) and Telekast-L (which contains Montelukast, a medicine that reduces allergy-related airway swelling) are not controlling your symptoms, we must first ensure the basics are correct before changing treatment.

Please check your inhaler technique; small mistakes like inhaling too quickly, too slowly, or not sealing your lips properly can reduce the medicine’s effect by more than half. Use a reliable demonstration video if needed.

Think about possible triggers that might have caused this sudden attack, things like dust, a cold or viral infection, strong smells or perfumes, weather changes, acid reflux, or missing doses. Identifying the trigger can help prevent future attacks.

When someone continues to have symptoms despite a high-dose ICS–LABA inhaler (ICS = inhaled corticosteroid that reduces swelling, LABA = long-acting bronchodilator that opens airways) plus Montelukast, the next medical steps usually include:

1. Confirming correct inhaler use and routine.

2. Identifying and eliminating triggers.

3. Temporarily shifting to a triple-therapy inhaler (adds another airway-opening medicine) if needed.

Because your asthma seems difficult to control, your doctor may also advise tests like:

1. Total IgE (Immunoglobulin E) measures your allergy level.

2. Aspergillus-specific IgE checks for a fungal-related allergic condition called ABPA (allergic bronchopulmonary aspergillosis).

3. Chest X-ray.

4. Spirometry, a breathing test that measures lung function.

Please also tell the doctor if you have reflux, thyroid issues, blood pressure problems, or diabetes. These comorbidities (other health conditions) can make asthma harder to manage if not controlled.

For now, sit upright, stay as calm as possible, and use your reliever inhaler exactly as directed. If at any moment you feel, “This is getting worse,” or “I do not feel safe,” go to the emergency room immediately.

To guide you better, I need to know a few important things:

1. Have you checked your oxygen saturation (SpO₂) at home? What was the value?

2. Has any doctor ever checked your inhaler technique in person?

3. Do you know your common triggers - dust, pets, perfumes, reflux, infections?

4. Have you ever had tests like IgE, chest CT (computerized tomography), or spirometry?

5. What were the results?

I hope this helps.

Kindly revert so I can assist you further.

Thank you.