I am seeing my GP in a couple of weeks to discuss my inhaler. I would welcome any thoughts from the community to consider before I go.
There are 2 issues. The first is recurrent thrush and hoarseness from my current inhaler, which is dry powder. I will be discussing a switch to pressurised with a spacer. I already gargle etc after every dose.
The second, more major (to me), issue is that I have been trying and failing to regain fitness after my pneumonia in mid 2024. I have been reviewing all my spirometry from 2011 and a 2024 review done 6 months after the pneumonia. All the figures are broadly similar. I got fit after 2011. Why can't I do it again now?
What I have realised is that while the major readings (FEV1 etc) put me at moderate obstruction, my small airways work only at just over 20%. Maximum improvement with bronchodilator gets them up to 30%. I have hyperinflation/air trapping. RV 150%. This is causing me to 'hit a wall' quite early when exercising. Or even walking, sometimes, although my oxygen sats are always fine.
AI has been quite helpful and given me the analogy that my engine (heart and main parts of lungs) is fine but I am trying to operate through a clogged exhaust (the small airways). It has suggested a step up to Trimbow, because of the LAMA element. I am currently on Fostair and the consultant did say that Trimbow would be the next step.
For some reason I am a bit reluctant to move to Trimbow as it feels like the 'last resort'. I am aged 57. AI points out that stepping up meds to protect what I have rather than waiting until things get worse makes a lot of sense. And incorporating a LAMA does seem to make sense, given my small airway problems and hyperinflation.
My cardiovascular fitness has dropped off a cliff and is now starting to hamper my ability to maintain/build muscular strength.
I credit my fitness for getting through pneumonia as well as I did so I really do not want to have to accept that my current state is as good as it gets. Any future bout of pneumonia would be very unfunny indeed.
Local healthcare refuses to send me to pulmonary rehabilitation but I work with a fitness trainer and I think we know what needs to be done. Doing it is the problem.