I suggest that you visit the website of the largest bookstore in the
nearest city and type asthma into the search engine at that site. Purchase
a book (or books) that have been written by a doctor (asthmas specialist).
The book should
be written for people that have asthma. There should be detailed
information in that book that will help you to become an expert on asthma.
There might be advice in the book that will help you. If anyone can
suggest an excellent book related to asthma--please post the title of the
book and the name of the author.
Jason

Sometimes when your asthma isn't managed well by medication, and
you've tried every combination of drugs, it's because the asthma
is caused by bacteria.  Researchers think asthma has different
causes, one of which is bacteria.  It's possible that your asthma
is either caused by, or has been made worse by, bacteria.  Look
at the studies and the support forum at www.asthmastory.com to
learn more.

I'd like to extend my sympathy to you, it's a rotten illness to be
landed with.

Asmanex is another inhaled steroid, that's supposed to have a better
side-effect profile than fluticasone that is the current "gold standard".

It may be that you have "steroid resistant" asthma; this is a recognised
form of asthma where the patient doesn't respond to steroid drugs.
But you'd need to get your doc to confirm that, don't take my word for it.

If you have strong allergic reactions to the usual allergens (dust-mite,
pollen, etc) you can try allergen avoidance to cut down your exposure.
If you have pets, get rid of them.  If you live near a major road or
are otherwise exposed to smoke and pollution, move house (it's easy for
me to say but not so easy to do, I know!).  

If you're exposed to cigarette smoke in any shape or form, avoid the
exposure at all costs.

It sounds to me like you have the same virus infection trigger as me
(and most other people with asthma).  I find the best treatment is
to stay in a warm house, keep the heating up to around 20 degrees C or
whatever is comfortable, and get as much physical rest as possible.
I find that once I've got one of these wretched chest infections, any
physical activity such as driving the car or going shopping etc makes
it worse.  There's a syndrome where as soon as I start feeling better I
want to get back to my life and I go out for a drive or a walk or
to work or some other activity, and the next day my chest is much
worse.  It's boring but forcing myself to stay in and get complete
physical rest is the only way I've found to throw off the infection.
I'm lucky in that I can do my job at home over the internet (some of the
time, anyway) and I find this a real help, the additional physical
stress of going to work invariably makes the chest infection worse.

At work I'm in a sealed air-conditioned office where the windows don't
open, and colds go round like wildfire; I've taken to finding other
rooms on the premises to avoid sitting next to people who are coughing
or sneezing.  I'm convinced that nearly all of my colds are caught in
the work environment; after all, I'm there eight hours a day.
Avoiding the germy work atmosphere by working at home has definitely
helped cut down the number of colds I catch.

I also take an over-the-counter multi-vitamin/mineral supplement when I
get these infections but to be honest I don't know if there is any real
benefit.  I've tried all sorts of other things - zinc, manuka honey, high
dost vit. C, echinacea, fish oil - none seem to have any real benefit.

Another suggestion is to try taking a holiday at a ski resort; before the
advent of modern drugs wealthy Edwardian asthmatics used to go to clinics in
Switzerland; however the benefit was most likely not the special museli
diet or treatment offered by the clinic but more the complete absence of
dust-mites in the very dry high alpine climate zone.  I have a number of
friends who have gone on skiing holidays in the Alps and remarked that
their asthma improved a lot in the 2 or 3 weeks they were there.  
The humidity is very low and dust mites simply can't survive there.
Of course the benefit is only temporary unless you can go and live there!

My most important suggestion is to try to get specialist treatment.  
Find a hospital that has expertise in asthma (preferably one doing
research into it) and get on the list of the specialist doing the work.  
Of course you've probably already done that since you've been given all
the latest drugs like xolair.

Tony

It sounds like you have done the normal stuff like see specialists, look for
triggers, treid all the asthma med, explored other diagnoses, etc. A few
thoughts:

1) The suggestion of NSCEO to try long term Zithromax.

2) Look at other (non-asthma) meds.

I was going to suggest the diagnosis of steroid resistant asthma that Tony
did. If prednisone and all the other inhaled steroids didn't help I doubt
there is much chance that Asmanex will. Of course, it couldn't hurt to try.

Sometimes they try other immune modulators like methotrexate and cyclosporin
that they usually reserve for other autoimmune diseases in steroid resistant
asthma. Your history of seronegative arthritis and positive ANA make this an
especially interesting idea.

Plaquenil (hydroxychloroquine) is an antimalarial antibiotic that is fairly
benign, cheap, not really immunosupressive, and is used a lot in lupus and
rheumatoid arthritis as a "disease modifying agent". It isn't commonly used
for steroid resistant asthma so it might be a tough sell. You do have to
have eye exams every 6 months because a pignment can build up in the retina
that would be reason to stop it.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2
980288&dopt=Abstract

http://www.newsrx.com/newsletters/Respiratory-Therapeutics-Week/2004-12-27/12272
0043332RT.html

Recently there has been work suggesting a role for a chemical called TNF in
asthma. Drugs like Enbrel and Remicade might be effective and are curently
being researched. They are injected, do have significant toxicities, and are
very expensive (in the same league as Xolair) so they might be an even
tougher sell. http://www.medicinenet.com/infliximab/article.htm

You might be interested to know that you are not alone.
http://ajrccm.atsjournals.org/cgi/content/abstract/152/6/1753

Lastly, some people with steroid resistant asthma get symptomatic relief
from nebulised lidocaine.
http://www.respiratoryreviews.com/apr02/asthma.html

--
00doc

what were the warning about advair..i take it, but am being weaned off
because i have developed adrenal insufficiency..is this what you are talking
about..weaning off it, i am wheezy and feel awful!
pinkrianbow