Every day morning and evening I do one Advair, two puffs Flovent, and 4 puffs Intal. When asthma onsets, I add Combivent (4 puffs/every 4 hours), which I'm afraid of since it's contraindicated if one is allergic to peanuts and since it makes me feel very jittery, and 4 puffs Albuterol, the latter two of which are supposed to be done only every four hours. But I need them more frequently. I nave night-time asthma but lately it's happening daytime as well. I'm usually down two days in bed with extreme exhaustion. I mentioned a portable neb since I would need to bring it to work on bad days. I do have, thank God, a physician that will give me sleeping pills on bad nights. I was hoping to shorten the two days in bed by using a nebulizer. I live in California. I think you're both in Canada so we may have different names for different meds. I'm going to have to download some of the info you gave me and ask questions in a separate post because I didn't understand some of your advice.
Thank you both so very much for taking time to answer. I'll be back.
Problem with you going to nebulized solutions is you can't get advair as a nebulized solution.
You can't get flovent as a nebulized solution, and you can't get serevent as a nebulized solution.
The only corticosteroid you can get as a nebulized solution is Pulmicort, which comes as a drug suspension, and thusly can't be used in an ultrasonic nebulizer setup. This means that the portable neb that you would buy would have to be a lightweight jet compressor type unit.
Intal and combivent you can get as a nebulizer solution no problem. They can even be mixed, makes for a faster treatment.
It sounds to me like if you have to take 4 puffs of combivent every 4 hours (That's a puff an hour, or roughtly twice the recommended dose,) it's possible yo0u're not taking the puffers properly. Look into purchasing a spacing device before you get a nebulizer. They're a hell of a lot cheaper, and if that's all it takes to do the job, then great!
The different-names-for-different-meds up here ... most everything is called the same thing, except for Albuterol, which in Canada is called Ventolin. (Airomir is what 3m is marketing their HFA as but you can get some generic ones that are still called Ventolin HFA.)
Dear all: Thank you so very much for your valuable information. First, I believe I mislead you with my current med regimen. Twice each day, I take 2 puffs Flovent; 1 puff Advair; 4 puffs Intal. Once each day, I take pills: Singulair and theophyll (also known as Uniphyl). I use Combivent and Albuterol for fast action.
Yesterday, I did a lot of research on nebulizers on the web, all of which basically matches what you all have said. However, I ran across an article that noted that hormones can affect asthma and since I recently stopped taking them since I am postmenopausal, I had a eureka of sorts. I had been doing very well on the meds noted above, used with spacer, until I stopped the hormones. I'm going to start taking them again and see if how I do. If there is no substantial change, then a neb it is. It must be portable, however, since I spend at least 9 hours per day at work five days each week. It appears that the jet nebulizer is the one to go for. I'll also consult with the pulmonologist before making a final decision (he is currently on mini sabbatical for about another month).
If there are any women who are post menopausal, too, and even if you aren't, let me hear from you.
1. You cannot get Flovent or Advair (or even Serevent) in nebulized solution.
2. You CAN get combivent and ventolin in nebulized solution.
3. You CAN get Intal in nebulized solution. Intal is best taken more often than twice a day. Try spacing your puffs of Intal out, 2 puffs every 4 hours or something. What does your dr. think? On a neb this might be tougher to do, though.
4. You CAN get an inhaled steroid in nebulized solution -- down side is that it looks like you're going to be switching to Pulmicort if you go to neb.
5. When you switch to neb, because neb dosages and MDI dosages are different, make sure they keep an eye on your theophylline levels for the first little while to make sure they don't fluctuate.
THe hormones is a good thing to look into. Congrats on paying so much attention! :D
First: I love you ALL for replying. Can't thank you enough.
Now: Wrin: No, I don't do daily peak flows because with me, they are not predictive. I do have a meter, thogh. The PF can be great at 9:00 p.m. and at 4:00 a.m., I'm grabbing for the albuterol. What is ventolin? What is pulmicort? Rescue or long-lasting meds? Steroids or not steroids? The intal, 4 puffs morning and evening, is what the doctor prescribed. I hear you about medicating per the printed label, but that would be hard to do with my work schedule and distance from a place to rinse my mouth. Perhaps that's why he prescribed the twice-per-day regimen. What is pulmicort? Steroid or no? Does it have another name? Thanks for the heads-up on the theophylline levels. I saw that in the literature. Overall, my doctors say the manufacturers are covering their behinds with a lot of the cautionary info they hand out, but I'm included to think we have to be more proactive than they are.
All: So the nebs are used for both fast-acting meds (albuterol) and the longer, maintenance acting meds (Advair, Intal, etc.). I thought it was used solely for rescue med purposes.
Carolyn B: drat on the nausea thing. I want some damn relief from being sick for as many as three days per week each week! Yes, I am complaining.
Charleyhorse: what is atrovent? Isn't that combivent with another name?
Lyn HW: Yup. Guess it is harder for postmenopausals. Wouldn't you think all these highly educated types, and especially my allergist who is postmenopausal, would know about this hormone thing?
Cripes.
I'll be back. I'm having trouble getting the hormones reordered since I went off. I will let you know how this works out.
Ventolin is the brand name for Albuterol. I think they call it something like Proventil in the States? All over the world it's Ventolin/Salbutamol, and only in the USA is it Proventil/Albuterol. Silly kittens.
Pulmicort is an inhaled corticosteroid, sort of like Flovent, but a little different. I found I couldn't tolerate Flovent, so I'm on Pulmicort. Some people found they couldn't tolerate Pulmicort, so they're on Flovent. Flovent works a little FASTER, but neither one works really "better" than the other. Pulmicort is more classically prescribed for little ones because ... well, it's FDA approved for munchkin-type-sized people, and because it's the only corticosteroid that comes as a nebule.
Peak flows don't predict a whole lot for me either, unless I'm so desperately sick that it's not even funny, they don't work very well for me. Of course, it helps to that peak flows tend to add to my bronchoconstriction. Yum!
Intal, 4 puffs in the morning and evening is what your doctor prescribed. Ah. Okay. Nothing wrong with that, I just happen to know that spaced more closely together they tend to work better than high doses spaced far apart. The drugs are great, great ideas, but they don't work as horribly well as one would hope they did. Tilade (kind of like Intal) works a little better but tastes SO NASTY that most people just don't take it. It's not a very popular drug anymore. Nice thing is, you don't have to rinse your mouth if you take it, unlike an inhaled steroid.
Besides, even with an inhaled steroid, I understand that it'd be difficult to do with your work schedule and distance from a place to rinse your mouth -- but hell, if you have to, swig from a water bottle and spit on the ground, or swallow it. It's better than nothing. Or make an effort to eat after you take your inhaled corticosteroid. Whatever keeps the drug from SITTING in your mouth will do the trick.
Pulmicort can also be called "budesonide".
The theophylline thing .. well, they DO call theophylline the 'poison of asthmatics'. It's a derivative of caffeine. I'm sure you know you have to constantly have your levels checked, and I'm willing to bet you've had it explained why. It's because at low levels it doesn't work, and at therapeutic levels it works rather well, and at high levels it causes seizures and heart arrhythmias and death. Be ESPECIALLY cautious if you are put on antibiotics -- the list of drugs that interact with theophylline (to either increase or decrease blood levels) is as long as my arm. And I'm not exaggerating.
The manufacturers ARE covering their behinds with the info they hand out -- do you know what malpractise insurance in the states is like? It's ATROCIOUS. You go into surgery, dr says you're going to have a scar, guy comes out and sues for malpractise cos he has a scar. It's insane. I think the warnings are great to have -- butt-covering is NEVER a bad thing. Doctors aren't omnipresent or omnipotent either -- it's good that you know that -- we DO have to be very aware of what kind of things our medications are doing to us.
Nebs can be used for any drug that's available for nebulizer. That includes everything from Acetylcysteine (which smells like rotten eggs and is used to break up mucus) to racemic epinephrine (which is used to shrink swelling in the throat with things like croup and that) up to and including lidocaine (for things like vocal chord spasm). You could even theoretically take morphine IV solution and nebulize it and give it that way. Lots of things can be delivered via inhalation -- it's just that sometimes the solution has other properties that do things that you don't want happening in your lungs. Like nebulizing alcohol to get real drunk real fast -- it'd work, technically, but it'd also break up your lung's surfactant and make all your little alveoli collapse. Bad thing!
But yes, you've got that right. You can't get Advair for nebulizer, though. You can only get Pulmicort, which like I said, is kind of like Flovent but a little bit different.
Atrovent is not combivent with another name. Atrovent is combivent without the Ventolin in it. Atrovent and Ventolin are two bronchodilators that work two different ways -- Ventolin works by stimulating your sympathetic nervous system (hence why it's called a sympathomimetic bronchodilator) to force the muscles to relax. Atrovent, on the other hand, works by keeping your parasympathetic nervous system from getting stimulated, (hence why it's called a parasympatholytic bronchodilator,) which keeps the muscles from contracting as much in the first place.
The sympathetic and parasympathetic sides of your nervous system are in a constant state of opposition -- so one drug sort of works like taking your foot off the brake of the car and one drug works sort of like putting your foot on the gas. Both will make you go faster, just when you do both at the same time it works REALLY good.
This hormone thing is actually relatively rare (<3% of the population) and so it isn't the first thing that most people think about when it comes to exacerbations of asthma, until the patient actually comes up with something saying 'when I pms then I get all asthma-y'. They know about it -- just within the realm of all the information they have in their head, it isn't the first thing that comes to mind unless you specialize in that sort of thing.
Wrin: I am in contact with the doctor's office, and will be going in as soon as they can schedule an appointment.
You're right about the profit thing. Healthcare should not be profitable. We have a lot of horror stories about people being denied medical care, and I feel deeply about this issue. The right to access shrinks daily. In fact, HMOs have pulled out of the rural areas in California, leaving many residents without viable alternatives.
I started doing the Intal four times per day, as you suggested, and yes, I do it first thing when I get up. I'm afraid to cut back to six doses since I'm symptomatic every day now. I hear you about the prednisone, but I have to work. The doctor knows I'm doing this. I haven't had a chance to call the HMO about giving me two inhalers per month. The doctor was "astounded" at the peanut warning with Combivent. I faxed the package insert. He advised they did not have this information! This is one of the biggest medical centers in the country, a teaching hospital. I realize I'm jumping around here, but must leave the office now.
Thanks for replying. I appreciate your input greatly.
Again, of course, I am hurrying off to yet another meeting, but I feel human today for the first time in weeks. I don't know if hormones can kick in that quickly and the combined readministration of Intal can work so quickly, but nonetheless, I am myself today. The true test will come after I take the last prednisone. Taxes are due here in the U.S. April 15th and I've been to ill to address the issue. This is usually a time-consuming effort but nonetheless a wonderful result since I always receive money back and usually earmark this "pour moi."
Can't wait to hear from the doctor's office about the Combivent peanut warning. Perhaps they can prescribe something in its place. At any rate, they are setting up an appointment. This takes a long time because, as I said, the system here in the U.S. is so impacted.
Today I must find time to call the insurance company.
I've looked up the combivent thing -- you can still take Ventolin/Albuterol, it's the Atrovent in combivent that they don't want you to have.
From Rxlist: "Ipratropium bromide inhalation aerosol is contraindicated in patients with a history of hypersensitivity to soya lecithin or related food products such as soybean and peanut."
I have a feeling if you're not INCREDIBLY allergic to peanuts, it won't kill you. I didn't know about this, and I'm going to guess that a few ER staff I know of didn't know about it either. I think it'd be a good idea to take it under supervision of your doctor. I think they're afraid it might cause the same kind of reaction that peanuts would? Not sure! I can't seem to figure out WHY, but the documentation IS there.
I hope the Intal is working for you -- and the hormones, too. Like you say, the real test will come when you're tapered off the prednisone, but I've got my fingers crossed! If this means you can cut down on the amount of medication you take (the hormones) then by all means, right?
Wrin: well hopefully the word on peanut allergies and Combivent will get out and I'm glad I could potentially help someone else. I am highly allergic to these suckers and constantly read food package content info to see if they've slipped any peanuts in whatever I'm thinking of buying. I don't usually have a problem because I eat little junk food, but I do have to ask when I go to Thai or Chinese restaurants. Peanut oil is also a concern.
I read that you think I'm taking too many meds. I am also concerned about that as well but don't plan on cutting back on anything until I've stabilized and have several weeks if not months behind me of feeling well. It's been five years since I've had "several months" of feeling well. But I'm determined to try.
I would also like to do more exercise to strengthen my lungs, diaphragm, etc.; however, when I underwent some advanced breathing tests not long ago, my blood oxygen fell to 85% just walking around the clinic corridor and they made me sit down. This was without active asthma, no symptoms, feeling great. Any advice?
Don't worry about the combivent then; most asthmatics don't find it makes that huge a difference. It usually works better for people with things like emphysema anyway.
I do think you're taking a LOT of medications, but if they're all working, it's probably not 'too much' per se. You're doing this the smart way -- let's get under control, and THEN we shall begin to wean off some of the drugs.
Most low-impact cardio tuning exercises are wicked for your cardiovascular system. Your heart and lungs are irriversibly and unignorably intertwined. Take care of one and the other will have a slightly easier time of things. My favourite cardio tuning exercise is stationary bike -- winters up here are kind of nasty, and I've got some seasonal allergies, so this is what's kindest to my body. Lots of asthmatics swear by swimming pools, especially if you don't have a chlorine allergy, because the dust/pollen counts inside a swimming pool are so low.
