Asthma sufferers, catch your breath and gather round

I am not seeking medical advice, but rather your own experiences, including any that might give me some good ideas.

Background: I am an overweight 59-year-old male with asthma. I also have sleep apnea. Before I was diagnosed with sleep apnea but while I was exploring reasons why I might not be sleeping well, my doctor who then was said I should use an asthma inhaler at night to help me sleep (I had a childhood history of asthma, and it kept me out of the military during Viet Nam). He prescribed Albuterol. Before I started using it, I was rarely aware of any asthma symptoms. After I started using it, I experienced asthma symptoms all the time when I wasn’t using it. In other words, it made the condition worse. I then started using Serevent twice daily which controlled the symptoms pretty well, but I asked my doctor (a different one) for something else when I found out that Serevent could stop working suddenly and with disastrous results (i.e. death). So now I take 10 mg of Singulair once daily. This works pretty well.

Problem: recently I have been having (apparently random) instances of asthma symptoms, especially in the evening or at night, making it difficult to sleep again. I use a CPAP, and I keep it clean, and I keep my sleeping area clean. I don’t understand why these instances keep happening. I am starting to feel like I did before using the CPAP, sleepy during the day, too tired to go to the gym even though all I have done all day is sit at my desk, and so on. My energy is much lower, and I have been putting back on weight that I had lost. There is also more stress at work due to the constant possibility of staff cutbacks; if there is a psychological element to this, that is a good candidate.

I will be seeing my doctor again in January for my annual physical, and I will discuss it with him then. I’m thinking I should maybe go to a specialist, but I also don’t have confidence in a lot of doctors, who only seem to know how to prescribe the strongest possible medications without regard to the longterm effects. I don’t want a temporary fix, I want a long-term strategy to manage my asthma to minimize its impact on my life.

I am very interested to hear your reactions to this (sorry it’s so) long story. Your experiences are especially interesting to me.
Roddy

Because it is especially in the evening or at night, I want to ask you if your new symptoms coincided with turning the heat on. Sometimes a change in humidity in the air or an increase in new dust/mold/what have you particles from the vents can set off a really unpleasant cycle such as you describe. Also of course when the weather is bad people stay indoors more during a time when the hosue is less likely to be well ventilated.

Have you ever had allergy testing done? If not, you might want to look into that. I know it really helps minimize asthma symptoms when I treat my allergies properly. Particularly if you are allergic to something in your sleeping area, like dust mites, this could make a big difference. You might want to look into dust mite-proofing your bed, and washing your bedding, pillows, blankets, etc. more often and in hot water.

I feel so sorry for you. I’ve got really bad Asthma and have to take Bricanyl and Symbicort for it, these give me the shakes. I also have problems sleeping for which I tried herbal sleeping pills - they kicked started me back into a normal sleeping pattern for a short while but is no way a long term solution and is something which should always be discussed with your doctor first. I would def. see your doctor about allergy testing as I know first hand how bad this can make your Asthma. Sometimes swallowing something the wrong way can set off an attack.

I’ve done some research on the Asthma UK website and have joined as a member on a few Asthma charities. Perhaps speaking to an Asthma specialist would set your mind at ease.

Let us know how you get on :slight_smile:

Warning: IAAD, and I treat a lot of asthmatics, and I oversee our health system’s treatment of all of its asthmatics.

The symptoms you describe sound like someone who is on inadequate maintenance medication. Singulair is great, but some folks need more. Studies have indicated that the best first line maintenance medication for asthma is inhaled steroids.

If, after interviewing, examining, and testing an asthmatic patient with the sorts of complaints you’ve brought up, I was still of that opinion, I would consider getting the person on twice a day inhaled fluticasone, in addition to continuing the singulair.

I’d also advise the patient to not fear serevent. It’s a good med, and helps far more folks than it hurts. Keep in mind that 5000 people die in the US every year due to asthma attacks. Many of them are folks whose asthma has mostly been a mild inconvenience until they had their fatal attack. So I’m very much into good asthma control.

I’d also evaluate the patient for possible reflux disease which might be triggering symptoms, and make sure their CPAP settings were correct.

Just my two cents.

I’m an asthmatic, not a doctor, but I agree with everything QtM says.

Back when I was first diagnosed, they were much more hesitant to prescribe inhaled steroids as the primary medication - this was 20+ years ago and they were a relatively new option. Nowadays, the inhaled steroids are pretty much the first line for anyone with anything more than occasional symptoms. And even for someone who doesn’t need them as a maintenance med, it’s useful to have them around to start when you have any sort of flareup (or the potential for one). My daughter is on a daily inhaled steroid as she starts coughing uncontrollably if she is not (she’s also on antihistamines and singulair). We were not surprised she became asthmatic: family history, preemie on ventilator, and lots of other allergies. My son very rarely has symptoms but when he develops a cold, he benefits from being put on the steroid inhaler for a few days also.

Try to identify anything that may have changed about the time your symptoms started getting worse. Switching on the heat, possible reflux, new pets, etc.

It’s definitely worth seeing either an allergist (who should have plenty of experience managing asthma) or pulmonologist. Either of those should help you figure out what’s really going on (what if it’s not really asthma for example), and help you get things under better control.

My suspicion is that you simply need something other than Singulair as a maintenance med - I personally have found Singulair to be only minorly helpful for me. If I’m running toward the end of my Flovent (inhaled 'roid), however, I notice it!

Thanks all for the replies. One obvious thing that I take away from this is to put in a new furnace filter, which I had forgotten to do when we started using the furnace again (about a month ago or less). The other observations about house dust and so on I am familiar with from childhood, but it wouldn’t hurt to be more diligent in this regard.

SpecialAgentJem, it sounds like you have it much worse than I do, and if I may I extend my sympathy and best wishes to you. I hope you find relief.

QtM, I hope my remarks about doctors did not flick you on the raw, and I do appreciate your observations. I still can’t help feeling that I wouldn’t need to be taking medications for a chronic ailment at all if I had never started on Albuterol in the first place. But that is the realm of might-have-been, and in any case only one doctor’s actions (however, knowing what I know now about my own reactions to albuterol I would have declined to take it). Perhaps in another thread we might discuss alternative medical philosophies, where in some cases it may be possible to ameliorate symptoms over the long term without resort to medicines with major side effects, or to which one builds up immunity over time. I have some (probably uninformed) opinions on the subject.

In any case, I fear you are right that Singulair by itself is no longer adequate maintenance medication. I think my best bet is to consult with an asthma specialist, and probably to do further reading on the subject so I know what I’m talking about.
Roddy

I’ve got a thick skin. I’ve got patients threatening to kill me when I don’t prescribe what they want. :wink:

I’d say your thoughts about albuterol are misplaced. Albuterol does not cause reactive airway disease, it relieves it.

Every asthmatic needs a rescue medication, one which reverses the bronchospasm so their airways open. Albuterol is one of the most common and effective for this purpose.

Every asthmatic who needs a rescue medication twice a week or more should be on a maintenance medication, which reduces the swelling and mucus in the bronchioles, thus keeping them open and reducing the frequency of future bronchospasms.

A good internist or Family Medicine specialist can take care of 95+% of the asthma problems out there. When I get out of my depth, I send them to an allergist. Pulmonologists are also capable of treating more complex asthma cases.

Seven-year bump!

Just found this thread while searching for anything about singulair / montelukast (I may start a new thread about that), and I have something to add.

I know it’s seven years old and a lot of medicines might have flowed under the bridge in that time . . . but I see some complaints above about albuterol, and no mention of levalbuterol. So I’ll mention it here, just in case any of the above posters (Roddy in particular) might find it useful . . .

Albuterol is a racemic mix (meaning it’s a mix of left- and right- molecules), and a common side-effect is jitteriness and perhaps anxiety attacks. I got a few big loads of albuterol while in the ER a few weeks ago, and I was jumping out of my skin and bouncing off the walls. I’ve used this med before with lesser side-effects, but this time it was bad. I think it also has cardiovascular effects, jacking up your blood pressure.

Turns out, there’s also levalbuterol, which is the purified levo-rotary form instead of the racemic form. This does everything good to your lungs that albuterol does, without those side effects. No jitters, no panic attacks, no blood pressure jack-ups. It’s sold under the brand name Xopenex, in both inhaler and nebulizer forms, and isn’t available generic. So maybe it’s a newer drug. And it cost big bucks (I think it was about $70 for a 200-puff inhaler) which my insurance won’t cover :mad: They never seem to want to cover the meds that actually cost a lot. They don’t cover QVAR either, also expensive. But I digress.

When they switched me to levalbuterol there in the ER, it worked a lot nicer. None of those bothersome side effects. I’m using it at home now, too.

Thanks for the info, Senegoid. I use albuterol so rarely and only one puff at a time that I haven’t had those side effects. In fact many of the times when I use it is at night, if my asthma is acting up and interfering with sleep.

Since this thread has been revived, note that I am still on montelukast (generic Singulair) lo these many years later, and still use my rescue inhaler only once in a while, so I guess I was wrong about needing to change meds. Also I no longer think that albuterol makes the symptoms better in the short run while making the condition worse in the long run. I have observed my reactions more carefully and this is not what is going on. My only complaint now is about the new nebulizers. With the older ones I could feel the little droplets hitting the back of my mouth/throat and that was good, plus I could tell when the thing was empty. Newer nebulizers make a mist so fine that I can’t feel it, and I can’t tell when it’s empty except by waiting to see if it doesn’t work. Relatively minor in the grand scheme of things, but still mildly annoying.

Glad it works for you.

But a meta-analysis done in 2012 did not demonstrate any real superiority of Levalbuterol over albuterol. http://www.ncbi.nlm.nih.gov/pubmed/23207739

Certainly those asthmatics who have problems with tachycardia from albuterol can give it a try, and if beneficial it certainly makes sense for them to use it. But it is not the universal solution for all those suffering from tachycardia with their asthma treatment. The idea that levalbuteral will cause fewer cardiac side-effects in adult patients has not yet been clearly demonstrated in good quality studies.

Note that in a pediatric population, it does seem that levalbuterol does have fewer cardiac side-effects.

Ditch your Aspirin.
It can aggravate asthma.
As can pills with Aspirin in them.

Bosda, the vast majority of asthmatics can tolerate aspirin just fine. And many of them benefit from aspirin’s anti-platelet effects.

So: Asthmatics, don’t ditch your aspirin if you’re taking it on your doctor’s recommendation, until you’ve discussed it with them.

For further clarification, the incidence of aspirin-induced or aggravated asthma is 7% among people with asthma.

I have Qvar 80 and was told to take 2 puffs twice a day. I was told it is not to be used occassionaly. What are the side effects if someone just uses it now and then like maybe 3 or 4 times a year?

The side-effect of using it 3 or 4 times a year is that it’s a useless and expensive gesture, as it has no significant clinical effect when used that way. It needs regular twice a day dosing, every day, to significantly decrease lung inflammation.

Inhaled steroids are NOT rescue medications, they are maintenance medications, to preserve lung health. They are recommended for regular use in asthmatics who need to use their rescue inhaler more than once a week.

If you are an asthmatic that needs to use a rescue inhaler, the use of such a maintenance inhaler should reduce your frequency of asthma attacks, reduce your need for your rescue inhaler, and reduce the overall inflammation in your small airways, and reduce the likelihood of developing COPD from chronically inflamed lungs.

NOT using a steroid inhaler regularly could thus have the side-effect of more asthma attacks, increased risk of destruction of lung tissue over time, and increased risk of death from respiratory failure.

This notion - which I’ve heard before - reminds me of folks who think insulin causes diabetes complications. Well, no, but by the time some of these folks actually start using insulin severe damage has already been done and they correlate that with the start of insulin use.

My pet theory on the albuterol issue is that some of those folks have gotten used to being half smothered, but when they finally get relief they suddenly realize the difference between that and normal, so when the albuterol wears off they think the return to the prior baseline is a worsening of their symptoms even if it isn’t.

One of the frustrations is the exacerbation of my asthma I can get with an upper respiratory infection - between the crazy work schedules and the usual rigamarole with a doc with a waiting room [del]full[/del] overflowing with impoverished sick people by the time I do get seen I’m usually better and there is no apparent need for steroids. (Outside of that, it’s common for me to go a month or three without any symptoms, my asthma is very mild and intermittent - except, of course, when it isn’t :rolleyes: ). In many ways I’d like to be evaluated by an allergist or pulmonologist, but my current insurance coverage and finances are an obstacle. Basically, no one wants to pay for anything unless a major crisis occurs, after which on-going monitoring by a specialist will be fully covered but apparently the thought is something like “well, you haven’t needed a trip to the ER for this condition since 1995 so you must be well controlled”. It’s the same reason I can’t get my insurance company to pay for an epi-pen, even though that’s supposed to be standard for people with food allergies.

Not that I particularly love steroids, but damn, they ARE effective for certain things!

Yeah, that’s another annoyance, too - even quite a few medical personnel think asthmatics shouldn’t have aspirin or even other NSAIDs across the board, but in my experience they work a heck of a lot better for my mild arthritis/joint pain than Tylenol. Never had a problem with aspirin, although these days I’ve largely switched to ibuprofen (my-dad-the-pharmacist suggested that that might be preferable and the doc said that it was my choice since neither seemed to cause me a problem).

But, yeah, speaking as someone who despite years of being well controlled with minimal symptoms, take even mild asthma seriously because it can bite your rear without warning, and your situation can change over time. “I didn’t need that 20 years ago!” is a pointless statement, you have to deal with your current situation.

I’ve got radiation induced asthma. The way it was explained to me is the radiation I received for my breast cancer treatment scarred up my lung, so that’s why I got asthma in my 40s.

It tends to manifest itself as a chronic cough, although I had one instance where I truly lost my breath (I was having problems speaking) after a day of doing hard chores. I took some puffs off my rescue inhaler and I was fine.

I take Pulmicort twice a day and generic Singular once a day, and I have my rescue inhaler as needed.

I get Xopenex (I think there is a generic, now) for the nebulizer when I need it - fortunately rare.

Regular albuterol inhalers shouldn’t have much in the way of side effects after the first few times you use the drug, unless you’re really hitting it hard in the middle of a flare. Nebulized albuterol, on the other hand, is misery-making. Xopenex isn’t that much better, but enough so that I definitely prefer it.

Ditto, and also with everything you’re saying, Mama Zappa.

It is not uncommon for asthmatics to have more difficulty in the evening than in the daytime. This has many possible reasons, but I’d suggest putting dust-mite covers on your pillows and mattress as a start. I also second seeing an allergist to see if you need additional medication. If I don’t take my damn steroid inhaler every day, my quality of life really decreases.

Good luck.

GB, lifelong asthmatic.

ETA: Dammit! I’ve been zombied!