Side effect from twice a day inhaler

In My Humble Opinion
1

About 3 months ago my Dr. prescribed a twice a day inhaler for me during a bronchitis flare up. It did a good job opening up my lungs but my condition started rapidly deteriorating as far as being short winded. Walking 200 feet would completely wind me and I would be out of breath.

I travel back and forth between a desert community and my home on the coast in Ca. For some reason every time I came home I could stop using the inhalers and my wind would come back. I finally figured out that the inhaler was causing me to develop a thin layer of sticky mucous that I think was coating my lungs. The volume was small enough that I couldn’t feel it. Once I quit the inhaler for about 8 hours or so past the time I should have taken it the Phlegm would break up and 2 or 3 small coughs and my lungs were right back to normal. I have to wonder if others are not also experiencing this. When I informed my Dr. of my worsening condition he never suggested that the inhaler might be causing this.

2

What type of inhaler? There’s a lot of different ones out there these days.

3

I wasn’t sure it was ok to post the name but it is Advair. I had a similar reaction with Qvar 80mg. Both caused me to build up mucous in my lungs. I have been off for about 48 hours now and my lungs feel fine with no wheezing or shortness of breath, 24 hours ago I thought I had weeks to live if I was lucky.

4

Are you rinsing your mouth out after you use it. IIRC Advair can cause thrush. That could be your issue.

5

There are a whole bunch of different inhaler meds for asthma, chronic bronchitis, and COPD. (There are also other inhaler meds for other unrelated conditions.)

They fall into three categories:
(a) Bronchodilators: These relax the tissues in the trachea and bronchi, causing your “windpipe” to open up some, making it easier to breathe. The most common one is albuterol (also known as salbutamol). These are further of two sub-types:
(i) Fast-acting ones: These take effect very quickly (within minutes), although they may also wear off and cease to be effective very quickly (within hours). Albuterol is of this type, and is commonly used as the “rescue inhaler” for asthmatic when having a sudden acute episode. A common side-effect is that it might make you feel nervous and jumpy and possibly keep you awake at night.
(ii) Slower but longer-acting ones are used on a regular basis (like twice a day) for chronic cases. Salmeterol is one example.

(b) Corticosteroids: These reduce inflammation in the trachea and bronchi and lungs.

© Inhalers that are a combination of one drug from column (a) and one drug from column (b). Advair Diskus is one of these. It is a combination of fluticasone (a corticosteroid) and salmeterol (slow-and-long acting bronchodilator).

I’ve used a whole bunch of different inhalers of all the above types, with varying degrees of effectiveness (and extremely varying degrees of effect on my bank account). I’ve never had an unpleasant side-effect other than nervousness with albuterol. My HMO plan pushes Advair because, I presume, it’s less expensive that many others. But, alas, Advair had no effect whatsoever with me so they had to try other stuff. I am now using Alvesco, which is a corticosteroid-only inhaler, with generally good results. I am not aware of the effect that OP describes. YMMV I suppose.

If you have problems getting too jumpy with albuterol, there is also levalbuterol (Xopenex) which doesn’t have that side-effect, but is substantially more expensive.

6

ETA:
Advair, as I mentioned, is a combination drug of both types.

Qvar, also mentioned by HoneyBadgerDC, is a corticosteroid-only type. If that is also causing the side-effect OP mentions, that would suggest that it is the corticosteroid in Advair also causing it.

ALL of these meds come with the instruction to rinse your mouth after use. In fact, it is only the corticosteroids that have the potential to cause thrush. Rinsing after using a bronchodilator-only is recommended as well, but not really so essential.

Cite: My experience with respiratory problems, chronically over the last several years, as discussed for example in this thread from December 2013. (Although that thread doesn’t mention much, if anything, about inhalers and is more focused on the Prednisone that I was given.)

7

Kind of hard to describe the problem I was having, lungs felt clear and I was breathing fine I just couldn’t seem to absorb any oxygen. My 02 levels were dropping into the 80’s. Without the inhalers my 02 goes between 96 and 99.

8

Bizarre. I’m a long-term user of Flovent (fluticasone), which is the steroid in Advair. Advair also has a longer-acting bronchodilator (salmeterol).

Qvar is just a steroid (beclomethasone). I used that (brand name Beclovent) before they discontinued it in favor of Flovent - “shortage of raw materials” but frankly I think it was just that Beclovent was about to go generic. I just did a search and Qvar has been reformulated (to a RediHaler format) - again, almost certainly because the older one was about to go generic and they could market the newer one with a longer patent.

My first thought was that you might have been reacting to the excipients (non-active ingredients) in the inhaler - a quick google suggests that Qvar just has the propellant and ethanol. Advair is a dry powder inhaler that contains lactose.

Thrush can indeed result from use of a steroid inhaler - but your symptoms don’t sound at all like thrush. Even if they were, rinsing your mouth wouldn’t help that since the symptoms are in the breathing passages - which can’t be rinsed easily for fear of drowning yourself!

Honestly, if you feel better without the inhaler, then do without it for a bit. Doctors can be dismissive of medication side effects (my oft-repeated story of a BP medication mimicking worsening GERD; when I finally refused to use the medication any more, my symptoms went away). If the doctor is pushy about it, make him listen to your story. If he won’t, find a new doctor.

When you say the inhalers “opened things up”. what do you mean? Could you breathe somewhat better despite hacking up mucus? Doesn’t sound like it since you say you could barely walk 200 feet.

Some wild speculation:
When I’ve been on oral steroids, I can feel things tightening up as the dose wears off (as I’m tapering to a lower dose, for example). Any chance that what you describe might fit, time-wise, with when you’re getting close to time to take another dose?

And - is it possible that without the inhaler, there’s the same amount of mucus production, but with your breathing passages opened up you are now able to hack it up more easily? (something I experience when recovering from a case of bronchitis: for a few days, I sound worse even though I"m better). Again, with your saying you can barely walk 200 feet, that doesn’t sound like what’s going on.

9

The problem with the inhaler was that I was not hacking up mucous or even producing much. It seemed like I had a very thin but dense coating over my lungs. Breathing was easy and clear with no sounds but my oxy levels were dropping and I was out of breath. Once I got it out of my system normal phlegm seem to come back, a couple of hacks and I was back to normal.

10

This sounds like something you really need to discuss with your doctor, next time you’re having issues. You may want to see a pulmonologist to get a specialist’s opinion. You may need just a bronchodilator. You may need some sort of preventative medication (ie, pills) to prevent problems, and then only use inhalers as a rescue medication.

In any case, breathing issues are worth taking seriously. I’ve had a lifetime of problems to illustrate this.

Oh, you might check into a pneumonia vaccine if you haven’t already.

11

I agree. See the doctor again.
My first instinct is to say if it’s doing something bad don’t use it. IANAmedical person, of any kind, so YMMV.
I kinda think you maybe allergic to the inhaler ingreds.
Ask the doctor.

12

As an aside, you’re not supposed to use steroids in a stop-start manner (which is why they give you a steroid card if you’re on tablets). Granted the systemic levels from an inhaler are going to be pretty small, but in this document*, for example, we get the statement:

So it’s a consideration. I’ve worked on steroid inhalers but I’m no expert (and not a doctor) - we need to page Q the M for this.

j

    • UK Healthcare Professional document