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Old 04-24-2011, 02:22 PM   #1
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albuterol not working

I've had asthma my whole life. It was bad when I was younger, with several er visits before I started getting allergy shots. The allergy shots helped tremendously, and my asthma is much better. I'm 30 now, and have been getting shots off and on for the last 8 years (I keep moving and having to re-start).

For the past several years, my asthma has been well-controlled with advair. I've been using the albuterol very rarely (like once a month or so). But the past few weeks, my asthma has gotten worse. I've been having asthma attacks once every week or two, and they are the worst attacks I've been having in years. One was really scary because I went to bed fine and woke up an hour later and could hardly breathe.

The weird thing is that the albuterol doesn't really seem to be working at all. In the past, albuterol has worked quite well for me, with one or two puffs completely fixing the attack. For the past few weeks, I've used up to 10 puffs when I'm having an attack (over the span of about 20 minutes), and it really doesn't even seem to have much effect even then. Usually it happens in the evening, and I end up sitting up wheezing and coughing for a few hours before I can breathe enough to even go to bed.

I don't know if maybe there's something wrong with my inhaler? I just recently switched over to the new proair inhaler, because my old ones finally ran out (which tells you how well my asthma was controlled, that I still had old ones 2 years after they switched over!). It just doesn't seem to do anything for me at all.

Obviously, I'm going to call the doctor on Monday, because I've been wheezing since last night with no relief, but I'm wondering if maybe I need a different medication or a nebulizer or something. It's just so frustrating, because in between attacks I have no symptoms at all, but when I get an attack I can't seem to reverse it.

My questions:
-Anything specific I should make sure my doctor checks out?
-Has anybody else had this problem, and what worked for you?

 
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Old 04-24-2011, 05:48 PM   #2
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Re: albuterol not working

Okay, there are a few possibilities. One is, you are allergic to the new propellant, in which case you should switch to a nebulizer. I have had all kinds of trouble with rescue inhalers and weird reactions, so it's not as strange as it sounds.

Another is your inhaler nozzle is clogged, so you aren't getting any medicine. Puff in the air and watch. If you can't see a nice big puff, the pump is not working and needs to be cleaned.

Also, the new inhalers work just a little bit differently. You might not be using it quite right. Ask for training.

If you have a bad attack tonight, before you can get to the doctor, obviously go to the ER. If you have bothersome, but not emergency symptoms, try some coffee.

When you get there, ask if you need to use a controller medicine, at least until you get this flare-up better.

Hang in there!

 
Old 04-24-2011, 06:03 PM   #3
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Re: albuterol not working

Jane gave you some good advice.

Also, if your asthma is that bad right now, you might ask about getting a nebulizer. It uses a liquid solution of albuterol that works its way further into your lungs.

Have you had any problems with acid reflux? "Silent" reflux can aggrevate asthma by irritating your lungs. With "silent" reflux, many people don't even have heartburn or other obvious symptoms. For many people, the reflux can be worse at night when lying down. You could try propping up the head of your bed on a couple bricks to see if that might help.

What dosage of Advair are you on? You might talk to your doctor about temporarily going up in strength until you get your asthma back under control. You could always go back down at that point.
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Old 04-24-2011, 06:24 PM   #4
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Re: albuterol not working

I'm actually on the lowest dose of advair, and for the past few years I've only been using it one puff once a day (and my asthma was controlled, but stopping that resulted in problems). I've upped it to twice a day and it hasn't made a difference.

I don't think it's a problem with the mechanics of the inhaler, because I've had the same problems with two different ones. I suppose it's possible that I'm not using it quite right if it's significantly different from the older models.

I don't have any heartburn problems (no symptoms, plus two endoscopies showing no evidence). Other than the one attack, they usually come on in the evening before I've gone to bed, not after I've laid down.

 
Old 04-24-2011, 06:57 PM   #5
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Re: albuterol not working

Are you taking the Advair at night? If not, switch to then and see if that helps.

 
Old 04-25-2011, 10:07 AM   #6
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Re: albuterol not working

Yes, I've always taken it at night. Now I'm taking it morning and night.

I called the allergist and they were willing to get me in tomorrow, but I live an hour away from them, so I'm going Friday instead.

 
Old 04-25-2011, 01:08 PM   #7
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Re: albuterol not working

It is common for asthmatics to have more problems at night than during the day. There's a hormone in your body whose levels drop at night time. Besides helping you fall asleep, they also give you a breathing boost (sorry I'm not using very scientific terms here).

If you're not already using a nebulizer (I know it's been mentioned several times already) I would check into it. I'd be in the ER every month if I didn't have my own nebulizer. Often times my inhaler seems to "quit working", but the nebulizer will do the trick for me.

Are there any allergens in your bedroom that might be setting you off? If you're allergic to dust, dustmites, etc - you might try getting covers for your pillows and mattress. Things like plants, stuffed animals, old carpet can be allergen triggers as well. Some people get HEPA air purifiers and they help too.

 
Old 04-26-2011, 12:36 PM   #8
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Re: albuterol not working

It's definitely allergy-related. I have the most problems on the weekends when I stay with my friend out of town. That's why I waited so long, because I thought that maybe the problem was smoke from the woodstove. But even now that it's gotten warmer, I'm still having problems. It doesn't seem to be the bed, since I end up having trouble breathing before I go to bed. I'm highly suspicious of the cat, since I am allergic to them. The funny thing is that my friend has borderline OCD, and cleans all the time. Vacuums at least every other day, mops the floor, dusts... She empties the fridge entirely once a week to clean it, and then spot-cleans in between (not that I'd be allergic to the fridge, but that's an example of how much she cleans).

In contrast, when I visit my parents I don't have any problems, even though they have 3 cats, and my mom only cleans when there's company coming (I doubt that house gets dusted more than twice a year, or vacuumed more than once every few months). It just doesn't make sense. I guess it's a good thing that I don't have more problems at my parents' house, though, since I'm moving in with them in August to go back to school!

 
Old 04-29-2011, 07:34 AM   #9
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Re: albuterol not working

Ugh. My allergist was just about entirely useless. Apparently if you pass your PFT with flying colors, then your asthma is well-controlled and you can't possibly be having asthma attacks. So, since my breathing is so good other than these asthma attacks, she suggested that I increase my advair, and see if that helps the albuterol work better. Nevermind that I've doubled my advair and it hasn't helped one bit. But maybe doubling it again will be magic.

She also suggested that maybe I'm not having asthma attacks at all, but just spasms of my larynx caused by acid reflux. Nevermind that I've got absolutely no symptoms of reflux, and have had several GI-related diagnostic tests that would have shown evidence of reflux if I had it, and they showed no such evidence. Plus, I've had asthma all my life. I know what an asthma attack feels like. Wheezing, tightness in the chest, mucus, coughing, etc. Plus, I get these asthma attacks mostly when I go to my friend's house. Now what is more likely, that I'm allergic to something there and it's triggering my asthma, or that I just happen to have asymptomatic reflux only on the weekends, and only when I go to a certain person's house???

She suggested a spacer (I absolutely hate spacers). Then she suggested to maybe try another brand of alubterol inhaler, but she didn't have any samples of any other brands in stock, and I just got the proair refilled so insurance won't cover another albuterol inhaler prescription.

Then she looked at me and asked what I wanted to do (since I wasn't buying her solution of just increasing the advair). So I asked for either a different rescue medication, or a different delivery system. She looked pretty annoyed, but wrote me a prescription for a nebulizer. My friend actually has a nebulizer at her house, so I'll try that this weekend and see if it helps before I go buying my own, but I suspect that it will.

It's just so frustrating when the doctor doesn't believe you.

 
Old 04-29-2011, 07:41 AM   #10
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Re: albuterol not working

Quote:
Originally Posted by kehorner View Post
Ugh. My allergist was just about entirely useless. Apparently if you pass your PFT with flying colors, then your asthma is well-controlled and you can't possibly be having asthma attacks. So, since my breathing is so good other than these asthma attacks, she suggested that I increase my advair, and see if that helps the albuterol work better. Nevermind that I've doubled my advair and it hasn't helped one bit. But maybe doubling it again will be magic.

She also suggested that maybe I'm not having asthma attacks at all, but just spasms of my larynx caused by acid reflux. Nevermind that I've got absolutely no symptoms of reflux, and have had several GI-related diagnostic tests that would have shown evidence of reflux if I had it, and they showed no such evidence. Plus, I've had asthma all my life. I know what an asthma attack feels like. Wheezing, tightness in the chest, mucus, coughing, etc. Plus, I get these asthma attacks mostly when I go to my friend's house. Now what is more likely, that I'm allergic to something there and it's triggering my asthma, or that I just happen to have asymptomatic reflux only on the weekends, and only when I go to a certain person's house???

She suggested a spacer (I absolutely hate spacers). Then she suggested to maybe try another brand of alubterol inhaler, but she didn't have any samples of any other brands in stock, and I just got the proair refilled so insurance won't cover another albuterol inhaler prescription.

Then she looked at me and asked what I wanted to do (since I wasn't buying her solution of just increasing the advair). So I asked for either a different rescue medication, or a different delivery system. She looked pretty annoyed, but wrote me a prescription for a nebulizer. My friend actually has a nebulizer at her house, so I'll try that this weekend and see if it helps before I go buying my own, but I suspect that it will.

It's just so frustrating when the doctor doesn't believe you.
Dude, I've been dealing with this for three years. I've fired 3 doctors in the time span. I eventually switched to a different allergist in the same practice and I've had a much better experience.

I'm the same way with PFTs. I used to do 130% of expected and now i'm in the 90 to 110 range. Most doctors see that as still being awesome, yet that's most frustrating for us. I also keep track of peak flow numbers. For my age, height, etc I should be around 625, but I can hit 900 if I'm feeling good. It's hard to find a good doctor that will actually listen and not just look at the numbers. Hang in there. I'd try out the nebulizer. They work wonders for me. I have both a big workhorse, and a smaller portable one.

You should check out the Pari Trek S. Mine came with a battery pack, AC adapter, and car adapter. It only weighs a few pounds so I just take it everywhere I go in my backpack. Beats dragging around the big one.

Good luck.

 
Old 04-29-2011, 07:39 PM   #11
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Re: albuterol not working

Yeah, my doctor can be the same way.

Yes, it's good to have high peak flows. It means you're probably getting enough air to do things like stay alive and conscious, and probably to walk and talk too. But the charts are only an average, and some doctors tend to ignore reported symptoms if the breathing tests are within the normal range.

My allergist recently referred me to a well-respected pulmonologist, who said that my asthma is more the nuisance kind than the severe kind, but is not well controlled at present. He had a number of suggestions for me, which I'm now following up on.

I'm not sure about doubling up the Advair. Is that much Salmeterol safe? Shouldn't you be on a higher number (like 250/50) instead?

Definitely give the nebulizer a try, and let me know how it goes.

 
Old 04-30-2011, 06:58 AM   #12
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Re: albuterol not working

Doubling the advair would be safe. The standard dose for any of the strengths is 2 puffs twice a day. I was only taking 1 puff once a day, and doubled it to 1 puff twice a day (made no difference) and the doctor wants me to double it again to 2 puffs twice a day (the standard dose).

 
Old 04-30-2011, 10:22 AM   #13
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Re: albuterol not working

I thought the extra salmeterol wasn't safe too. I used to be on the 500/50 dose for years. Tried going down to the 250/50 for a while, but when that wasn't working I was back on the 500. My doc told me I shouldn't take extra "puffs" of the 250 cause I'd be getting too much salmeterol.

 
Old 04-30-2011, 10:59 AM   #14
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Re: albuterol not working

Ah, you were on a half-dose of the HFA version, and she wants you on the full dose.

That's fine. I wouldn't take MORE than 50 mcg of salmeterol at one time, though.

 
Old 05-18-2012, 07:03 AM   #15
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Re: albuterol not working

Quote:
Originally Posted by kehorner View Post
I've had asthma my whole life. It was bad when I was younger, with several er visits before I started getting allergy shots. The allergy shots helped tremendously, and my asthma is much better. I'm 30 now, and have been getting shots off and on for the last 8 years (I keep moving and having to re-start).

For the past several years, my asthma has been well-controlled with advair. I've been using the albuterol very rarely (like once a month or so). But the past few weeks, my asthma has gotten worse. I've been having asthma attacks once every week or two, and they are the worst attacks I've been having in years. One was really scary because I went to bed fine and woke up an hour later and could hardly breathe.

The weird thing is that the albuterol doesn't really seem to be working at all. In the past, albuterol has worked quite well for me, with one or two puffs completely fixing the attack. For the past few weeks, I've used up to 10 puffs when I'm having an attack (over the span of about 20 minutes), and it really doesn't even seem to have much effect even then. Usually it happens in the evening, and I end up sitting up wheezing and coughing for a few hours before I can breathe enough to even go to bed.

I don't know if maybe there's something wrong with my inhaler? I just recently switched over to the new proair inhaler, because my old ones finally ran out (which tells you how well my asthma was controlled, that I still had old ones 2 years after they switched over!). It just doesn't seem to do anything for me at all.

Obviously, I'm going to call the doctor on Monday, because I've been wheezing since last night with no relief, but I'm wondering if maybe I need a different medication or a nebulizer or something. It's just so frustrating, because in between attacks I have no symptoms at all, but when I get an attack I can't seem to reverse it.

My questions:
-Anything specific I should make sure my doctor checks out?
-Has anybody else had this problem, and what worked for you?

 
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