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    Old 10-19-2002, 10:38 PM   #1
    zionspegasus
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    Red face New, Severe Asthma

    I have had exercise induced asthma since middle school... Recently my dr did a test (PFT?) and diagnosed severe asthma. I started on Advair, but it made me cough. Also the insurance would not pay for the Singulair my dr prescribed. So now I take Serevent, Accolate, Zyrtec (changed from Allegra to go with these others), Pulmicort, Rhinocourt Aqua, plus Ventrolin HFA as needed (not often). Problem: Ive had coughing and trickle early and at night which is bothering my family as well as me. My dr prescribed Tessalon Pearl drops, but they dont seem to help much. What can I do? Should I take my Ventrolin for these attacks? Is this normal? I also suffer with anxiety, so I confused the tight chest with that and was unaware I was having trouble breathing, but the meds have helped me breathe better and easier. I had no treatment prior to now and took no meds. I did not know that I needed meds, and so many is a bit overwhelming. I hope someone here can help me understand more about asthma and dealing with it.

     
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    Old 10-20-2002, 07:40 PM   #2
    wrin
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    Depends, was it huge and convoluted and involved a computer? Or was it a plastic tube with a hole in one end? PFTs are long and involved.

    Well Accolate and Singulair are the same thing, mostly, so if your insurance doesn't cover Singulair but they cover Accolate you're not missing out, really.

    Are you talking about Airomir? Ventolin's HFA is marketed under the name Airomir, by 3M.

    Yes, yes, yes, yes, take your ventolin. Take it before you go to bed, take two puffs, give yourself a chance to loosen up and hack up some of the gunk before you go to bed. Laying down makes gunk (the trickle) pool around your carina, which is where your cough reflex is. Try to cough as much out as you can. Until your anti-inflammatories start working to the best of their abilities this trickle will be rather noticeable.

    What you're taking is actually very structured and makes a lot of sense. I'll run through some of this very quickly so I hope you understand some of them.

    Zyrtec is a prescription antihistamine. I'm assuming they think you have allergies that are making your asthma suck.

    Accolate, Pulmicort, and Rhinocort are all drugs to deal with the inflammation that is secondary to asthma. Accolate works by blocking a certain substance (leukotrienes) that are known to cause problems with asthma. Pulmicort and Rhinocort are the same drug, practically, as they are both corticosteroids that are administered locally, either inhaled or with a nasal spray. These are some of the most common drugs used for asthma.

    Your Ventolin and Serevent can also be lumped into the same category, as they are both bronchodilators. These work by relaxing the muscles in your airways that make your asthma worse. Serevent is taken twice daily and lasts for 12 hours. Ventolin is usually taken on an as-needed basis and lasts for 4 hours. Ventolin is useful when there's gunk in your lungs you can't cough up, as it helps to relax the smaller airways and gives you more room for a bigger breath to generate a stronger cough, as well as freeing secretions trapped behind constriction.

    Nearly all asthma can be controlled.

    Your pulmicort and rhinocort may take up to 2 weeks to work fully, but your serevent and ventolin will work almost immediately. (within 15 minutes.) The other drugs, I'm not certain, as to onset and duration of action.

     
    Old 10-20-2002, 08:33 PM   #3
    rugratsmomma
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    In the US Ventolin HFA is marketed under Ventolin HFA just like Proventil HFA,not airomir.

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    Old 10-20-2002, 09:34 PM   #4
    zionspegasus
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    I understand, this makes more sense now. The information is appreciated as well as your taking time to explain basic stuff to me. It has already proven helpful.

    zionP

     
    Old 10-21-2002, 07:02 PM   #5
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    Quote:
    Originally posted by rugratsmomma:
    In the US Ventolin HFA is marketed under Ventolin HFA just like Proventil HFA,not airomir
    oh well color me blue and call me canadian.. I never even heard the word 'albuterol' until I started talking to americans... why do they call things differently... what a pissoff...

    Glad to have helped, zions, please feel free to come back here and ask questions on this board; it's so much nicer than asking them in e-mail, this way maybe we're teaching somebody too shy to ask!

    see you again, hopefully

    [This message has been edited by wrin (edited 10-21-2002).]

     
    Old 10-25-2002, 09:08 AM   #6
    itsmd
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    I take Advair, too, and it also makes me cough. I call it "mummy dust." I have to take a second dose minutes later because I cough up most of the first dose.

    The reason I'm on Advair? I've had a weird sensation in my throat for 8 months now,like I've been exercising outdoors in winter, and my throat "aches" from the cold air or feels like I inhaled Menthol. It only happens when I inhale past 40-70%, but I have to force myself to take a deep breath. I can swim almost 40 meters underwater, but if I run 25 meters
    on land I get what I call "winded Cheetah Syndrome - I have to pant to recover. When I'm resting, or not inhaling, the sensation is gone completely, and the more sleep I get, the more deeply I can inhale before I get the effect.

    My doctor says it's exercise-induced athsma, but the Advair doesn't always help (it was much more effective in the beginning). A guy who has had 5 heart attacks told me he had the EXACT same sensation during the year before his first heart attack, but his "aching" happened all the time, even at rest or when he was exhaling. And he smoked right up until his 2nd heart attack.

    I'm a 50-yr old engineer, but I swim and work out, and I don't smoke, but I spent a lot of time in smokey bars until age 40. That worries me a bit.

    I have an exam in 5 days, and I'm going to insist on a stress test or some other diagnostic. My cholesterol is 210, but my HDLs are high, so my doctor isn't worried about it. He doesn't have to- I worry enough for the both of us.

    Has anyone else experienced this sensation? Was it asthma?

     
    Old 10-26-2002, 10:28 AM   #7
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    1. How long have you been on advair? Have you been on it for 8 months? If you have problems with the powder, tell your Dr. and ask him about going on Flovent and Serevent spray with an aerochamber, it's a little less hard on your lungs and the aerochamber keeps the flovent from settling in your mouth too much.

    2. I had much the same symptoms, with a few differences. 'twasn't my throat that ached, (though thanks to anatomy training I tend to think of my throat as having ended before my vocal chords,) but I would get a burning, aching sensation in my trachea. Another difference, after swimming 20 meters, I would tend to become breathless. The running on land thing, though, is a much less fluid (if you'll pardon the inadvertent pun) and much more forceful motion; since you are fighting gravity, it's much more work to run. Any other feelings that grip you while you're panting? For example, I have a huge excess of gunk in my lungs to cough up after I run, in addition to the inability to take a deep breath or to exhale one fully. I end up breathing very small, very high tidal volumes, and my vital capacity changes. I can't exhale fully without coughing.

    I'm not sure what kind of effect sleeping would have on it. I don't know what to tell you as far as that goes.

    To your doctor's credit, it DOES sound a lot like exercise-induced asthma. I found that taking Ventolin would help sometimes, but not all the time. I also found what you found about the advair (I take symbicort, a similar preparation) helping more in the beginning. It seemed to have much more of an effect.

    The bars-thing, unless by 'a lot of time' you mean every single day for hours at a time, I wouldn't worry too too much about. If your doctor suspected cancer, he probably would have had you go for a bronchoscopy to rule it out. Doctors tend to be rather nervous about the possibility of missing a cancer, and if they suspect one, they tend to jump on the tests to rule it out right away.

    Talk to your doctor about a methacholine challenge. An exercise challenge might work too, but the methacholine challenge is pretty definitive. You start by taking a simple blow-in-a-tube lung test, then inhaling a solution that has an irritant effect on asthmatic lungs. If you are asthmatic, even exercise-induced asthmatic, this solution will make the muscles around your airways tighten up a fraction, that fraction being measureable by comparing the lung test taken before and after you take the methacholine. It works on this principle; since most peoples' lungs lack this hyperreactivity, it is practically unique to asthmatics.

    If you don't react to that concentration, they try a higher one. It's also a method to see how severe asthma is -- if you react to the teeniest tiniest bit of methacholine, your asthma is relatively severe, or would probably require daily medication. If you don't react and don't react and don't react until the higher concentrations, chances are your asthma is pretty mild. It's not 100% for sure for sure, as there are other situations that can make people have airway hyperreactivity, but they tend to be rather easily differentiated from asthma.

    The lung tests will give you a better idea as to whether this is a lung problem or not. I'll bet considering your heart history, your doctor won't think it's a heart condition, but the important role for you here is to get your doctor to tell you what HE THINKS.

    The biggest thing that happens with doctors and patients is that doctor suspects something and patient has no idea what's going on. If you come in there armed with a little information (like how you think it'd be a good idea to check out a pulmonary function test with a stress test or a methacholine challenge since the advair isn't working for you very well) and asking him if it could also be a heart condition. It might not be a pre-emptive symptom to a heart attack, but your friend is right, lots of cardiac problems manifest themselves first in difficulty in breathing.

    Don't settle for dismissive answers, tell your doctor you are worried about this. Anxiety is known to exacerbate both heart problems and asthma. Some people get air-hunger feelings simply from anxiety; if no other cause could be found for your breathless attacks, that's something I might suspect, but it wouldn't be my first suspicion because of the way you react to exercising in dry air and moist air.

    I'm going with your doctor on this one. If it turns out to be asthma, tell him the powder bothers you and makes you cough. It's more of a pain in the *** to take the drugs as two seperate MDIs (multi-dose inhalers) but it's also a lot easier on your lungs, comparatively. (Lots of people have problems taking powder inhalers, so you're not alone.)

     
    Old 10-28-2002, 09:42 AM   #8
    itsmd
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    Wrin:

    Thank you for the speedy reply. When I mentioned the bar thing, I was more worried about congestive heart disease or emphysema than cancer. The TV ads imply that even the slightest exposure to "second-hand smoke" can damage a non-smoker's health, and I basically spent Friday and Saturday nights doing the "bar scene." But I hopped around a lot, so much of that time was spent walking outside from one pub to another. I live 10 miles from Baltimore, Maryland, where there are sections with dozens of "theme" pubs.

    I've been on Advair for about 3 months. I haven't tried the Albuterol or Flovent yet. Apparently my physician felt that the "twice a day and forget it" dosage regimine of Advair would be more suitable.

    I'll know more Tomorrow when I have my exam. The Stress test is mainly to put my mind at ease, and to establish a "baseline" for future reference.

    [This message has been edited by itsmd (edited 10-28-2002).]

     
    Old 10-28-2002, 10:38 AM   #9
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    Emphysema results more from a lungs' losing the ability to repair themselves. Smoking firsthand keeps the body from being able to repair itself, (if you don't believe me, talk to a smoker who's broken a bone, it takes fully twice as long to heal.)

    Congestive heart failure is something rather serious; if hanging out in bars on a friday and saturday was enough to cause it there would be a lot more people with huge heart problems out there today. You'd have to abuse your health a lot more than just that to find yourself with congestive heart failure; if, however, you've been overweight and smoke yourself, that's a little more towards likely. You don't.

    Advair takes up to 2 weeks to begin working properly. Advair is a combination of two drugs that have been available on the market for years, Serevent (like albuterol that lasts 12 hours) and Flovent. So, indiretly, you have tried Flovent. Albuterol should be something all asthmatics or suspected asthmatics should be prescribed as if any kind of life-threatening attack presents itself (as it can, no matter how mild your asthma is,) you will have a way to counter it.

    Most patients with EIA are prescribed albuterol and only albuterol, to take before they exercise. It tends to calm things down a little bit easier, but I found my EIA didn't completely resolve itself until I had started taking daily steroids, so your dr. is not wholly misled. (Symbicort, like Advair except by a different company.)

     
    Old 10-30-2002, 09:36 AM   #10
    itsmd
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    Wrin:

    I had a complete physical last night, and my doctor listened carefully to my lungs and heart, checked my EKG, etc. He looked in my throat and said I have a nasty post-nasal drip, which is causing redness and
    irritiation in my trachea. He said my heart sounds like it's from a horse. On the way to his office, I was almost dragged into a car accident by someone who was driving like an idiot in rain and fog, and I was all wired up, but my blood pressure was only 122/82.I use Nasonex, which reduces the drip for awhile, but it wears off in a couple hours and then I'm coughing again.

    I weighed in on a balance scale at 168 lbs in my clothes. I haven't weighed in the 160's for 8 years or so. My target weight is about 160, but I work out, and my 8-yr old son has nagged me into getting my "abs" back, so I'm not worried about the 8 lbs.

    I managed to talk my doctor into giving me referrels for a stress test, a sonogram, a pulmonary function test, and a lipid profile. He says he knows positively that it's not heart-related, but he put down on the report that I had a chest pain while
    exercising. Assuming everything is normal, he'll report it as a pulled muscle so I'm not excluded from ever buying life insurance again.

    I'll let you know how the tests go. I won't have the results for a couple weeks.

    Most of the drip & asthma is caused by the air and pollen in this area. When I go camping with my son's scout troup up in Pennsylvania, the throat problem disappears on the 2nd day. But as soon as I return, it starts up again. Unfortunatley, that's why the air is so good up there - there's also no industry, employment, etc. I guess I have "Industrial disease."


     
    Old 10-30-2002, 05:31 PM   #11
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    look into having testing done to see which allergies (likely inhaled allergens) are causing your postnasal drip.

    There are drugs kind of like the flovent that are for your sinuses, they do the same thing as for your lungs except in your sinuses (reduce swelling and thereby reduce secretions)... one that's very well marketed is nasocort. Also, if it does happen to be an allergic thing causing your postnasal drip, look into taking something for your allergies. Preferably something /strong/.

    And if you have to move? Consider it. I live in Edmonton, which, for a metropolitan area, is a pretty piddly excuse for a metropolitan area. But I'm healthy here; I took a trip to Vancouver in the summer, and I wasn't there six hours before I started feeling it in my lungs and nose.

     
    Old 12-03-2002, 02:42 PM   #12
    itsmd
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    Wrin:

    I completed the stress test and another echogram, and the results were well above average for "a man my age." My maximum heart rate was 155 (vs an expected 171) and my max. blood press was 145/80. METS achieved during the stress test was 10.1. My BP yesterday at my post Stress/PFT exam consult was 109/64 with a heart rate of 70.

    My PFT indicated a high lung capacity, and a high exhalation rate, but my diffusion rate was low. My D.O. level has steadily fallen since I started into this thing 6 months ago, from 98% to 93%. The PFT was negative for Asthma. The irritation and drip is due to exaggerated airflow as my body attempts to compensate for the low diffusion rate by increasing volumetric flow.

    So, today I had a chest X-Ray, and in a few days, a pulmonary 'scoping. I'll keep you posted. I don't smoke, nor am I exposed to industrial fumes. My high exhalation rate all but eliminates emphysema, TB, or CF. I hope it's just "walking" pneumonia, or something simple like that.

    John


    [This message has been edited by itsmd (edited 12-03-2002).]

     
    Old 12-03-2002, 02:56 PM   #13
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    I hope at the least it's something correctable, nothing like pulmonary fibrosis.

     
    Old 12-11-2002, 06:06 AM   #14
    Xenos
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    wren

    I hope you are not a doctor or respiratory therapist. There has been some very bad advice given all across this asthma board.

    Xenos MD
    Pulmonary Medicine
    Critical Care
    Sleep Disorders

     
    Old 12-11-2002, 01:28 PM   #15
    wrin
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    Mmmmmmmmmm is pel
    ling

    anyway

    Perhaps you could tell me what was so wrong about it? Yes, good idea, blaze the boards and tell us what morons we all are

     
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