Is Symbicort safe?

Your Question:  I'm an asthmatic and have been taking Symbicort for three days, one puff twice a day.  Should I keep using it or stop?  From what I've read, I am afraid about side its side effects and that it may cause asthma-related death. 

My answer:  Your physicians prescribed this medicine because he believes the benefits outweigh the risks. It is a very good medicine for controlling and preventing asthma, and  is a top line asthma medicine. 

and, so long as it is used as prescribed, is considered safe. I wrote an article about just this topic a few years ago, and I will link to it here for you to review. If you have further questions please feel free to ask.

Can you take cold and flu medicine with COPD and Asthma?

Your Question:  Can I take cold and flu syrup for my COPD?

My Answer: Let me put it this way. When I was a kid I suffered from severe asthma due to severe allergies.  When I had a cold my asthma got even worse.  Yet regardless of how much I sniffed and sneezed, my asthma doctor insisted that I not be given any antihistamines nor any cold medicine.  One of the main reasons was because of a warning that existed back then (it was way back in the 1980s) that said: "May cause bronchospasm in cases of asthma."  The end result was that I needlessly suffered.

The fact of the matter is, in cases like this, any benefits of medicine outweigh the disadvantages. Still, when we're talking about cold and flu medicines, side effects tend to be negligible anyway.  So any wise asthma or COPD physician should not deny you the right to such relief as can be obtained from such medicines.

That said, you may still wish to heed the warning of my fellow healthcare experts at . healthcentral.com, as there are a few medicines that may interact with cough syrup.  Likewise, you will want to make sure cough is not a symptom of a COPD or asthma flare up that could be treated with other medicine.  So it's always a good idea to work with your physician in order to come up with a plan for such instances.

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Will overdosing on Claritin hurt me?

Your question:  I just took two claritin tablets back to back and now I'm worried about side effects  I now have a headache and I feel nauseated.  What should I do?

My answer:  First of all, I would recommend when you have this type of question that requires an immediate answer to call your physician, pharmacist, or nurse hotline in order to get an immediate answer.  I say this because it may take a long time before someone reads an email or responds to a post like this.

That said, as I wrote about last week, Claritin is a medicine with negligible side effects.  Studies show that doubling the dose from 10 mg to 20 mg is safe.  In fact, the recommended dose in some countries of Europe is 10-20 mg.  Some people take even more than that are do just fine.

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Does a double dose of claritin benefit allergic asthma?

Your Question:  I have allergic asthma and take claritin because it does help. However, on some nights I wake up and the allergies as so bad that nothing seems to do anything. I was wondering if a double dose of claritin would benefit me on those days?

My answer; For the record, the standard dose of Claritin (loratadine) is 10 mg, and you're talking about doubling that dose to 20 mg.  Since I am not an expert on allergic medicine, I am going to allow the physicians over at healthtap.com answer your question.

1.  Dr. Luis A. Matos:  It may make you drowsy.  The full adult dose of Loratadine in other parts of the world is 20 mg. This amount caused a 12-14% drowsiness rate. The 10 mg dose was tested in the us in order to find a non-drowsy dose and it worked. If your allergy symptoms are controlled with Diphenhydramine (benadryl-50% drowsiness) and not 10 mg loratadine, you can try a second 10 mg dose and it may help with a lot less drowsiness.

2.  Dr. James W. Ferguson:  Studies of loritadine show the medication is well tolerated at twice the recommended 10 mg dose. However, the same studies show no added benefit of the double dose in symptom relief over the regular dose schedule.

Concusion:  So it appears that it is safe to try a second of Claritin if you want, although it's important to understand there is no evidence it will do any good, and that there will be a slight increase in your risk for side effects, of which the main one is somnolence.

How is lung capacity affected in people with asthma?

Your question:  How is a person's lung capacity affected if a person suffers from asthma?

My answer:  If you have well controlled asthma your lung function should be relatively normal between attacks.  The way to develop well controlled asthma is to see your doctor on a regular basis, take your asthma medications exactly as prescribed. There are about 10-20% of asthmatics who may develop severe asthma, and this may be due to repeated uncontrolled asthma exacerbations or by other things, such as smoking cigarettes, that cause lung scarring, or chronic airway changes, withing the lungs.  These severe asthmatics may develop some degree of permanent loss of lung capacity.  Otherwise, the only time your lung capacity will be diminished is while you are having an asthma attack.  


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Are fizzy drinks bad for asthma?

Your question:  Are fizzy drinks bad for asthma?

My answer:  By fizzy drinks I'm gong to assume you mean carbonated drinks like cola and beer. If this is so, then the answer is no. Fizzy drinks are safe for asthmatics. The only exception might be if your asthma is triggered by gasstrointestinal reflux, or GERD. In this case, your asthma is caused by stomach contents working their way back up the esophagus, some of which makes it into your lungs, thus triggering asthma. GERD occurs in about 10-20% of asthmatics. If you have GERD, "fizzy drinks" may worsen this effect. So, overall, fizzy drinks are safe for asthma, unless you have GERD.

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What is asthma

Your question:  What is asthma?

My answer:  Asthma is a disease of chronic (it's always there) inflammation in the air passages of your lungs. This makes your lungs hyper sensitive, or over reactive, to certain substances, such as cockroach urine, dust mites, animal dander, molds, fungus, strong smells, smoke, etc. These would be your asthma triggers. When exposed to your triggers this may irritate this inflammation, thus making it worse. The result causes an acute asthma attack. During an asthma attack the muscles lining the air passages spasm and this causes the air passages to become narrow. This results in airway obstruction, whereby air gets trapped in the lungs and can't get out. The inflamed air passages also produce excessive secretions, and this can exacerbate the problem. The end result is wheezing as air passes through the obstruction, chest tightness, coughing, and shortness of breath. An acute asthma (it's happening now) attack can be treated with asthma rescue medicine like albuterol and levalbuterol, and steroids. An acute asthma attack can be prevented by taking asthma controller medicines that control the chronic inflammation, thus making your lungs less responsive to your asthma triggers. The best way of treating acute asthma, and controlling chronic asthma, is by working with your asthma physician.

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The conundrum of asthma and strong smells

Your question:  During the summer I live with my 3 sisters. All of them are obssesed with nail polish and apply it every day. Whenever I smell the polish my lungs clamp up and give me a hard time. I have given up telling them that as they complain, ignore me, and say it's in my head. Is it in my head?

My humble answer:  No it's not.  Strong smells are a common asthma/COPD trigger.  In fact, there are many lungers who can't even walk down the laundry aisle in grocery stores because the strong smells trigger attacks.  You are not alone in having trouble explaining your conundrum with family and friends.  It's hard for people who've never had lung problems to comprehend that something so simple can bother you.  Many people have no empathy for asthmatics because most people don't have asthma.  It's a shame, and it's one of the things that make this disease so complicated to deal with.  When I was a kid I had a problem even explaining to my parents that incense and plants, cigarette smoke, and strong smells bothered me.  There comes a point you just give up, as there's no point in beating a dead horse.  In fact, things never really got better for me in this regard until I got my job as an RT was able to get my own house where I have more control of my environment.  Assuming you're financially unable to get your own place, perhaps the best thing for you to do is provide your friends with scientific proof.  A good place to start are sites like this and this and this. 

Can dogs and cats really prevent asthma?

Your question:  I read about a recent study that showed that exposure to a cat or dog can prevent asthma or allergies.  So why don't doctors recommend that all parents get a dog or a cat to prevent asthma and allergies.  I know it sounds goofy, but...

My humble answer:  I'm going to give you the oposite answer that you'd expect me to give.  I'm the kind of person who doesn't like to jump on the popular bandwagon.  I don't like to support something just because everyone else does.  By this I'm going to imply, that even thoug I wrote an article about it called "Having a dog or a cat may help prevent asthma," doesn't means I think the study is even viable.  In fact, if you think about it, asthma is a hereditary disease.  By this you must realize that most people who have asthma and allergies are more likely than those without asthma to have pets.  So it's only fitting that such a study would show that people who have a dog or cat are more likely not to have asthma.  So I'm going to say that there is no evidence a dog or cat will prevent asthma, and suggest that if you have a family history of asthma that you don't get a dog based on studies like this. 

How can I manage asthma around smoke?

The following Q and A sequence is from healthcentral.com/asthma:

Your question:  How can I manage asthma around smoke?  I am currently having trouble managing my asthma because of the brush fires that are around my neighborhood. Do you have any advice for management when there is a trigger you cant control?

My humble answer:  That's one of the things that's kind of crappy about having asthma:  there are certain things beyond your control.  It's not like you can walk up to all your neighbors and tell them all to stop burning wood.  The same can be said of backyard campfires and bar b ques. 

The same can also be said of allergens.  You can close all your windows and sit in a hot and stuffy house if you want, but tree, grass and ragweed pollen still have a way of getting indoors.  And no matter what you do, you'll have to go outdoors at some point. 

At least for allergies there's a few medicinal options that aren't avaiable to prevent smoke induced asthma

Of course another option may be to move to a neighborhood that bans brush fires, camp fires and the like.  However, from my own personal experience, such asthma triggers will find you no matter where you live. 

The best advice I can give is to try to stay indoors as best you can on days the air is filled with smoke.  The only other really good option is to continue to do what you've already been doing, and that's work with your doctor to obtain good asthma control.  

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Advair Diskus versus Advair HFA

Your Question:  The Dr. told me that there is now an arosol puffer for advair now. Can you tell me about it, please?

My humble answer:   We have covered this topic to some extent, and you can read more here.  Of the studies done so far regarding the new HFA propellant, it appears it takes the medicine deeper into the lungs than the old CFC propellent and the dry powdered version of inhalers.  While studies are ongoing, and so the debate is ongoing, some asthma experts recommend switching to the HFA version of a medicine if you continue to have trouble with your asthma. Personally, I'd recommend trying the DPI first if you have uncontrolled mild-moderate asthma, and then if that doesn't work try the HFA version.

Yet the main reason for making an HFA inhaler, I think,  is to provide another option for asthmatics who have trouble generating enough flow to suck in the medicine using a Dry Powder Inhaler.  With the HFA inhaler you squirt the device and the flow is automatically generated, and all you have to do is inhaler.  
Regardless, studies seem to show the medicine is at least equally as effective as the Advair Diskuss and is another option for us asthmatics to try.  For more information regarding the Advair HFA check out this link.  

Have you ever switched from Advair to Symbicort

Your Question:  Have you ever switched from Adair Symbicort ? If so were the results the same, or is one better than the other?

My humble answer:  As of right now there are no FDA approved generics for Advair or Symbicort.  I did switch from Advair to Symbicort once.  As far as control of my asthma it was the same either way.  The Symbicort was nice in that it acts like a quick relief inhaler opening my airways immediately, as opposed to 15 mintutes for Advair.  This was nice.  However, Symbicort made my heart pound while Advair never did that.  So in my case I switched back to Advair.  The medicine in both are "relatively" the same, so from the expert standpoint I think which one works best is a matter of personal or professional preference.  In my case, I prefer Advair.  I do know quite a few asthmatics who prefer Advair and also quite a few who prefer Symbicort.  There' salso another option available along this line of medicine called Dulera.  I tried that once too and it was basically the same as Symbicort.  So that's my own personal experience with Advair and Symbicort.

Does asthma effect your sex life?

Your question:  My docter told me that my asthma will prevent me to have a proper sex life.  He said that in 7 years i'll be like a 70 year old woman when I'll be of only 24years old.  I'm still a virgin and I do not really know if this is true or not.  I'm really scared and don't know what to do.  Help?

My humble answer:  I have never heard such folly in my life.  If your doctor is telling you stuff like that then perhaps it's time to get a new doctor.  It's not true.  You should call your doctor and ask him or her to provide you with some evidence.  If he does please share.  So don't worry about it.  If you need any proof, I've struggled with asthma for 42 years and have four kids.

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What happens when asthma goes untreated?

The following was originally published at HealthCentral.com/asthma on May 3, 2011.

What Other Medical Problems Can Occur When Asthma is Untreated? 

It's said a gallant asthmatics can live a normal, active life.  Yet what happens to the goofus asthmatic who doesn't treat his asthma?  

The truth is, many goofus asthmatics are lucky and are able to escape without asthma trouble, yet far too often they end up making frequent visits to their doctor, or to the local emergency room for asthma flares.  Sometimes they simply stay home and tough it out like our Martyr Asthmatic.

While it's rare, untreated asthma can lead to serious medical problems that can make asthma even harder to control.  Consider the following worse case scenario.

Joe Goofus refuses to see his doctor, and he is too dog-gone lazy to take his Advair discus, or maybe he simply forgets to take his medicine.  He also refuses to avoid his asthma triggers. He's simply a bad asthmatic patient.

So after sifting through dusty boxes in his basement, he makes yet another rushed trip to the emergency room.  His asthma is so bad this time that he needs to be admitted to the hospital.  He's put on systemic corticosteroids.

Finally after a couple weeks in prison he's released on good behavior, and he once again quits taking his asthma medicine.  He's short of breath for two weeks before he finally decides to seek help. 

He's readmitted to the hospital and put back on inhaled corticosteroids.  The cycle continues.

The following are the risks of untreated asthma:

1.  Severe Asthma:  Asthma that is not diagnosed and treated agressively with asthma controller medicines can increase the risk for lung scarring.  This is permanent damage to your lungs that can make you always feel short of breath.  It also makes it so your asthma might not be reversible when you use your rescue medicine (Ventolin or Xopenex).  This type of asthma is called severe, persistent asthma, Chronic Obstructive Pulmonary Disease (COPD) or what I like to call hard luck asthma. 

2.  Steroid side effects:  If Joe needs systemic corticosteroids long term to control his asthma, serious side effects can occur that can make it even harder to manage his asthma, such as:

• Fluid retention:  Swelling in your legs
• Increased blood pressure
• Mood swings:  Can effect how you manage your asthma
• Weight gain:  Chemicals released from fat can trigger asthma, plus obesity makes it even harder for you to get the exercise you need to manage your asthma, and keep your heart and lungs strong
• High blood sugar:  You'll now have diabetes that needs to be controlled
• Infections:  Can you imagine if you also developed pneumonia?
• Thin skin:  It easily bruises and is slow to heal. 

3.  Anxiety/ stress/ depression:  These can make it even more difficult for Joe to manage his disease, although treatable. 

4.  Muscle wasting:  His lungs become so bad he's unable to get the exercise he needs. This can greatly complicate caring for Joe.  It can lead to obesity, which complicates things even more. 

5.  Respiratory Failure:  If Joe doesn't seek help, his asthma attack might get so bad he simply poops out.  This is a serious complication that must be treated immediately.  It can lead to death.

While what I describe here is the worse case scenario, I've seen it.  It's basically self-induced hardluck asthma.  It's not pretty.  It can also be avoided. 

It's much better to be a gallant asthmatic.  It's much better to be properly diagnosed and stay on a treatment plan. 

Asthma experts have long said asthma is easiest to control when it's diagnosed right away and treated aggressively.  Now you know why.

Does Albuterol lower potassium?

Your Question:  Does Albuterol lower potassium?

My answer:  Albuterol does have the effect of lowering potassium.  While one treatment can lower potassium in your system, it's usually by an insignificant amount.  However, if you are using a lot of Ventolin throughout the course of a day, it can have the effect of lowering potassium.  It's generally not something that's considered significant, however.  I have never heard of a physician not prescribing an asthma rescue medicine due to it's potassium lowering effect.  However, it's something to consider if you have other medical problems.  It may also be a good idea to eat a banana or two if you use Ventolin a lot, because bananas are a good source of potassium.  Maybe that's why I crave a banana for breakfast every day because I used to use Ventolin a lot.  Anyway, here is a good article written by a good friend of mine that answers your question in more detail if you're interested.  I actually wrote a post on the subject myself but it's location presently eludes me.

Will levalbuterol ever come down in price?

Your question:  Will the price of levalbuterol ever be comparable with albuterol so insurance companies will start paying for it? 

My humble answer:  I would image the patent for xopenex (levalbuterol) should be running out soon.  I know for a fact one of the makers of albuterol are ready to launch their own generic of levalbuterol.  I'm sure this will happen as soon as the xopenex patent runs out.  The price should start dropping once generics are on the market.  I don't know that levalbuterol is really any better than albuterol, yet I do see the day when levalbuterol replaces albuterol as the most popular asthma medicine.  Once the price of levalbuterol is comparable to albuterol, insurance companies will have no choice but to start paying for it, you'd think. 

Can a methacholine test be a false negative?

Your question:  Can a methacholine test be a false negative?

I have been tested for asthma, but my results came back negative. My doctor has ruled out all other possible conditions that could be a cause for my symptoms. I have all the symptoms for asthma, but they are mild. Is it possible I got a false negative because my asthma is not that severe? I did not have the 20% drop on the test, but my symptoms were present by the last vial. Confused and worried, please help!

My humble answer:  There really is no difinitive test to diagnose asthma.  However, the methacholine challenge is a pretty significant indicator.  If you have a negative methacholine challenge chances are you don't have asthma.  The reason I can say this is because if you have asthma the challenge will make you short of breath, and a bronchodilator breathing treatment will make you feel better.  If none of these happen, chances are you don't have asthma.  A second opinion is always a good idea, however. 

What is a normal oxygen percentage in the blood?

Pocket size pulse oximeter

Your question:  What is the normal percentage of oxygen in the blood?

My humble answer:  I believe you are referring to pulse oximetry, or spo2.  Your blood has many red blood cells (RBC), and each RBC has a hemoglobin molecule.  After passing through the lungs, an oxygen molecule binds with a hemoglobin molecule.  So, an spo2 gives a percentage of hemoglobin molecules (in arterial blood) that are carrying an oxygen molecule.  A normal percentage is 98%.  However, anything over 90% is acceptable.  As we age, sleep, and with various disease conditions it's normal for this percentage to decrease.  Pulse oximetry is now considered the 5th vital sign after blood pressure, heart rate, respiratory rate and temperature.

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Do I have to fill my Albuterol prescription?

The following is a question from a fellow asthmatic at MyAsthmaCentral.com. 

Your humble question:  I just left for college and I guess my new dorm room caused me to have an asthma attack. I haven't had one in years and so the only inhaler I have is from 3 1/2 years ago. I went to the health center and after a nebulizer treatment I feel better. My question is can i just keep this old inhaler with me or do I have to get a new one. What are the odds of even having another asthma attack. I really don't want my parents to know because they will over react and panic if they knew so I dont want to have to fil the prescription. Thank you for any help.

My humble answer:  I always find the older the inhaler the worse it tastes.  Old asthma medicines are proven to be safe.  However, the longer the inhaler sits around the less potent the medicine becomes.  So your 3.5 year old inhaler will probably work about 1/2 (if that) as well as a new inhaler. 

It seems to me obvious your "old" inhaler wasn't working well enough to keep you out of the health center.  So I'd recommend you bite the bullet and go see your doctor and get a new one.  That way you'll have one to keep on hand for the next emergency.  A fresh inhaler may be all you need to avoid the health center.  You should toss out old inhalers and get new ones at least once per year.

I wrote a post about this recently.  You may want tock it out by clicking here.

Can mild asthmatics take preventative medicine only when needed?

I continue to receive some great questions from you guys.  This is one I received a while back.

Your question:  I recently read an article that stated mild asthmatics didn't need to take medication, and that there was no improvement for there lungs to take medication everyday as opposed to when they experienced an asthma flare up. Is this statement true. I have attached the article here... http://www.msnbc.msn.com/id/7490689/ns/health-allergies_and_asthma

My humble answer:  I read that article too, and like you it made me wonder.  Back in the 1980s asthma was treated only during acute attacks, and modern evidence shows that daily treatment with preventative medicines are needed to control asthma.  Personally, I am living proof that a daily dose of steroids in my lungs works, and using steroids only during an attack doesn't work. 

However, I think the key to that article is the words 'mild asthma.'  I believe there were some asthma experts who hypothesized, "Does EVERY asthmatic need daily preventative meds?  Can those with mild asthma get by with using inhaled corticosteroids only during an attack?"  The answer to the study they did obviously leans one to think that those with 'mild asthma' might be able to sneak by without taking daily preventative medicines.  Or, at least this is something worth trialing under the supervision of a physician. 

It actually makes sense.  This study might explain why some asthmatics can go years by not taking any preventative medicines and not have any symptoms.  And it's actually a good thing too, considering the less medicine you can get by with the better. 

Asthma experts have contended for years that if you are on asthma controller medicines and have had no symptoms for years, you should work with your doctor on scaling down your medicine.  If you try and it doesn't work, then you go back on your old medicine regime and leave well enough alone.  So in this regard, the study results are not much of a surprise.

So if you have mild asthma, this is another option for you.  Yet if you have moderate to severe asthma, chances are you'll need to stick with the daily preventative asthma regime that's been taught the past several years.

Other studies continue to confirm (such as this study) what asthma experts over the past several years have noted, that combination therapy works best to control asthma symptoms for those with mild persistent asthma. 

A recent study performed at the University of Arizona of 400 children showed that those taking an inhaled corticosteroid to prevent asthma and Albuterol to treat acute symptoms were 35 percent less likely to have an exacerbation of asthma.  The rate of treatment failure was reduced by 60 percent compared to those taking placebo.

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