need advise on asthma treatment

nurscee · Sep 17, 2004

Hopefully oneday I will be able to answer this question for myself, but as I am just a student right now, i'm asking for all your experence.
I have been asthmatic all my life from anytime I could ever remember. always hoping that I would grow out of it as some popele are able to. my asthma has changed overtime from being a little more constant with severe episodes to only episodal. right now I can not take a puffer for 6 months or more then randomly it starts, it is never a rapid start, but progressive over about 4 days. puffers seem to slow things down but not prevent. when it reaches it's peek I've often had to go to the ER and been nebulized (not a fun thing)
SO my question to you is that I know that I have to take the puffers as perscribed when i'm having any tightness at all, and even for a couple weeks to make sure that the problem is gone and I'm ok with that. But should I take the steroid inhalers when I'm not having any difficulty?
I'm being told by a new dr, (mine got old and retired, I guess that happens when he was around when i was born) that I sould stay on the advair all the time problems or not. when my old (this time not making fun of his age) DR told me to ween myself off.
I'm a little nervouse about taking steroids longterm if they are not needed, or are they needed? I'm also concerned about any long term effects of taking these steroids, you always hear about long term steroid and the negative effects that it can have.
I tried looking them up. but i couldn't find any longterm effects of advair, does that mean their are none, or they are just unknown?
also what is the difference between a advair puffer, and the disk?
I have a recheck and i would like to go informed so I can really ask what is going on, and be an informed to ask questions and make the desition that is right for me.
sorry this was so long, and i'm sure my grammar and spelling are off but i'm on my way out to class and don't have time to proof it.
SR

Dear SR,

Ever since this semester has started my daughter has suffered increased asthma. The other night she went to the ER (again). This time REALLY bad. This scares us...she and I had a mutual girlfriend who died in the ambulance of an asthma attack. So young, in her thirties. Such a shock!

Well, they finally sent her to a pulmonary specialist. She is still not out of the woods. I was there again today (it's soooo hard to get homework done!0

For now he has her on prednizone and a HUGE advair dose. Along with usuall puffers.

She was told that Advair doesn't get in your system and mess you up like steriod pills (such a prednisone). So if she has to take it every day the rest of her life at least she'll BE alive.

Just remember to gargle and rinse and spit after you use it. The steriod can stay in your mouth and cause sores, yeast, etc.

Please go to a pulmonary specialist. He was soooo mad that they had waited so long to send her to him. HE really knows his stuff.

God bless...asthma is a terrible thing. You take care, ya hear?

Silverdragon102, BSN · Sep 17, 2004

Dear SR

I am also asthmatic but I also review patients with asthma where I work.

I always advise the taking of a steroid inhaler on a regular basis, and I teach the step up and step down of the inhaler.

You should have a maintainance dose which is generally the minimum dose required and when you notice a increase usage of your reliever inhaler (consistant) over a couple of days you increase your steroid inhaler to its maximum and continue until improvement, and then decrease back to maintainance dose. If no improvement after 7 days it is recommended to see GP(physician). I live in the UK and we have in recent yrs had new guidelines in management of asthma and try to get management involment from the patient.

I hope this helps

Long Term Care Columnist / Guide · Sep 17, 2004

My pulmonologist says that if you're using your rescue inhaler (e.g. short-acting bronchodilator like Ventolin or Proventil) more than twice a week, your asthma is out of control. Your treatment may require a short course of oral steroids, such as prednisone, as well as a maintenance medication such as Advair, in order to keep your airways open. Do NOT ignore symptoms; I've never had to go on a ventilator myself, but I came close a couple of times, and I've certainly seen many patients on vents because of this disease. It can be extremely serious, even deadly......over 5000 people die each year from exacerbations of asthma.

Run, do not walk, to your doctor or the nearest ER if your symptoms are persistent, regardless of how mild they may seem to be. You must also learn what your triggers are and how to avoid them; some common ones are upper respiratory infections, cold air, exercise, smoke, perfumes, and mold.

Please let us know how you're doing.......it's like the American Lung Association says, when you can't breathe, nothing else matters!

Still Riding · Sep 17, 2004

Thanx everyone for all your advice so far, I've had the bad attacks and understand how scarythey can be.

I want to add a question, when I say I'm off the inhaler for sometimes 6 months that is also off the rescue inhaler. given that I need nothing for that long should I remain on the maintance level of the advair? also since it is so random my attacks I've never foung my triggars, I know that any sort of respiratory infection will sent me running for the inhalers of anykind, but their seems to be another one out there that has remained hidden. How do you find some of these triggers? would an alergist he a useful visit? that was mentioned off hand once (in may after a long night at the ER, almost vented not fun) but it was never mentioned again or a referal wasn't made.

thanx again SR

NeuroICURN · Sep 18, 2004

As a fellow sufferer of asthma, I can feel your pain. Personally, I find that my asthma is very well controlled using Flovent. I actually found my own routine that works very well for me...at night, I first use two puffs of albuterol to open me up, then after a couple minutes, I use two of my Flovent. I have found that this is what works for me and should in NO way substitute as advice for you from a pulmonologist.

Now, to answer your questions....as the OP stated, inhaled steroids do not have the systemic effects that PO/IV ones do. So yes, I agree that a maintenence dose of inhaled steroids is appropriate for most asthmatics. Remember what they teach you in nursing school...your airway is always the number one priority!!! :) So, protect it!

Another thing to remember that you can actually make it worse by using albuterol more than it's prescribed! When you use it too much, you will have rebound swelling, which further complicates the problem...so please be careful not to use it any more than it is prescribed!

Also, you will find (as most of us do) that you have certain triggers such as allergies, stress, exercise, cold weather, etc (contrary to people with bronchitis, true asthma is usually worsened by the cold). Once you learn what your triggers are, you can learn to compensate for them.

Are you using a peak-flow meter? This can help you to judge good/fair/bad days and when you are having problems vs. when you need to seek immediate attention.

Well, if you have any other questions, feel free to ask...but please see a pulmonologist (or, at least, your PCP) soon!

leslie :-D · Sep 18, 2004

i've had excellent success w/duoneb (bronchodilator and steroid) via neb rxs.

Salty1 · Sep 18, 2004

Thanx everyone for all your advice so far, I've had the bad attacks and understand how scarythey can be.
I want to add a question, when I say I'm off the inhaler for sometimes 6 months that is also off the rescue inhaler. given that I need nothing for that long should I remain on the maintance level of the advair? also since it is so random my attacks I've never foung my triggars, I know that any sort of respiratory infection will sent me running for the inhalers of anykind, but their seems to be another one out there that has remained hidden. How do you find some of these triggers? would an alergist he a useful visit? that was mentioned off hand once (in may after a long night at the ER, almost vented not fun) but it was never mentioned again or a referal wasn't made.
thanx again SR

After noting all of your posts and the nature and number of questions you have posed it would appear that you do not have a pulmonologist. The questions you are asking of this BB are ones that should be directed to a pulmonologist. It appears obvious that the prescriber of your MDIs and Advair Diskus may have missed the class in patient education. As other posters have suggested, YOU NEED TO SEE A PULMONOLOGIST.

Godd luck!

Godswill · Sep 21, 2004

ok, i am not a nurse yet, just a mother of an 2 year old ashtma patient, the only way my dd does not get an attack is if she take singular EVERYDAY if she miss one dose she gets an attack, doc said its a asthma prevention med, but it not a steriod. i have a friend who son is 6 months old is on steriods and i wonder why my dd wasn't but i realize he thinks it not the best thing for her and she stayed sick almost every month before the singular even been hospialized before the age of 2, now shes on singular and zertex as of friday.