Hi All, wondering if any of you can give me a bit of advice?
First a bit of background: I was diagnosed at the start of December after having an attack and having to go into hospital. I should have a PF of about 650, but was down around 250 in the hospital.
My GP started me on Salbutomol 100mg 2 puffs, four times daily for the first week to bring things under control, and then added Beclometasone 200mg, 2 puffs morning and evening, and changed the Salbutomol to 'as needed'. To start with, I was using the Salbutomol regularly (four puffs a day), but now I'm down to a maximum of 2, usually 1, and even none in the past couple of days.
In the 7 weeks since, my PF has improved a lot - usually around 400 to 450 in the morning, and about 430 to 500 in the evening. I'm feeling a lot better now than I have for several years (my GP thinks that I've probably been asthmatic for a while, but it developed slowly enough that I didn't notice until I had my attack).
What I have noticed is that since shortly after I started taking the inhalers, I've been finding it harder to sleep, and I've had feelings of anxiety - almost like I've just drank 4 cups of strong coffee! (I've been caffeine free for over a year, so it's not the coffee!). I've also been feeling Heartburn a lot more - been taking rennies almost daily since I started on the inhalers.
I'm due to see my GP again to get my next prescriptions authorised in a week or so, but before I do, I wonder if any of you can tell me if those side effects are normal, or if I should be discussing alternatives with my GP?
Salbutamol in large doses can make it hard to sleep, but beclomethasone doesn't usually have that effect, Although steroids in tablet form (prednisolone) definitely turn you into an insomniac.
As far as the heart burn is concerned, you should definitely go back to the doctor. Heart Burn / Acid reflux can actually exacerbate asthma, and it can turn people who were mild asthmatics into severe ones. There is tons of published research on this, but not all gps know it. You could ask your doctor if you can try a proton pump inhibitor drug like omeprazole for a while and see if that improves the situation. In fact I think you can even buy this over the counter in the chemist now. I think it is best to talk it through with you doctor first though.
I hope this helps
RI
hope this may be of help to you
Hi Ordan77 and welcome to AUK,
I can relate to your symptoms although my preventer is Bricanyl rather than Salbutomol.
If possible, I try to avoid taking my Bricanyl inhaler late at night as one of the side effects of Bricanyl is an increased heart rate. The increased heart rate only tends to happen when you are not accustomed to taking the meds, once taken on a regular basis your body gets used to it and the heart rate returns to normal.
When you go to bed, it is normal for the heart rate to gradually slow down as you proceed into sleep mode. The artificially increased heart rate (due to the meds) interferes with the body’s natural sleep rhythm which can prevent you entering sleep mode and thereby inadvertently causing anxiety as your mind is also kept awake by the increased heart rate.
I also occasionally experience a wee bit burning sensation in the back of the throat/upper chest when I take a couple of puffs of my reliever. I believe this is caused by the propellant used to deliver the dose. Some people take a drink of water after taking their meds to relieve this mild burning sensation/discomfort.
I would imagine that salbutomol could cause similar side effects. I am sure one of the more experienced regulars will give you more specific advice regarding this type of med.
But as rihobbs says, you might be best to go back to your GP if you suspect acid reflux/heart burn as a cause/exacerbation of your asthma.
I hope this helps a wee bit.
Derek
Hi Rihobbs and Derek,
Many thanks for your replies and supportive words. I'll definitely talk in more detail with my GP at my next appointment.
I realise that my asthma is far milder than most of you here. I'm still getting used to the whole thing, and so really appreciate the supportive environment here. Even just reading through the forums has been a big help.
Many thanks,
Mike.
hi Mike,
Welcome to AUK. I am on the same as you - Ventolin when needed, Becotide 2 puffs am & 2 puffs pm & also on Serevent. I have been having problems sleeping for months now which my dr said was prob down to the inhalers most likely my becotide - but this is a rare side effect she says not many people experience it. I have been given temazepam sleeping tablets to try to bump start me back into a normal routine. Ventolin gives me the shakes sometimes if I am taking a lot in a short space of time but the more I have it the more it takes to start giving me the shakes but yes a lot like when you have too much coffee.
Personally i dont get heartburn much but I always have water after my inhalers - particularly becotide as I hate the taste - yack. But you should tell the dr as having rennies every day is no good for you at all - my husband is on a pump inhibitor called lanzoprosil or something & it works for him.
Glad you are feeling better - hope that continues.
Hi mrsscoles,
I got the shakes a little when I was taking lots of ventolin, but that's gone since I've been able to cut it back. I wasn't too worried about that one though because when I was in A&E I was put on Salbutamol nebuliser, and my feet and hands were shaking like crazy for a good 20 minutes after! The Doctors and Nurses explained that it was a common effect and not to worry - and at the time I was more concerned about getting the next breath anyway!
Definitely agree that the becotide has a really horrible aftertaste, but I've largely got used to that over the past couple of weeks.
The thing I really need to try and get sorted is my sleeping - I've almost fallen asleep at work a couple of times this week - not good if the boss catches me!!
I'll definitely chat to my GP about these things when I see him.
Thanks again,
Mike.
I did fall asleep at work last week as had 2 hours sleep the night before - whoops. Fortunately my boss was out & I was most senior person in - but didnt look good did it to them? My team have been taking the mickey out of me ever since & feel like they can have a good old skive when ever they want.... I keep catching one playing Spider. Never mind!
Hi Mike,
I take a different approach to asthma than some of the other people on this forum and try to give slightly unusual advice.
To start with, it seems like you might not even have asthma - although i'm not ruling it out just yet! It is certainly quite strange to have it for the first time at age 29 - asthma mostly manifests itself as a child and only usually appears adult-onset at a much later age. In cases like yours, it tends to be with people who are for some reason exposed to a lot of allergen - either occupationally or developing a severe allergy to some sort of pet.
There are many cases where people of your age develop asthma because of a broken nose or severe sinus infection, which causes them to mouth-breathe for an extended period of time, causing asthma-like symptoms from all the allergens you are breathing in.
In addition, there is another condition called GORD (GERD in the USA) which stands for gastro-oesophageal reflux disease. In the US they actually look to treat that before looking to see if it is actually asthma at all. In addition, I read a study recently that shows that asthmatics are 3 times more likely to suffer from GORD than non-asthmatics. The primary symptom of GORD is heartburn - so that is definately something for you to look into, ESPECIALLY with regard to sleeping at night, because that is when most GORD patients have problems. There are several major tips for dealing with GORD:
1) Take a rennie before bed
2) Don't eat or drink anything for 3 hours before bed
3) Prop the head end of your bed up about 6"" with some planks or breeze blocks. This will give a barely noticable tilt to the bed, but will make a lot of difference to how much the acid rises up your oesophagus, causing heartburn and irritaiton at night.
As for your attack, it does sound very strange to me. Although your doctors first prescription (to take 4 salbutamol a day) sounded completely crazy to me when I first read it, I realise that you were probably having some trouble breathing and this may have helped. You shuold continue to follow your doctors advice, and hopefully your asthma will be short lived. Like the asthmatics who got their asthma after nose-problems, hopefully your asthma will fade away again. Like I said, it probably wasn't really asthma after all.
As for the side effects, salbutamol and beclometasone are very good drugs with relatively mild side effects. As asthmatics, we are very lucky to have them indeed. Good luck and keep updating us with your symptoms, it is interesting to hear your story.
Hi there,
Xephos - I have to tell you that asthma can come later in life. Mine arrived with an almighty thud at 18. Kids can have it and grow out of it and adults can develop it, i think its called late onset asthma or something. Mine was triggered by a chest infection, it may have been around before that but milder. I don't know if you have any medical training or not but you shouldn't tell people they don't have asthma if you don't know. ordan has been to a doctor and a doctor would not put him on meds for no reason. I just wanted to put this in case someone read your post and stopped meds without seeing a doc or getting advice. Hope you havn't taken offence.
My mother had her 1st asthma attack totally out of the blue at 34 her sister had her 1st one at 36. So it is perfectly possible to get asthma later in life.
Bex
Xephos,
As a doctor I can tell you that it is not at all unusual for people to develop asthma as adults. If you think that it is, then maybe you need to do some more reading about asthma before you start giving advice to people.
As for giving regular or as required salbutamol to begin with, that is pretty common as well, and is far from 'completely crazy'. Quite apart from controlling the immediate symptoms, giving regular salbutamol also acts as a diagnostic test - if the peak flow improves on bronchodilator medication such as regular salbutamol, the patient has a reversible obstructive lung disease, ie asthma. Giving salbutamol alone as a first step follows the British Thoracic Society guidelines for the treatment of asthma.
I don't believe there is any evidence for saying that a prolonged peroid of mouth breathing causes asthma-like symptoms. If you have references for any published studies which suggest this, I would be grateful if you could pass them on to me. However, I don't think that this phenonomen is widely recognised in the literature.
Gastro-oesphageal reflux disease *is* recognised in the literature as a trigger for asthma, and should certainly be considered in anyone with difficult to control disease, especially anyone with predominant night-time symptoms. However, it is thought that there must be a pre-existing hyper-reactivity of the airways (ie asthma!) in order for people to react to acid reflux. The advice given is adequate, as far as it goes, but anyone who suspects that they might have reflux that is provoking their asthma should consult their doctor for definitive treatment.
Xephos, I am slightly disturbed by the information that you 'take a different approach to asthma than some of the other people on this forum and try to give slightly unusual advice'. As a doctor with experience in diagnosing and managing respiratory disease, I recognise how difficult it is to give medical advice over the internet without access to the patient's medical history or physical examination. When I do give advice it is largely as a fellow asthmatic rather than as a doctor and I will usually follow it with the caveat that people should consult their own doctor if at all worried. I find it grossly irresponsible that you should be advising people, with very little information, that 'it probably wasn't really asthma after all'. Such advice given to someone new to asthma could potentially encourage them to stop taking their medication, which could have life-threatening results. I would suggest that you refrain from giving advice to others, and I will be informing the moderators of this site of my misgivings about your post and others that you have written.
Ordan,
Having said all that I will give you some advice on your asthma!
Firstly, despite what others have said, what you have described does sound typical of asthma... the low peak flow and the improvement with salbutamol are virtually diagnostic.
The side effects you describe sound pretty unpleasant! Significant side effects from inhaled medication are pretty uncommon as they don't tend to get into your bloodstream in very high doses, but idiosyncratic effects can always happen. Anxiety and difficulty in sleeping could concievably be attributed to either beta 2 agonists (ie sulbutamol) or steroids, although usually at much higher doses than you are on. I would suggest you discuss this with your doctor! Please don't stop any medication without talking to them first.
As for the heartburn, that could also be caused or worsened by medication. Drugs like salbutamol, which open the airways, (ie relax the smooth muscle of the airways) are thought to also have the same effect on the muscle valve in between the gullet and the stomach, potentially relaxing it and allowing acid to reflux from the stomach into the gullet. This causes the heartburn symptoms and also can allow acid to slip over slightly into the airways, irritating the hyper-sensitive airways and potentially worsening the asthma, which results in you taking more salbutamol. Such effects would again usually be seen only at much higher doses than you are on, but some people are unusually sensitive to these drugs. This again is not a reason to stop the medication! The tips about raising the head of the bed and not eating large meals before bed are relevant, and simple antacids from the Chemist can be useful, but ultimately if you are having heartburn on most days you need to see your doctor and get some more definitive treatment. It may seem counterintuitive to take medication for the side effects of another medication, but that may be what you need to do to break the vicious circle. If reflux is a factor in making your asthma worse, then taking medication to treat it may ultimately allow you to reduce your steroid inhaler or even stop it, but this should only be done under the supervision of your doctor.
I very much hope that you get some answers and get your symptoms under better control... despite the impression that you may get from reading about the experiences of some of the severe asthmatics on this board (myself included!), 90 - 95% of asthmatics can be fully controlled, symptom-free and lead normal lives provided that they take their prescribed medication appropriately. I hope that you will be one of those!
Em H
I was 25 and went from nothing to severe uncontrolloed, so it is possible and wide knownOrdan please follow Em H advice, as she is medically trained, and dont do anything without consulting your GP or medical pracitioner.
I thought this site was for advice and support and not treatment changes?
I am very disturbed?
Andrea
Xephos: Thank you for your comments - It can sometimes be useful to consider alternative opinions, however, I have just been away for a weekend (I'm a volunteer on a heritage railway), and I have experienced more wheezing over the weekend than in the previous 10 days whilst not experiencing the heartburn as badly as when I am at work. For the time being I am putting both the wheezing and less heartburn down to being more active over the weekend than I am during the week, and will be discussing this further with my doctor.
Nutbug, Bex and Wheezyab: Thank you for your comments - you have essentially confirmed the results of my own reading and the opinion of my GP that it is perfectly possible for this to be Asthma. My GP mentioned the possibility of Bronchitis or Emphysema as alternatives if the Salbutamol in the first week didn't work - which also fits with EmilyH's reply.
EmilyH: Thank you very much for your reply. You have given some very detailed information, which has helped me to understand the reasons for my GP prescribing as he did, and also much more about the side effects I'm experiencing. As I'm a technical person by nature (though not medical!), I appreciate detailed information like this, as it helps me to understand what is happening and why. I appreciate you taking the time to write such a detailed and complete reply.
Hi Ordan,
What everyone else has said is very valid. Perhaps I was incorrect or overly zealous in some of my suggestions, but it does not hurt to consider the possibility that something else is responsible, rather than just getting on with it and taking the drugs blindly.
Asthma is a lot of detective work - identifying the different triggers that affect you in particular. This could be exercise, laughing, coughing - allergens like smoke, dust, pollen, mould - or even certain foods and food additives (like preservatives). Minimising exposure to these is a big part of being an asthmatic, and as a 'new' asthmatic, I thought that any knowledge about asthma and related conditions would be beneficial to you.
As for the ""4 doses of salbutamol every day"" [that is 8 puffs of Ventolin A DAY by the way] argument, I suggest that EmH re-reads the BTS guidelines, since nowhere does it say that >>regular<< salbutamol, (especially these doses!) is a good idea for diagnosing or treating early-stage asthma.
I am familiar with the Guidelines, thank you Xephos.
From Section 4.1:
‘Prescribe an inhaled short-acting beta 2 agonist as short-term reliever therapy for all patients with symptomatic asthma.
4.1.1 FREQUENCY OF DOSING OF INHALED SHORT-ACTING BETA 2 AGONISTS
Using short-acting beta 2 agonists as required is at least as good as regular (four times daily) administration. Unless individual patients are shown to benefit from regular use of inhaled short-acting beta 2 agonist then as required use is recommended.’
Although they do say that using salbutamol as required should be as effective as using It regularly, they allow for the fact that some people may benefit from using it more regularly. Starting off on regular salbutamol is an accepted and common strategy, especially if there is diagnostic doubt or the patient has severe symptoms that need controlling rapidly. A newly asthmatic patient who is told to take the medication ‘as required’ may have some difficulty in knowing when it is ‘required’ and may end up using it too little or not at all.
If you read Ordan’s original posting, you will realise that his GP only put him on that regimen for a week before changing him to regular inhaled steroids and salbutamol as required once the diagnosis had been confirmed and the symptoms were more under control. A perfectly reasonable strategy.
As for the doses concerned, 8 puffs of salbutamol a day is not a particularly unusual or high dose, although it can certainly cause significant side effects in some people. The BTS Guidelines state that they consider using more than 10 – 12 puffs per day to be a marker of poor control, so 8 falls comfortably within that limit, especially as we are only talking about short term usage at this level.
You are right that it is always useful to consider triggers and alternative diagnoses, but to tell a newly diagnosed asthmatic that it ‘probably wasn't really asthma after all’ and that the treatment their doctor has given them is ‘completely crazy’ is not just ‘overly zealous’, it is irresponsible in the extreme.
Emily H
Hi Ordan
Just in case it's helpful, I wanted to let you know that since starting beclomethasone, my salbutamol usage has dropped and I've had considerably less symptoms (which is really good considering I've had a cold for the past week). I've also found that as a long term stomach acid sufferer, my heartburn and throat pains associated with acid production have dropped quite a lot. And I've been sleeping better since starting the beclomethasone. I hope this helps, and as always, the doctor's the best person to advise!
Good luck
David
Ordan something i thought you might find a bit comforting my Resp nurse at my local hospital always reminds me it takes weeks for inflammation to build so even though you now have a treatment it may well take several weeks foryou to get complete control. Most GP surgeries have an asthma nurse which may be worth you having a chat with. Your GP may know of a breathe easy group in your area of people with resp diseases that help people to learn to keep control of their breathing and can answer questions etc. If you are at all worried or think your GP may have missed something then ask for a referral to a respiratory consultant. Though you sound like you have a very good GP who is following protocol.
PS I am another adult onset asthmatic!!!! I used to be a nurse also and one thing i have learnt from life as a health carer. Diseases dont read books!!!! My meaning by this is it is all very well having protocols, theories, documented evidience each human being is different and reacts differently both to the disease and treatments. Which is why as EmH says to give advice when you have a patient and all their results in front of you is difficult to give specific advice over internet is nigh on impossible.
I sincerely hope you get all the help you need. We are always here to support you thru whatever you experience.
Take care
Louise
ditto louise, as a fellow adult onset severe asthmatic who had to give up nursing!!
patients dont fit protocols and protocols are just there to guide.
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