adverse reactions to LABAs?

[yaf_user681_53148]

I've had a pretty rough few months since moving from clenil (steroid only) to seretide, then symbicort, both of which contain a long acting beta agonist. I've been back on the clenil for about 10days and feel a bit better, so my GP is working on the assumption I may be sensitive to the LABAs. I'm wondering how common this is? The asthma has been fairly well controlled for about about a month or so, but I'm left with sob at the slightest bit of exertion. This has improved a bit on the clenil and the GP is hoping it'll carry on improving as the clenil continues to kick in over the next month. I've also just found out I'm vitamin D deficient - not sure how relevant that is, but thought I'd throw it in there just in case.

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Hi sorry to hear you've not been too good. Just wondered what happened to you when you were on seretide? I'd been using clenil on and off for years, being lucky enough to control my symptoms with about 400mcg per day, ie 2 puffs morning and 2 night but often going years without requiring any at all. All that changed when I started becoming sob and was put on seretide. I was on it less than 2 weeks but had to come off it as I was becoming increasingly tachycardic and gp said must be sensitive to the LABA in it.Had a very rough time after this. Needless to say back on clenil now but also taking montelukast. (Singulair) has your gp / asthma nurse ever suggested it to aid your control?

[yaf_user681_53148]

Hi. Montelukast has been mentioned to me by an AUK asthma nurse, but I'm not on it. It is something I would like to discuss with my GP anyway, but at the moment no one is 100% sure it is asthma. We're waiting to see how I feel on Clenil for next 3-4 weeks and see if there's an improvement.

As for Seretide, to cut a long story short, I asked to be put on a steroid + LABA because I wanted to be on a lower dose steroid (silly me!). The adverse effects, if that's what they were, didn't start straight away, but I got a nasty virus, which made me feel rubbish and I didn't improve after it went. Persisted with Seretide for a couple of months but asthma just got worse and worse, then was put on a high dose Symbicort. That did get my coughing under control but I remained sob. Had course of pred, still sob, so now trying no LABA to see if that does it. Failing that it'll be a cons referral, which is probably not a bad idea because I just want someone who really understands lunsg to have a look at me. My GP thinks I'm 'interesting' - good for him, but in the meantime I can't do an awful lot, I feel like an old lady!

I did feel very shaky on Symbicort though. Not tachycardic, but definitely weird, but that may have been because I was taking quite a lot of the stuff (8 puffs a day). Glad to be off that now.

Currently also on nasal steroids, antihistamines and vit D for my non-respiratory symptoms (tiredness, lack of concentration, poor memory and, in the last few days, dizziness too. Fun fun).

[yaf_user681_53148]

Oh, and I hope you are feeling better on Montelukast? Has that helped at all?

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Hey I really sympathise! Like you my main symptom at the start of this episode I've had has been coughing as and sob following a nasty cold which clenil wasn't helping. I too then went onto pred for 15 days but after a week, suffered 3 acute attacks within a week and went downhill. As I wasnt responding to pred I was started on montelukast. Its taken my lungs 2 weeks to start calming down and stop coughing and wheezing. Its only been the last few days I've felt like I've been getting back to normal so it's hard to know what effect its having yet (I've been on it for 19 days now).

At least your giving your gp something to think about it lol!

Know how you feel with the other symptoms. I have allergies and chronic fatigue syndrome so regularly have similar symptoms! Apparently montelukast is good for asthma which may have an allergy component. Been referred to resp med too.

Totally know what you mean re old lady syndrome !xx

[yaf_user681_53148]

Oh no, sounds like you've been having a really rough time! How did you manage to take pred for two weeks??? I know some are on it long term, but my week-long course was hellish side effect wise.

Any idea why they would choose montelukast over antihistamines? Or vice versa? GP told me to take over the counter antihistamines and they seem to be helping the urticaria I was having, which he thinks might be related to the asthma. If it is asthma! One of the nurses in the practice is convinced it isn't and my lack of improvement after a week of pred has confirmed that for her. But GP seems to still be working on the basis it is, so I'm confused!

I hope you carry on feeling better. Scary, isn't it?

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Yes it is scary . No wonder you're confused if the medics are confused! Asthma is very difficult to diagnose and as it's something that can't be seen its often diagnosed by symptoms and response to treatment but it's def more complicated than that given the range in severity and different symptoms. At least they are keeping an open mind and looking at different possibilities. That's a good question re antihistamines. My gp has considered it as I thought there might have been an allergy component to my recent flare up. I think tho because I've been asthmatic since I was 5 and I'd been back and fourth for the 2 months previously complaining of escalating symptoms there was a need to try get the asthma under control quickly so she tried me with the pred first but as soon as I stepped down the dose my coughing and sob got worse hence the montelukast. I found the pred OK, first couple of days I felt restless and irritable but it soon calmed down. How did you feel on it??

My 6 year old daughter has a ?asthma diagnosis hanging over her too. Coughs for weeks on end then periods where she doesn't cough at all! Ventolin doesn't seem to make any difference either so I feel your frustration with it all! X

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PS have you had allergy testing? Is it possible youve become allergic to something new or something you weren't allergic to previously? My dad knew someone who became allergic to the leather in his watch strap!!

[yaf_user681_53148]

Well, my GP didn't seem too keen to go down the allergy testing route as allergies can be to anything and you can miss so many things with a test. He did do specific IgE for pollen, dust mites and cats and they all came back negative. Esp relieved about the latter as I have a kitty, so glad I was tested and that it's not him that's causing all this grief!

I think the main reason the nurse doesn't think it's asthma is that my PEF has never been below 80% of my PB, even at my worst periods of taking ventolin 3x + a day. I'm not sure what to make of that either, all I know is that my symptoms are very asthma-like. They come and go, I react to chemicals (as in bubble baths and air fresheners) as well as cigarette smoke, I cough a lot, I improve on clenil and ventolin, I feel very 'itchy' inside... I could go on.

I felt awful on the pred. I think the thing that kept me together was knowing it was only for a week. I felt really anxious, couldn't sleep, I felt wired and couldn't settle, but felt tired at the same time. I also felt angry and lost my temper a lot. My poor OH put up with a lot that week! I hope to never have to take it again!

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I think your asthma nurse should absolutely not discount asthma due to your pf. My pf at absolute worst was 70% of my pb recently after during a week where I had 3 acute attacks.I felt absolutely awful despite a small drop. So I also asked this question in a previous thread on here . The very helpful response I got was that if you have small airway disease your pf can remain normal as pf often drops if there's large airway constriction. You sound very ""atopic” and asthma would fit with all that.

Know what you mean on the pred, I was like that the first time I was put on a course but OK this time thankfully. When do you next have a review with gp or nurse? X

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Hi,

I've looked at this thread a few times and keep meaning to reply as so much of what you say is similar to me.

I am very allergic and what you say about feeling 'itchy' is very familiar - I once described it to a cons as wanting to take my airways out and give them a good itch. I also get a good build up of mucus and sometimes find a steamy bath is got to relieve both (presuming steam is not a trigger). I hate fizzy drinks but when I am bad, I get through quite a lot of diet coke as it seems to sooth my throat too! I have tested positive to loads of things and also negative to a few which def gives me a reaction. Did they do a total IgE level? I have taken monteleukast for years and it does help my asthma control. I do have anti-histamines in the summer for hayfever and then when needed in the winter on top. I think monteleukast is much more targeted for inflammation in the lungs.

Have you tried any other combination inhalers/LABAS? There are a few about. I did find that when taking is as part so SMART (so quite a lot in one day), Symbicort made me feel bad. I react a lot to salbutamol (tachy, shaking, on edge) but find that terbutaline/Bricanyl is a lot better.

If you still can't get to the bottom of it, a referral sounds like a good idea -if only to confirm the diagnosis. In a way, I am glad I was diagnosed as a child when my asthma was a bit more classic because I would probably struggle now. When I saw a cons, they did some reversibility tests and did detailed lung function tests which confirmed that I have a lot of inflammation and do respond to a reliever. The lung function tests showed that while my peak flow was ok, the other indicators showed it should be better and some tests were really low. All of this and history/family background of being atopic confirmed the diagnosis. I cough a lot rather than wheeze and this was put on my diagnosis which has really helped too.

I hope this helps.

[yaf_user681_53148]

My pf at absolute worst was 70% of my pb recently after during a week where I had 3 acute attacks.I felt absolutely awful despite a small drop. So I also asked this question in a previous thread on here . The very helpful response I got was that if you have small airway disease your pf can remain normal as pf often drops if there's large airway constriction.

Ah, this is interesting! I wonder why she was so hung up on the PF then?!! Or if there was something else that made her think it isn't asthma? All I know is that the GP I saw after that told me she was thinking too much in terms of the guidelines, and that seeing as I responded well to a trial of treatment (back then) the diagnosis was correct. And I suppose when I saw her more recently there was still nothing that would have changed her mind as I wasn't responding to treatment. I really wish I would get a referral, only if for my own peace of mind knowing that someone who really understands lungs has had a look at me and agrees (or not, as the case may be) with this diagnosis. Because right now I sort of feel that they are trying to put a square peg into a round hole. Or just chuck a lot of drugs at me and see what sticks. Sigh.

I am very allergic and what you say about feeling 'itchy' is very familiar - I once described it to a cons as wanting to take my airways out and give them a good itch. I also get a good build up of mucus and sometimes find a steamy bath is got to relieve both

Yeah this is how I feel. Steam does seem to help me, but I've not used it much this way because there seems to be conflicting information about it. Or perhaps I'm misinterpreting it - I don't know.

Have you tried any other combination inhalers/LABAS? There are a few about. I did find that when taking is as part so SMART (so quite a lot in one day), Symbicort made me feel bad. I react a lot to salbutamol (tachy, shaking, on edge) but find that terbutaline/Bricanyl is a lot better.

No, I've only ever used Seretide and Symbicort. I can feel a bit odd on ventolin as well sometimes, but in a way I don't mind that because it's a rescue treatment. The thing about LABAs is that you need to take it everyday regardless of how well you are and at least these two I tried didn't work well for me. The former didn't seem to help at all and the latter made me feel strange. I don't mind feeling a bit strange if it means I can breathe, but feeling strange everyday is no quality of life. I'm quite happy to experiment with other drugs, but I feel frustrated that the GP doesn't seem to make heads of tails of what's going on and yet won't refer. Doesn't instil a lot of confidence, does it?

Sounds like montelukast is worth a go. Do people generally get side effects from this drug?