New puffer

[Willow7733]

Hi, for around 10 years now I have had asthma. Recently, my lung function is dropping. This week it is at 41%. I am having trouble catching my breath, and blood tests show I am not getting enough air. Was put on Breztri aerosphere. It is a three medication puffer. Has anyone taken this for their asthma. When I look it up online, it says it is for COPD. Which is weird because I have never smoked my whole life and I am youngish - 50. Just scared of the future if my lung function is dropping so rapidly. (Last December it was at 65%, then in June 46%, and a month later 41%).

[Poobah]

I haven't taken Breztri, but the additional long acting muscarinic antagonist (LAMA) is now licensed to treat asthma and acts differently to the long acting bronchodilator that is also in the inhaler. I've tried 2 different LAMA inhalers before and they can transform things for many patients. It certainly relaxes the airways and does this by blocking the nerve signals that make the smooth muscles of the lungs contract.

As with all meds, there can be side effects. So you should have a review in a few weeks to see how your progressing with the new inhaler. I would say, check your blood pressure occasionally and get regular eye tests, just to ensure the inhaler isn't affecting your BP or your eye health (eye pressure). The majority of patients don't experience these side effects.

It's horrible to experience a rapid decline in lung function, especially without understanding why it's happening. I was going to suggest talking with one of the Asthma UK nurses, but I see you're in Canada. I'm wondering if the WhatsApp route would work for you? The number is 07999 377 775. UK office hours, Mon to Fri. I think you need to explore what's happening with your lung function decline and the Asthma UK nurses are best placed to do that with you.

Hopefully others will share their experiences with LAMA inhalers and their lung function. I remember saying to my manager, after starting a LAMA inhaler, that I felt like an Olympian (I certainly didn't look like one). I know exactly what affects my lung function and it's my weight. But that's just me and in a way I'm lucky that it's something I can control, albeit reluctantly. I got equally good results by losing weight and I was able to ditch the LAMA inhaler.

I also have to avoid omega 6 rich foods, sulphites, preservatives and artificial colourings. There're all huge triggers for me, but it was a difficult at times to figure out what the culprit was. Just using soya milk as a substitute for cow's milk made me very ill, very quickly (over months). It hever occurred to me that something natural could be so bad for me. Low humidity is another trigger. I got very ill once my workplace had AC installed. The system dried the air so much, I was ill most of the time. It seems obvious now, but not at the time as we had no idea that the humidity was so badly affected. In summary, cause and effect.

Doctors may say, "it's just one of those things". But sometimes there's definitely something that has changed that is now affecting your health. It's important to rule out cause and effect.

[Willow7733 in reply to Poobah]

Oh wow! Thank you for your help. It seems you have a great system of support over there in the UK. I am also starting to look at what I eat and how that affects my health. Last night I watched so many informative videos on YouTube. I. Off on vacation all week. It is amazing how much the food industry is getting away with! I have a follow up pulmonary function test and appointment with my pulmonologist in four weeks to see how things are going. He was talking about biologics? But really, it sounds expensive. Long term prednisone is a no for me right now. I don't need to effects since I already have a cataract in my left eye from being off and on it for a while. And the weight gain. Don't get me started. Lol

[Poobah in reply to Willow7733]

Do you know what phenotype of asthma you have? Eosinophilic, non-eosinophilic or something else? Biologics are great for eosinophilic asthma. They are expensive but can be transformative. It's difficult to qualify for them in the UK because of the expense to our national health service. So we too have challenges with service access and rationing. If only everything was available just on a clinical basis!

I've been able to understand my asthma better, knowing the type of asthma that I have. And understanding that things have changed or evolved since my 20s. Now that I understand that my asthma doesn't respond well to Prednisolone but does very well with Azithromycin, it's helped me with flare ups that can go on forever. I've reluctantly accepted that weight is a major factor and continue to work on that. Again, it really affects my type of asthma (I'm non-eosinophilic). I know now that I have fewer infections if I keep my Vit D levels up. And so on. It continues to be a learning curve. And I've learnt so much from this forum.

[Willow7733 in reply to Poobah]

I am realizing everything is not so easy to diagnose with this. I have no idea what type I have, but my recent blood tests show my eosinophils are normal. No sign of increased white blood cells. My red blood cells (hematocrit, hemoglobin,and eurythocytes) are all high though.

[Poobah in reply to Willow7733]

I think that it's something asthma doctors should discuss with their patients, if only to understand what inflammation pathways are active and what treatments are best for that asthma type. I do know that eosinophils can be low when tests are undertaken if the patient has taken their steroid prevention treatment, inhaler or tablets. So tests should be prepared for by stopping prevention meds for a short period, if only to unmask the driver; under medical advice and supervision.

As for high red blood count, your doctor should explain if this us a result of your asthma or if they think it's a factor in your asthma symptoms. It could be explained if you live at high altitude or your body is compensating for your asthma. As you say, you never smoked,so that's ruled out.

I think a WhatsApp chat with the Asthma UK nurses would benefit, they're really helpful and knowledgeable. And they can help one get the best out of their doctor appointments.

[Willow7733 in reply to Poobah]

I am so lost when it comes to these medications. What is a LAMA puffer? What does it do? Is there a good site I can go to to look up these medications and learn what they are all about?

[Poobah in reply to Willow7733]

I would normally refer to the Asthma UK website for a start about asthma and lung disease treatments. But Mayo Clinic is also a good source. I'm sure there's a North American asthma society; aafa.org

LAMA stands for long acting muscarinic antagonist. It works differently to a long acting bronchodilator antagonist. A LAMA medicine works on relaxing the smooth muscles of the lungs and helps them not to constrict. The bronchodilator will open up the airways. Both tackle inflammation in different ways, but work within half an hour. These combo inhalers, like your new inhaler, also contains steroid and this works over time. So the triple combo is a preventer and a reliever. BUT you can't take extra doses as it's important not to take more LAMA than prescribed. That's where you can use a separate inhaler, like Ventolin or Salbutamol, both being a short acting bronchodilator; giving relief for about 4 hours.

Asthma is divided into phenotypes, but even then, each asthmatic will have their own experience. Triggers aren't standard across the asthma population. Treatments are an individual experience too. What suits one person, another will find it doesn't suit them.

I can understand why your doctor wants you to try the Breztri inhaler. It contains 3 meds; steroid, long acting bronchodilator and the long acting muscarinic. The long acting muscarinic has proven to be a very useful treatment where patients have experienced a decline in lung function. But you still need the bronchodilator and steroid in the inhaler. You won't know if it suits you until you try it. It may take up to 8 weeks to know if you're making progress. But at review at that time will measure any improvement and then a decision can be made about continuing with it or trying something different.

Unfortunately, asthma can be a journey of trial and error where treatments are concerned. It should help, once your specialist has diagnosed what phenotype you have.

But again, it will help talking to asthma UK nurses as their knowledge well exceeds mine and I encourage you to learn what you can from appropriate sources. And hopefully, your asthma doctor will take time to answer all your questions about your asthma, asthma type and why they think your rapid decline in lung function has happened.

[Willow7733 in reply to Poobah]

Wow! Thanks for the info. I feel less lost!

[Biggles2612 in reply to Willow7733]

I started biological a year ago and it was a real game changer and haven’t needed my ventolin now for six months. I do take Fostair 200 and Alvesco as preventers.

[Kniterbug in reply to Biggles2612]

Yes me too I’ve been on biologicals for a year now. Only problem I have is when I had Covid vaccine had 2 lots of antibiotics and steroids to clear but not bad for 12 months. Is been really good for me I’m on fostair 200

Only one puff morning and night off all other tablets now too.

[Danielmystar]

Hi my Brother never smoked he had copd sadly he's no longer with us but you don't have to be a smoker to have copd one of my sisters never smoked either she also has copd she's on the same inhaler as you are she finds it good im on Trimbow it's for asthma aswell as well copd hope you get sorted with yours good luck x

[Scampiharris1 in reply to Danielmystar]

how do you find the trimbow inhaler?

[Jamesd1234]

sorry to hear you are having trouble. It looks like others here have made some great suggestions - especially with learning about your asthma type. For me, it’s allergies and pollen which is high right now. I hope the triple inhaler helps improve things and / or you can get biologics covered on your health service… here in the uk I am having a battle and a big challenge to get approved for biologics, despite meeting all the criteria, probably because they want to restrict it and save money! And my private insurance with my employer won’t cover asthma either… however, the triple inhaler sounds very interesting and promising , and maybe something I might be allowed in the future. I hope you manage to make some progress.

[Willow7733 in reply to Jamesd1234]

I hope it works. I am currently in samples my pulmonologist gave me until I see him again in four weeks. I can almost guarantee that even if this works, my insurance won't help. As it is, I was on Zenhale/Dulera and had to pay the $200 a month out of pocket. This new one is more expensive. I just won't be able to swing it.

[Jamesd1234 in reply to Willow7733]

Im really sorry to hear that. I hope you can find a way or an insurer to help with these costs. Keep researching and seeing if there’s other things you can do to help as well. I hope you can make progress