Twice a week rule for inhalers?

[Marktime]

In the US this is medical guidance:

"If you need to use your quick-relief inhaler more than twice a week, it signifies that your asthma isn't well controlled and you might need a stronger treatment plan."

My asthma requires inhaler every three hours sometimes, 4× a day + steroid inhaler. I am also on Dupixent ( monoclonal antibodies) for eczema/asthma. My triggers are, beauty products, laundry detergent, almost anything that stinks or has chemicals, stress, smoke, car exhaust, etc. Sometimes I can smell and be irritated by a bar of soap from across the room, yet other times I can stand right next to it and have no reaction, I'm kind of losing my mind because I never know when or how reactive I will be. Sometimes I can shop like normal and other times I can't get in the same aisle with a person who has clothing washed in fragrance soap. At times I just have to leave and try later. Is this just another day in the life of an asthmatic or am I crazy. Thank for reading this huge post. Mark

[Itswonderful]

hi Marktime. I just wanted to say that you are not crazy. I experience similar. Hopefully someone will be along with more to share with you but yes, it is very difficult to plan.

[runcyclexcski]

I have the same triggers, plus pollen, dust, mold, cold air, dry air, wood burning, altitude, etc.

The guidelines with the rescue inhaler sometimes seem disconnected from reality. Every asthma doctor recommends taking it before exercise, and every asthma doctor recommends exercise (despite pollution, pollen, dry air, cold air etc -- which automatically make me exercise in a respirator, to doctors' surprise). Thus, if one exercises a bare minimum of 2-3 times a week, this automatically puts one in the "not well controlled" category, no matter how poorly one is doing with asthma. I guess I am just happy to be alive, and do not care how they classify me.

[Marktime in reply to runcyclexcski]

Yeah really, who has well-controlled asthma I don't know. If you don't mind I'd like to ask you about the respirator and do you really wear when you exercise and does it work, would i be able to breathe in it and ride a bicycle, you think? My pulmonologist he's a great guy but he scares me, he looked at me and he said "be very careful of spring" but he scares me because he knows, last year I was able to ride in the spring and summer but I was not as flared up as I am now and have been. I have been thinking about a HEPA filter with a hose and a mask, but I don't want to look like a government HazMat team and I think that the cost would be highly prohibitive.

[runcyclexcski in reply to Marktime]

I run, bike and nordic ski in the 3M half-masks with carbon cartridges when the air is warm (above 50F/10C). The respirator reduces the speed by about 25%, but if you are at commuting speeds, it's fine. If you are trying to do a hill climb race, you won't be anywhere at no-respirator levels (the air resistance goes up as a square of air flow/effort). When it's colder I ride rollers at home and breathe through a powered respirator with a HEPA filter with a hose which also humidifies and warms the air to 95% RH and 37C. Just finished another workout like that :).

Upd: if you try 3M respirators, keep in mind that the silicone mask and the silicone gaskets/valves may have a "chemical" smell which may, or may not, be irritating to you. I am yet to find a single respirator/powered respirator that does not have this issue. However, with 3M respirators there is a simple solution -- one can bake all the silicone parts for 3 hrs at 135C with moving air and the smell goes away (found this protocol in an old NASA document). For powered respirators, it's a whole different story: had to make my own carbon filter for those. It is much easier to live if one is not triggerred by smells.

Disposable 3M P2/N95 masks (made of non-wovents) generally do not have this smell issue, but also are not as good at filtration and are not as tight fitting as respirators.

[Marktime in reply to runcyclexcski]

Thanks, I'm definitely looking into that. I'm looking for some kind of HEPA filter that's portable like you described that you use at home, I would love to have something small enough and portable enough where if I were in a store for example and someone walked up with really bad perfume instead of having to leave I could just breathe through that momentarily, I wouldn't necessarily have to have it on all the time only if something invades my environment.

[runcyclexcski in reply to Marktime]

What you are describing (an emergency mask to put on) is why I have a respirator on me at all times (in the backpack). You can test a regular non-powered respirator: those are easier to quickly put on and take off. They do have some air resistance, you would just have to try and see how bad they are for your breathing. In my experience, they have as much resistance as P2/N95 disposable masks. Disposable masks are not very good at filtering smells and smoke (even those that have carbon impregnation in the faric). I.e. if there is a smoker walkin ahead of you on the street and you have a P2 disposable, you will still feel the smell.

These ones are really good at removing odors (but any carbon-cartridge one will prob be OK, as long as it's OSHA-certified etc). No smoker can harm you when you have one on :).

amazon.co.uk/3M-Reusable-Ha...

amazon.co.uk/3M-7502-Medium...?

I only use the powered resprator at home, even though I have tried using it while hiking. The latter is a bit cumbersome, and I still get triggerred by the cold air, even if the air is clean.

Be prepared for people to take offence when you put on a mask in their presense. I started to put a very large fluffy scarf around the mask. It's not as obvious, people think that I am just very concious about being warm.

[Marktime in reply to runcyclexcski]

Thank you, I wasn't aware that they worked that well, I will definitely get one, I might need it to ride in the spring/summer. The scarf or covering is a great idea. I will figure out how to make it work for me without making a scene. haha. I would like to have one with the filters on a small canister on the waist and a one inch tube going up to a mask similar to an oxygen mask, I've not seen one yet.

[runcyclexcski in reply to Marktime]

with a thin tube, there needs to be a blower motor, otherwise one cannot suck through the narrow long tube. They make "nasal filters" in various shapes; they are very inconspicuous, but restrictive to breathing. In general, it's easier to make these when one is at "resting" breathing rate. As soon as one does any kind of exertion (walking etc) the demand for air goes up. My home powered respirator for exercise is at 400 lpm, need to combine two standard ones for enough air flow. You can also check these out:

cleanspacetechnology.com/

I have one, but I am not using it: not enough air flow with exertion + smell of silicone. But everyone is differnet, may work for others.

[Lysistrata Administrator Community Ambassador]

Yep I know what you mean. I think for me, and others I know with severe asthma who experience this, it depends on how twitchy your airways already are and what other triggers you've encountered recently.

I've loosely categorised my triggers into 'things that will always cause a major asthma reaction', 'things that usually cause some asthma reaction' and 'things that will cause an asthma reaction if I'm already having issues.' I compared lists with friends in a similar position and we all had this sort of pattern - but the details of which trigger was on which list varied! Which is why I never accept someone saying that because X does or doesn't trigger their asthma, it will be the same for everyone.

My friend also coined the term 'trigger Jenga' - for when you can push out a few blocks but the last one is what makes the tower fall ie any one trigger alone wouldn't be enough, but several together might be. For me, it might be for example that it's very hot and humid, I've just had to deal with going too close to a rosebush (rose scent is a big one for me), and then when I've dealt with that there's someone smoking a few feet away outside who walks away. The brief smoking exposure alone might not be a big deal at other times but it will be in this situation. (Being stuck inside with someone smoking would always be an issue for me.)

I also don't generally consider exercise much of a trigger for me by itself, but I will really struggle with exercise tolerance and it will make my symptoms worse if I've already been triggered by something else.

I'd also say sometimes it can be difficult to tell what the actual trigger is with some products which have several ingredients. I react to mango, lavender and rose plus other flower/fruit scents for example, but only to the actual plant or to high quality products containing the essential oils or extracts. The cheaper end of the market seems to have removed whatever it is that affects me, so I'll react to posh lavender shampoo but not the cheap £1 stuff my partner uses, and mango juice but not my hairdresser's mango scented shampoo. For a friend, it's the opposite - she's worse with the artificial scents.

So it might be that part of the reason you only react sometimes to what seems like the same thing is that actually they're not always made with quite the same ingredients that you react to. My lungs can be incredibly picky!

Hope this helps so you know you're not going crazy - though it can feel very difficult!

[Troilus]

Hi Marktime.

I was pretty much the same. Sometimes things would smell very strongly and at other times I would hardly notice. I have this personal theory that when my airways weren’t happy I noticed things - a kind of danger alert, but when my airways were happy my body didn’t need to warn me. It’s probably rubbish, but there you go, that’s me😁

I have removed as many of the offending items from my life. Changed washing powders, soap, washing up liquid, bath bubble, perfume etc. I very rarely use sprays- if possible (polish for example) I spray into a cloth first. Hairspray I use in the utility room ,holding my breath, dash out of the door and close it behind me.

I suggest you look at the offending items and see if there are any you can change or limit your exposure.

[Marktime in reply to Troilus]

I think you're right I think it comes down to the level of inflammation at the time because my house, it never changes yet I'll walk into the room on a different day and I will smell irritating odors, and sometimes the hand dishwashing soap will be extremely annoying when normally I barely smell it.

[runcyclexcski in reply to Marktime]

*** sometimes the hand dishwashing soap will be extremely annoying when normally I barely smell it.

Sounds very familiar :). Me and my wife found a brand of odorless dishwasher/handwashing soap/laundry detergent and stick with it.

[Ossing]

Hi Mark,I relate with you in many aspects. I cough a lot day and night and anything can trigger my asthma. It's difficult for me to say what are the main triggers. I try living with this condition while being consistent with my medications. I have come to terms with the fact that cough and asthma are a pair, in my case. It's difficult and frustrating but I try living positively because I think of others who can't leave their beds or are in so much pain. Courage and keep on taking care of yourself.