Last night I had a very helpful phone consult with my GP where we revisited the when-to-use-reliever issue. I was really happy at the beginning of February because things looked like they were getting better, but then the Friday before I left the USA, things started getting worse. Despite this my doctor decided to reduce my oral pred from 40mg to 35mg when I returned from the USA.
Ten days later things never turned around and were in fact worse – not quite back to where I was mid January when we were trying to taper the pred and got down to 20mg, but getting close. Night before last I woke up in the wee hours and it hurt so much to breathe for a few moments that I wasn't even sure I could concentrate enough to put together a neb. Fortunately, it passed quickly and was a non-issue but I figured enough is enough and decided it was time to call the doctor.
He didn't want to change the pred because I'm already on 35mg. So I went onto my next question: ventolin use. I've had this theory for a while that the reason why I just can't seem to get over this post-cold exacerbation which started in October was that I was constantly irriatating my lungs and adding to the amount of inflammation. The pred does work, but slowly. In the meantime my inflamed lungs are hyper-reactive so I keep having lots of flare-ups – some nothing more than a nuisance and some that are much more serious and take a long time to recover from.
I generally only use reliever for (a) things that bug others like coughing in public (b) symptoms that are growing worse (c) things that make my ribs and abs sore – I've found that having sore accessory muscles makes me more vulnerable to a severe attack (d) breathing that actually hurts rather than being hard or annoying. Anything else I usually try to ignore.
My suspicion is that one reason why I'm not getting better is that every time I ignore symptoms even very small ones and let them ride, I actually increase the irritation and inflammation in my lungs. If pred worked as advertised for me, that wouldn't be a problem – the rate of improvement from the pred would outweigh those minor irritants. However, because pred works slowly with me, I either slow down an already slow process, or even lose what I've gained and move backwards.
He agreed that that might well be going on – actually I think he thinks that is exactly what is going on. Which got me to my next question. A while back he told me he wanted me to use ventolin at first symptoms, but I thought it meant first symptom that looked like it could lead to a significant exacerbation. It turns out that he really does mean ""first symptoms"" and not just first symptoms that get worse or first symptoms that seem serious rather than just annoying. And indeed he means slightest. I asked him
Me: Even if I think its stupid to use ventolin for something so trivial?
GP: Yup, even if its stupid.
Me: Even if it hasn't started to worse yet and I don't know if it will?
GP: Even then. At the very first sign.
Me: You do realise I might be using a lot of ventolin if I do – a lot more than 2 puffs every three-to-four hours?
So I've been trying. It does seem to help me feel better. And though I'm using a lot more ventolin than I usually do: 27 puffs=14 incidents(!) in the last 24 hours plus one unplanned neb (I always have two a day as a pre-treatment for the ICS so this makes a total of three nebs), it isn't as much as I first thought I'd use and I feel a lot better overall, probably because I'm breathing better in between.
So I'm wondering if anyone else has actually been given a formal go ahead to pump on the ventolin this often and if so why? Does it help? Just kind of looking for context I think.
Also if you have both an inhaler and a nebulizer, when do you use one or the other?