I have never had passive asthma or an emergency attack but have had breathing difficulties while excercising, so I have only ever been prescribed a relief inhaler.
Recently to manage stress I have started excercising everyday, and can only achieve my desired intensity of 5k by using salbutamol.
I have recently read online that regular use of salbutamol is dangerous because of the potential onset of tolerance and other side effects. I have already done this for a year and it still works well but I am concerned.
Would a preventer inhaler alone be able to help me control my excercise asthma or will I have to stop running everyday?
Could I cycle between salbutamol and other inhalers to preserve tolerance?
Thanks for any advice
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Fx9997
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The BTS guidance used by Asthma UK states that the aim of treatment is to have asthma under control using preventive measures. It is my understanding that if you need to use your salbutamol before or after exercise then you are not well controlled. If you are using your blue inhaler everyday then you certainly need to talk to your medical team about a preventer inhaler. I was using mine everyday and my steroid preventer was switched to a combination inhaler which might work for you as it has a long lasting dilator which is like salbutamol but lasts 12 hours. Your medics will be able to advise you on that one. My blue use has come down considerably since I’ve been using it. You’ll still need to carry your salbutamol as a combo can’t help in an emergency. Asthma shouldn’t stop you doing which ever type of exercise you prefer, how ever often you want to do it. 😀
Asthma guidelines have now changed, partially due to the research you’ve done and partially just cause it was due. Now it’s meant to be EVERY asthmatic has a preventer and should only need blue in emergency situations. That being said... as a teen I was training 4hrsx6/7 days a week... I only had EIA but cause of the amount I trained I was given a preventer...
Definitely worth talking to your GP/practice AN about this option. You shouldn’t have to give up any sport if you’re controlled correctly. The right preventer will stop the need for the blue reliever unless you’re in an emergency situation (which you state you’ve never had). You shouldn’t need to swap between inhalers at all... you’ll probably be put on a steroid only inhaler... this has no LABA so there isn’t the ‘dangerous’ tolerance potential anyway... but even those on combind inhalers don’t swap, they just find what’s right for them!
Its not what asthma UK says about everyone having a preventer.
Asthma treatment 'pathway' for adults
The treatment you're prescribed will depend on how often you're having asthma symptoms.
1. Just a reliever inhaler
If you only have very mild symptoms, for example if you occasionally come into contact with a particular, known trigger, your GP may just prescribe you a reliever inhaler to use when you get symptoms. Your reliever inhaler is usually blue.
But, if you notice you're using your reliever inhaler three times a week or more, or you're getting symptoms most weeks, go back to your GP or asthma nurse to talk about getting a preventer inhaler too.
“There are a very few people who just need to be prescribed a reliever inhaler for when they get symptoms. Most people with asthma benefit from a regular preventer inhaler taken every day to prevent symptoms coming on,” says Dr Andy Whittamore, Asthma UK's in-house GP.
I think fx997 needs to read the information on excerise and asthma
As I said new rules that came out this year so AUK may not yet have updated. There is also awareness now that the patient should be able to stop preventer inhaler during a good period, and restart when it starts to build with no judgy docs commenting... and this comes from WHO not NICE... so may take time to get into the system. Pretty sure the new BTS guidelines which came out this year say it tho (tbh I CBA to check so someone please correct me if I’m wrong!!)
Yeah. Basically it’s go see GP for a preventer 😅. Then won’t need the excessive vent useage (cause even if ‘only’ EIA if you’re exercising and needing vent/or exercising with vent more than 3x week you are classed as uncontrolled in most circles so need something more 😅)
I've only learned about salbutamol tolerance a few months ago and I've been worried ever since because I now use ventolin daily several times a day. I just can't go a single day without it despite the preventer that I use.
But if all bronchodilators can induce tolerance, does that mean that the one that is in the preventer might also stop working after some time ?
Ventolin/salbutamol the issue mainly cause it is what is used in emergency’s so if you’ve become tolerant to it can really escalate the attack (and the level of drugs needed to resolve). The main danger is in countries where they don’t commonly give preventer inhalers (USA etc). The LABA in combination inhalers works like the steroid component... gradually over time people become tolerant to them, find the preventer doesn’t work so switches for a different one... then you loose your tolerance to both, so can switch back again if needed 😅
Hope that helps explains the most recent research findings. If you’re severe/difficult it’s worth looking up the other options you haven’t tried and asking about them (such as Theo/amino, physio/pulm rehab/psych support, mabs etc and see if any help)... if it helps I went through a few years when I was on excessive vent a day, continuous high dose steroids, salb nebs atleast 1x week in hosp, and a lot of ED/resus attendences but a) I’m still here and b) finally found the right thing for me and good a very good team behind me, and now have days no ventolin, weeks/months no nebuliser, and 6 months between admissions... and this admission responded better than I used to to my ‘usual’ ED med cocktail when attack is due to virus 😅.
Sorry for the tangent Fx9997 😅. Hope it helps you too, and that you make the right decision for you! Let us know how you get on and what you decide
This may seem a bit heretical, but have you considered reducing your exercise limit so that you don't have to use any inhaler? Whilst I am sure exercise is a good thing generally, I am less sure that knowingly irritating your lungs is such a good idea. It would also solve the dilemma of whether regular use of salbutamol is safe and/or effective, because you might not need it at all!
In certain severe/difficult/brittle/‘uncontrollable’ asthmatics this would actually be what needed to be done. However, don’t forget a controlled asthmatic (with no other conditions such as COPD etc) should be able to do they exact same as a non asthmatic with no symptoms at all. My dance teacher for example is asthmatic, but teaches dance/fitness classes multiple times a day some days as she’s controlled, so long as she uses her ‘brown’ inhaler (her words 😅), she never needs her blue (unless chest infection like she currently has and is on a short course of steroids for). So what sounds like a mild asthmatic (the OP from the sounds of it, as blue but no preventer), SHOULD be able to exercise with no issues and not need their pump (there is now an idea in most spec asthma cons that EIA is mild asthma that’s not controlled properly). Hope that makes sense 😅 (plus from experience if you know exercise is helping your MH but you have to stop cause of lungs it can really drag you down... When I was at my most severe/difficult/uncontrolled I had to do the ‘what you can when you can approach’, but now I do a class or 2 weekly and just use pump if needed... and on a ‘good’ day if got through with just 2 puffs pre!)
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