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Beta agonist toxicity
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Beta agonist toxicity

I am female, 53, nursing administrator, healthy, thin, very active, never smoked.   For no known reason,  I developed allergies, chronic sinusits and asthma 3 years ago.  It's terrible to have this chronic disease because I pride myself on being so healthy and active.  I am having a very difficult time controlling the asthma.  For now, the second time in 6 months I have been to the ED in status and  in a lactic acidosis (almost was on a ventilator in May).  I was told I have a beta-agonist toxicity.  I use my Xoeponex inhaler for rescue and in my nebulizer machine to get me out of an attack but as mentioned twice now have had to go to ED and then end up very hypokalemic and in lactic state.   This scares me!   I don't want to be on a ventilator.  What will help me get out of an attack other than a beta-agonist???  I am scheduled for sinus surgery in December.  CT showed they are completly blocked.  I can't stay on these constant steroid bursts!  It's bad for my bones.   Current meds are:  Dulera 2 puffs BID, Spireva daily, Xopenex inhaler PRN and in Nebulizer.  (I cannot tolerate Advair and Q-Var did not control me well).  Also have an arrythmia and take Atlenolo 50mg daliy for that.    Help and thank you!
242587_tn?1355427710
What you describe is most worrisome, especially the episodes of status, a life-threatening condition.  Your medicine regimen is a good one, that would control more than 90% of persons with severe asthma.  That these medications are not controlling your asthma attests to your very severe type of asthma.

The cause and effect relationship between chronic sinusitis and asthma is strong and relief of your sinus condition is very likely to improve asthma control but we can’t assume that clearing of the sinusitis will totally resolve your problem.

The best advice I can give you is that you and your doctors seek a second opinion at one of the following institutions, where there is considerable expertise in the diagnosis and treatment of the most severe forms of asthma:  1) National Jewish Health in Denver, Colorado Dr. Richard Martin (a disclaimer, I am associated with this institution), 2) The University of Pittsburgh Medical Center in Pittsburgh, PA. Dr. Sally Wenzel, 3) Duke University Medical Center in Durham, N.C.  Dr. Monica Kraft.

If for any reason it is not possible for you to visit one of these Centers, I suggest you contact one of these doctors who may know of a similar center staffed by physicians with comparable expertise, in your geographical area.

I understand that for you and many other persons, making arrangements to be evaluated at one of these Centers, may be inconvenient and costly, but considering the threat this illness poses to your health and well being, it would be well worth it.  I suggest further that you and your doctors make arrangements for this consultation, without further delay.

Good luck
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National Jewish Health
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