Allergic rhinitis and Asthma

I have perennial allergic rhinitis and mild-moderate exercise/physical activity-induced asthma.

I am currently taking Symbicort 200/6 one puff bid and have been doing so for approximately six weeks. However, for the last few days I have felt a real shortness of breath/chest tightness for a few hours after taking the Symbicort – could this be paradoxical bronchospasm? My FEV1 ranges from 720 to greater than 800 even when I’m not on medication and even when I’m experiencing the shortness of breath. If I discontinue the corticosteroid and only use salbutamol before physical activity there will be a progressive decline in my lung function through chronic inflammation and scarring? In other words is it really necessary for me to be on corticosteroids given my FEV1? Is Symbicort really the best medication for me? What about using Flovent and salbutomol instead or salbutamol alone?

Any safe and effective natural/herbal remedies for allergic rhinitis and asthma?

Thank you.

[National Jewish Health]

This could be paradoxical bronchospasm likely due to the Foradil® Aerolizer™ (formoterol fumarate inhalation powder).  Measurement of your peak flow or FEV1 could confirm the diagnosis.  You state that your FEV1 ranges from 720 to 800.  I assume you are referring to peak flow measurement and, even if that is the case, these values would be exceptionally high.

It is strongly recommended that people with asthma not take a long-acting bronchodilator, alone.  There is actually a black box warning from the manufacturer, mandated by the FDA; this relating to reports of an increase in asthma deaths when the bronchodilator is not given along with an inhaled steroid.  Symbicort® (budesonide/formoterol fumarate dehydrate) Inhalation Aerosol and Advair® HFA (fluticasone propionate and salmeterol) Inhalation Aerosol are pharmacologically fairly equally effective.  Using Flovent® (fluticasone propionate) and Serevent® (salmeterol), which are contained in Advair® HFA (fluticasone propionate and salmeterol) Inhalation Aerosol, would be preferable.  The issue of whether failure of someone with any degree of persistent asthma to use an inhaled steroid, might increase the risk of active inflammation and scarring is still controversial.