Irreversible damage to lungs due to asthma

[AmyCB]

35-year-old female just diagnosed by methacholine challenge (21 and 23% on first dose). Symptoms of asthma for over 20 years. Self-treated with Primatene Mist and Ephedra. Just prescribed Advair 250/50 twice a day and Albuterol p.r.n. and pre-exercise. Any worries about long-term use of Advair or Albuterol? And, at what point does asthma cause irreversible damage? Does asthma cause other health problems? Approximately how long before see an improvement with Advair? Thanks.

[National Jewish]

The earlier in life that asthma begins, the greater the likelihood that irreversible damage will occur.  However this can happen at anytime to anyone with asthma.  This is more likely when asthma is poorly controlled.  Routine pulmonary function tests will show if this has or has not occurred.

There are no worries about long-term use of albuterol.

The most common side effects with an inhaled steroid are thrush, cough or hoarseness.  Thrush is an over growth of a yeast normally found in the mouth.  This causes a white discoloration of the tongue and mouth.  Generally rinsing your mouth and spitting out the water after inhaling the steroid prevents thrush.

The lasting side effects with a steroid pill are cataracts, glaucoma, diabetes, or osteoporosis.  It is rare to develop these side effects with an inhaled steroid, like the Flovent® (fluticasone) contained in the Advair™ Diskus® (fluticasone/salmeterol).  Steroid side effects are more likely to occur with higher doses of an inhaled steroid.  That is why the lowest dose of Advair™ Diskus® (fluticasone/salmeterol) that will control your asthma should be used.  Keep in mind, however, that an inhaled steroid has much less risk of side effects than a steroid pill.

You will see improvement with Advair™ Diskus® (fluticasone/salmeterol) as the inflammation in the airways of your lungs lessens.  This could happen during the first week.  However your asthma has been poorly controlled for over 20 years, so you may have a large amount of inflammation in the airways of your lungs.  It could take longer for the Advair™ Diskus® (fluticasone/salmeterol) to lessen this inflammation to the point where you see improvement.  As long as the inflammation is lessening, you will continue to see improvement.  This could continue for several months.

[starion]

Asthma is best when well controlled; taking Advair on a regular basis as prescribed will help with that, as well as using albuterol as needed.
The main bad long term side effect from Flovent, an inhaled steroid (which is contained in Advair) is possibly reduced bone density.  Because of this, many of us who take inhaled steroids also take calcium supplements to be sure we get adequate amounts of calcium.
The other more irritating side effect is thrush infections which can occur particularly if you don't rinse & gargle thoroughly with fresh water after EACH dose.
The inhaled steroid in Advair may take several weeks before maximum effectiveness & must be taken as directed for optimal results.  The long-acting beta 2 agonist portion of Advair, Serevent, generally is effective within a hour after taking it & lasts about 12 hours.
Once your asthma is under optimal control, your doctor may be able to "step down" you treatment, so you take a lower dose and/or less medication.
Aloha,
Starion

[blondeviolin1]

Asthma can be a fairly easy disease to control, provided you have the right questions.  Now that you've tested positive on your methacholine challenge, I would recommend finding what aggravates your asthma.  Things like VCD, allergies, sinusitis, and GERD are disorders that may aggravate your asthma.  Also find your triggers, and try to avoid them.  Allergy testing may help with that, and it may help to ask about the possibility of GERD because if you can control some GERD then you can control some asthma.

I hope that now that you have the answer you won't have to keep being confused and breathless...

[reader1]

I think it's more likely that one can get long term damage from primatene mist and ephedra than from Advair and Albuterol.  At any rate, the latter should be much more effective for you.

[DB47]

Advair is a godsend to those that it works for.

After many years on several different kinds of inhalers for asthma and 12 years on "allergy shots", Advair did for me better than anything else had.

Then, six months into using it, I started having a very irritated throat (had been rinsing properly, that was not it) seven asthma attacks in two months, two severe and discontinued it because of the sore throat.
That was one year ago.

About one month ago, I think, CBS news had a health warning to people using Advair and mentioned that 13% of the people using it were getting worse after a few months and 54 had been determined died from an asthma attack while on it.

That is a very small percentage for all the good Advair does in the other 87% of people, so I would use it, just be aware that, if your asthma starts getting worse, check back with your doctor about this soon.

As others mentioned, you will still need something like Ventolin for any acute episode.
Advair is for the long run, not for short of breath emergencies.
On Advair, I didn't have any wheezing or needed Ventolin hardly ever, had quit carrying it (until Advair quit working).

[AmyCB]

Thanks to all who responded. In a week's time, I feel a lot better. Just being able to take deep, full breaths is amazing. I don't get an asthma attack when I walk up steep hills. I ran for the first time in a long time the other day and I did a lot better starting out than I usually do. No loud breathing, wheezing or chest tightness and I was able to recover right away.

I do notice a little throat irritation but not bad. I don't know if it is a coincidence but I seem to notice more mucus.
Anyway, so far so good.

[Purified Air]

I have a 21 year old son with asthma but since having an air purifier in my home that covers the whole house; I've found it to help all 8 of my children who live at home still even in the midst of this WI winter - we've had no colds or flu or other respiratory ills.  Here's some obvious signs in your own home that can indicate a need simply for air purification.
COMMON TRAITS OF INDOOR AIR POLLUTION
Affected Household Members initials: ____ ____ ____ ____ ____
Dust on furniture / Visible in air
House odors
Allergies
Asthma
Sinus problems
Headaches
Sleeplessness / Light sleeper
Snoring
Sore throats / Colds / Flu
Itchy/ Watery eyes
Coughing / Throat clearing
Lack of Concentration
Depression / Irritability
Fatigue / Naps
Mold / Mildew in basement & bathrooms
Pet dander and odors
Smoking
Wood / Coal heater
Static Electricity

As you fill this in and realize how much is affected by your indoor air; maybe you should try an ionizing/ozone air purifier like I have.  It's removed all respiratory ills in our family with 8 children 19 down to two.

[mic388]

A related discussion, Primetine misr was started.