Reaction to Asthma Medications

[cageycorner]

When I use an inhaler like spiriva or flovent I cough and strangle for several minutes. I have had chronic bronchitis for years. Since last summer I have been treated for asthma. I have tried advair, flovent, foradil, albuterol, singulair, and a nebulizer. If I use spiriva in the morning by about 4p.m. I can feel the congestion returning. That's when I take the singulair even tho the doctor wants me to take it at bedtime.
The advair did not seem to help. The flovent and foradil combo did not seem to help either.
How do I know it's asthma not COPD?
Should I react with coughing after using these asthma medications?
Any insight?

[National Jewish]

Generally testing for asthma starts with a simple breathing test called spirometry.  This test provides detailed information about how your lungs are working.  It will show if there is obstruction in your airways.  To really test for asthma this test may be repeated after using a rescue inhaler, like the bronchodilator albuterol that you are using.  This measures how much the bronchodilator helps your lungs by reversing the problem.  When there is a 20% increase the test is positive for asthma.  However it is possible for this test to be normal when a person with asthma is not having breathing difficulty.

There is a complex asthma test that is the gold standard for diagnosing asthma.  This is called a methacholine challenge.  You will blow into a spirometer before and after each increasing dose of an inhaled medicine.  This test is positive for asthma if the result after the inhaled medicine is 20% lower than it was before the inhaled medicine.

With asthma the basic problem is chronic inflammation along with tightening of the smooth muscles that surround the airways of the lungs.  This tightening is called bronchospasm.  Usually asthma is treated with 2 types of medicine for long-term control and quick relief.  This is how they work:  
· an inhaled steroid, like Flovent® Inhalation Aerosol (fluticasone propionate), decreases and prevents the inflammation when it is used daily; and
· an inhaled bronchodilator relaxes the smooth muscle tightness.  A long-acting inhaled bronchodilator, like Foradil® Aerolizer™ (formoterol fumarate inhalation powder), prevents bronchospasm when it is used daily.  If it is known that something like exercise causes asthma symptoms, a fast-acting inhaled bronchodilator is used as a pre-treatment before exercise to prevent bronchospasm.  When asthma symptoms happen, a fast-acting inhaled bronchodilator is used as a rescue medicine to quickly relieve bronchospasm and stop the asthma symptoms.
Needing to use a fast-acting inhaled bronchodilator as a rescue medicine more than twice in a week means that the inflammation and asthma are not well controlled.

Chronic bronchitis is a cough with mucus that lasts for at least 3 months in a row 2 years in a row.  Your chest x-ray and spirometry may be normal with chronic bronchitis.  Most instances of chronic bronchitis are due to cigarette smoking.  However people who have not smoked may get chronic bronchitis from repeated exposure to high air pollution or from work exposures, especially when there is a family history of chronic obstructive pulmonary disease (COPD).  People with sinus problems or post-nasal drip may have a cough with mucus that can act like that seen with chronic bronchitis.

COPD is a general term used to describe the chronic lung disease linked with cigarette smoking and worsened by contact with industrial dusts and other toxins.  This is a combination of chronic bronchitis and emphysema.  It is a disease that worsens over time.  There is a relatively irreversible decrease in airflow and permanent destruction of the airsacs in the lung.  Pulmonary function tests (PFTs) that include a diffusion capacity (DLCO) would clarify if you have asthma not COPD.

The spray from a metered dose inhaler (MDI) can be irritating to the throat and cause a cough.  A spacer is a device that allows you to inhale the medicine at a slower velocity than directly from the metered dose inhaler (MDI).  Also the larger more irritating particles will settle out in the spacer rather than in your mouth and throat, so you shouldn’t cough and strangle.  Please read our information about spacers at http://www.nationaljewish.org/disease-info/treatments/devices/metered/mdi-spacer.aspx to learn more.

[mimi3535]

COPD (Chronic Obstructive Pulmonary Disease) is an umbrella term used to describe lung disease associated with airflow obstruction. Most generally, emphysema, chronic bronchitis and chronic asthma either alone or in combinations fall into this category. So, you have COPD if you have asthma.  

My asthma was real bad when I lived in Hawaii because of the humidity.  I had lived there all my life until 2 years ago. When I moved to Las Vegas my asthma has improved a lot. I still use medication daily, but I have only been to the ER once in 2 years for a flare up.  Not bad since I was making at least 1 ER visit a month back home.  I have heard of people having problems with asthma medication, so I would keep asking your MD to try something new.  Just FYI, asthma attacks can be brought on my stress, and environmental allergens. I'm not every good at keeping my house free of dust and stuff but I do have special pillow mattress covers that seem to help some.

[myproblem]

The deep inhalation needed to take inhalers can really dry out you throat, and get you coughing. Drink water before you take it, then rinse out your mouth, and drink more water. Also, make sure that you are taking them correctly. You should let your pulmonologist see how you take it, and make sure you're doing it right.

[MikeG55]

A related discussion, Reaction to Combivent Inhaler was started.