NIGHT-TIME OXYGEN RATE

[RBL364]

recently diagnosed with COPD/emphysema.  hospitalized three times:  finally determined that i'm allergic to sulfate based albuterol, combivent, all of the usual "suspects."  i'm now on advair (one week= 115 ) and doing okay - except the only rescue inhaler i can tolerate is primotene mist.  just took an oximeter test - came out 86-87.  i think it's too soon to go on oxygen, until we see if advair works.   but i worry about the advair too.  will i ever get better and be able to switch to lower advair dose?  my MD says i have "moderate" COPD....does it get better, or what?    help, rbl

[National Jewish Health]

A prime question is, how was it “finally determined that I’m allergic to sulfate (sulfite?) based albuterol?  You would want to be very sure that this diagnosis is correct before you proceed to eliminate a whole variety of foods and medicines that contain sulfite preservatives.  Also, albuterol is available in a preservative-free form – I suggest that you check with your pharmacist on this.  Primatene mist is not a very effective medicine.

Oximetry with a saturation of 86 to 87% is on the borderline of indications for the continuous oxygen.  You will need further information, for example what are your saturations while asleep, before making any decisions concerning the use of oxygen.

You are correct in wanting to wait until you have achieved optimum benefit from the Advair® HFA (fluticasone propionate and salmeterol) Inhalation Aerosol, before any consideration of oxygen use.  The Advair® HFA (fluticasone propionate and salmeterol) Inhalation Aerosol may raise your saturation, to a degree that will make oxygen use unnecessary.  Your current dose of Advair® HFA (fluticasone propionate and salmeterol) Inhalation Aerosol is low and, at this level, highly unlikely to be associated with any clinically significant side effects.

Chronic obstructive pulmonary disease (COPD) is a progressive disease that will slowly worsen.  There is evidence to suggest that the regular use of Advair® HFA (fluticasone propionate and salmeterol) Inhalation Aerosol may slow the progression.  The best way to slow progression is smoking cessation.  The rate of loss of lung tissue in COPD is roughly 3 times as fast for smokers as it is for those who quit.

Good luck.

[RBL364]

the doctor said:   "how was it “finally determined that I’m allergic to sulfate (sulfite?) based albuterol?  You would want to be very sure that this diagnosis is correct before you proceed to eliminate a whole variety of foods and medicines that contain sulfite preservatives. "   after you wrote i did some more research - evidently the preservative i'm allergic or sensitive to is "benzalkonium chloride BAC".  allergist didn't say exactly what the problem was, but she sprayed my inner wrist with al albutuerol spray and it felt as if i had been stung by a bee, an d it raised a nickel sized welt.   two weeks later i still have a slight mark on my skin.   now i'm worried that i had permanent damage when i used combivent and albuterol a few months ago.  (i first came up with this because i also took astelin and that produced similar bronchospasms...now i see that astelin has BAC in common with combivent and albuterol, etc.).  

now my internist has order a blood sugar test and an eye test....so i'm really getting worried.    thanks for your help.   rbl