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asthma flovent 220 four times a day

Hi, I am 30 years old. Was changed by my doctor from advair 500/50 twice a day to flovent 220 two puffs twice  a day as he believed the LABA in advair was making asthma worse. He was right and feel better. Even when I haven't been on flovent/advair my peak flow has been totally normal as well as all parts of the pulmonary function test. My only main asthma symptom is tight chest hard to take a good deep breath inward. I've never had a challenge test or anything like that. The asthma popped up around age 21. Had CT of lungs, xrays all normal. Ige level normal. Allergy tests show dust mites, and eggs. Can you recommend any other tests to confirm this is asthma? Is this cortisteroid dose rather high for adult onset asthma? Will i eventually need a higher dosage as I get older?
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242587 tn?1355424110
MEDICAL PROFESSIONAL
It is quite uncommon to have an adverse effect from a LABA but one cannot argue with the outcome of discontinuing the drug, in your case.  I am pleased that you have continued to have normal peak flows and PFT’s and have been almost completely asymptomatic.  

The most interesting information that you have provided is that, “..it is hard to take a good deep breath inward.”  This is not typical of asthma and suggests another diagnosis: Vocal Cord Dysfunction (VCD), which is an abnormal, inappropriate closure of the vocal cords with inspiration.  This condition can mimic asthma and can occur with asthma.  I suggest that you ask your doctor if the PFT’s included both expiratory and inspiratory flow-volume loops.  With VCD the inspiratory loop is abnormal; flat rather than elliptical.

A methacholine challenge test is the standard way to confirm the diagnosis of asthma and, given any uncertainty about the diagnosis of asthma, could help to sort things out.  In addition, in the circumstance of VCD, the methacholine may precipitate closure of the vocal cords.  Should your doctor opt to order a methacholine challenge, it would be wise for him/her or another physician skilled in the technique of fiberoptic laryngoscopy, to be present and perform a direct examination of your vocal cords.

Gastroesophageal reflux disease (GERD) is a condition that can cause heartburn.  In some instances, it can even cause inflammation of the vocal cords, resulting in VCD.  It is thus possible that the inhaled steroid (Flovent) has been effective by cause a reduction in inflammation of the vocal cords.

See the following report from the medical literature.  You may want to share this with your physician.

Authors Full NameParsons, Jonathan P. Benninger, Cathy. Hawley, Miles P. Philips, Gary. Forrest, L Arick. Mastronarde, John G.
InstitutionThe Ohio State University Medical Center, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, 201 Davis Heart/Lung Research Institute, Columbus, OH 43210, USA. jonathan.***@****
TitleVocal cord dysfunction: beyond severe asthma.
SourceRespiratory Medicine. 104(4):504-9, 2010 Apr.

AbstractBACKGROUND: Vocal cord dysfunction (VCD) is the abnormal adduction of the vocal cords during inspiration causing extrathoracic airway obstruction. VCD has been described as a confounder of severe asthma. The influence of VCD among less severe asthmatics has not been previously defined.

METHODS: We retrospectively reviewed the medical records of 59 patients with pulmonologist-diagnosed asthma who were referred for videolaryngostroboscopy (VLS) testing from 2006 to 2007.

RESULTS: A total of 44 patients had both asthma and VCD. 15 patients had asthma without concomitant VCD. Females were predominant in both groups. Overall, the majority of patients referred for VLS testing had mild-to-moderate asthma (78%) and 72% of these patients had VCD. Few patients from either group had "classic" VCD symptoms of stridor or hoarseness. Gastroesophageal reflux disease (GERD) and rhinitis were common in both groups.

CONCLUSIONS: Vocal cord dysfunction occurs across the spectrum of asthma severity. There was a lack of previously described "classic" VCD symptoms among asthmatics. Symptoms were diverse and not easily distinguished from common symptoms of asthma, highlighting the need for a high index of suspicion for VCD in patients with asthma. Failure to consider and diagnose VCD may result in misleading assumptions about asthma control, and result in unnecessary adjustments of asthma medications. The high prevalence of GERD raises the question of the role of acid reflux in the pathogenesis of VCD in asthmatics.

As to your question about the dose of flovent, in the treatment of asthma, and whether you will “eventually need a higher dosage as I get older”, the answer is that the dose required may vary over time and is unpredictable.  The general rule is that one should be given the lowest dose of an inhaled steroid, required to result in very good-excellent control of asthma.  This will require a combined effort by you and your doctor to establish that dose.

Once again, the main order of business should be to confirm (or refute) the diagnosis of asthma and to proceed to evaluate the possible diagnosis of Vocal Cord Dysfunction.

Good luck
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Avatar universal
Only thing that is abnormal is that its hard occasionaly to meet the 6 second expiratory flow, we have to try a few times sometimes in th epft
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Avatar universal
I can take a deep breath but cannot take a full deep breath . so I'm guessing that somewhere in my smaller airways where the test does not measure?
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