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    Back from hiking trip
    Aqua14 posted:
    Hi all,

    I haven't been here much over the past two weeks, and for most of that time I've been on a hiking trip to the NH mountains. There was only one day my asthma was problematic, and I think it was either due to the high elevation or heat-caused bad air quality (ozone), or maybe both in combination. I just took it slowly that day with more rest stops, and I finished the climb up (and down) two small mountains anyway.

    I think the main asthma trigger right now for me is reflux. I have read that bronchodilators tend to promote reflux, so when I see my allergist next week I'm going to discuss whether I could try a plain inhaled steroid without a bronchodilator and see if that helps. I do love Symbicort, but if I can reduce the reflux I'll be a happy camper.

    Hope all are doing well and have been able to get some vacation time, too.

    coughy16 responded:
    HI Judy, glad you had a mainly healthy trip! We were in Europe for 25 days in May/june, & I was also great except for some dicey days in spain. The weird thing was that I didn't feel too bad, but I was wheezy. It's odd for me to go straight to wheezing, but my rescue inhaler nipped it in the bud each time. I too am thinking about going down to just an inhaled steroid. I have an allergist visit next week, & since I haven't needed pred in over a year, I think she might ok me to give it a try. I just figure the less meds I can get by with, the better. I have reflux too, so if it helps that, so much the better! I never had it until I was on asthma meds for awhile, so that could be part of my problems too. Also good news, I see nasacort aq has gone generic, so maybe I can switch back! And I see that singulair is going generic next year, how great is that?
    Aqua14 replied to coughy16's response:
    Wow, 25 days, you are so lucky! I have not been to Spain but really want to go -- especially Barcelona, Grenada, and the Costa Brava. Maybe in the next couple of years I'll get there.

    Glad you were able to keep things under control while over there. It's a kind of scary thought to have to consult a doctor when you don't quite know the language. Do you think that maybe the air quality was bad where you were in Spain?

    It's always a great thing when the meds go generic. I haven't kept up on the generic drug news much since I'm reducing my allergy meds -- my shots are really helping keep things under good control. I'm hoping that by this time next year I can completely stop the Zyrtec since currently I rarely use Nasonex and Patanase, and am taking only half doses of Zyrtec.

    Let me know what your allergist thinks about the bronchodilator promoting reflux - thanks. Judy
    Mathchickie replied to Aqua14's response:
    I found that Advair and Symbicort both promoted reflux a LOT. After a few weeks, I was going around tasting acid 24 hours a day, regardless of what or when I ate. Then again, stimulants in general just don't like me.

    Singulair going generic would be awesome. The inhaled steroids are also going generic, but it doesn't seem like there's going to BE anyone stepping up to manufacture the generics!
    sgbl88 responded:
    HI Judy,

    That sounds awaesome. The NH mountains are gorgeous any time of year. So glad you got to enjoy them with little trouble.

    I have read/heard about the broncho dilaters causing reflux from many sources. I think my allergist suggested it as a reason for my reflux.

    Judy and Sue, I hope both of you get to go off the LABA. the FDA does recommend that LABA's only be used short term for asthmatics. If you can do without it, that would be great. One less med can make a big difference sometimes in how wedeal mentally.

    Sue, thanks for the info on new generics. I will have to talk to my doctor about the Nasacort. Unfortunately as part of my AERD treatment, my allergist switched me to Zyflo, so generic Singulair won't help me any. I do still take one Singulair before going to church to help with the issues there.

    Good news on that front - They did start working with a janitorial supply company. (I ran into the area sales rep at the church I taught in the homeschool co-op at. That church has a lot of fragrance issues as well.) They have FINALLY gotten rid of those plug-in airfreshners that seemed to asault me when I walked up to the building. I could smell them four feet from the frount door.

    I am so glad to hear that everyone is doing so well (or at least better). A combination of the laryngitis (most likely not the viral form as originally thought), heat, construction dust at work, and other factors have given me a good flare. I am hitting the albuterol hard this weekend trying to get over it. I will have to use my inhaler on schedule at work next week. Oh, well, c'est la vie. I am still very thankfull for where I am today as oposed to 4 months ago, unable to work and laid out with asthma issues constantly. Life is good, God is good.

    Take care and God bless.

    Jeremiah 29:11 For I know the thoughts that I think toward you, saith the LORD, thoughts of peace, and not of evil, to give you an expected end... Ye shall seek me, and find [me]
    coughy16 replied to Aqua14's response:
    Hi Judy, I went to europe with a bundle of pred just in case, but I didn't have to take it, for sure I would have hated to go to a dr in a foreign country. The pollen was exceptionally bad when we were there, and everyone we visited was having severe asthma/allergy problems as well. We spent 4 days in Marbella in Costa del Sol, & 5 days in Granada. It was really gorgeous there! I would highly recommend it for anyone! If you end up going, let me know, I can tell you a great place to stay & some places not to miss while you're there. We got the insider view because we were visiting one of our former exchange students & her family who live in Granada. I took my meds religiously while I was in Europe, because last time I was on vacation I got really sick & didn't want a repeat. I am glad you are doing so great & can reduce your meds. I am going to the allergist on Wed, so we'll see what she has to say. She has been much stricter than my old one (makes me do pfts every time!) but seems more open to letting me try to reduce my meds than he was (of course he was the one who diagnosed & saw it take almost 2 years for me to get it under control, so I can understand that) I would really like to try just the inhaled steroid to see if if will hold my asthma under control now that I am so much better. I'll let you know what she says. You are going this week too? Good luck!

    Oh, & btw, think about hosting an exchange student! It's fun, & a great way to see the real country when you go visit. You have to pick one from a country you have been wanting to visit. Helps with language problems to if you don't speak the language of wherever you want to go!
    Aqua14 replied to coughy16's response:
    Sue, thanks for the info. I'm definitely thinking about going to Spain in the next couple of years, and several people have said that I shouldn't miss Granada so that's on my "must see" list. And I'll hit you up for that info before I go.

    I confess that I have done a small experiment over the weekend and this morning -- I have not taken my Symbicort. And voila -- no reflux. Like none. It's absolutely heavenly!! So as Mathchickie said, that's got to be the culprit. I'll be asking my allergist for a 30 day trial of a plain inhaled steroid, and hope that is enough to keep me under control. I think it should be ok.

    I've thought about hosting an exchange student, but I'm not sure I have enough room. . . .would have to plan it out.

    hmingbrd replied to coughy16's response:
    There is a site, I believe it is, that offers a newsletter which includes a monthly listing of new drug approvals AND new generic approvals! I have found out about quite a few of my relevant meds becoming available in generic form over the past couple of years. Hope this is useful info for any of you who, like myself, struggle to pay for meds each month

    Sue1420 replied to sgbl88's response:
    Hello! A little new here but I found this thread and all your answers very interesting and would like to see if I could ask for your input and your opinions on something.

    " I hope both of you get to go off the LABA. the FDA does recommend that LABA's only be used short term for asthmatics. If you can do without it, that would be great."

    Do you know just how long is short-term? I've been on symbicort for a year and would like to know if this is too long.

    "I have read/heard about the broncho dilaters causing reflux from many sources. I think my allergist suggested it as a reason for my reflux."

    I have reflux and my pulmo keeps telling me that it is aggravating my asthma. Sounds like the opposite of what you have been told. I also had nasal surgery (polyps removed, sinuses cleaned and deviated septum repaired) in January
    in the hopes of clearing my constant sinusitis and post nasal drip. My ENT is very proud of the great job he did (he gets so excited when examining my sinuses!) however, he also blames my reflux for the raspy voice I have. I just had an upper endoscopy and my GI doc said there was no bad changes in my esophagus. I take Protonix 40mg in the morning.

    Sorry for the rambling - I see my pulmo on wednesday for my 6 month check-up and my yearly spirometry and as always am getting a little antsy. Perhaps you can answer a question about the spriometry - they have never had me use my albuterol. is that normal.

    Take Care all!
    and thanks!
    Mathchickie replied to Sue1420's response:
    Reflux can aggravate asthma, but unfortunately, LABAs can cause or worsen reflux in some patients. Asthma attacks can also cause reflux, just from the coughing and struggling to breath. I went through this vicious cycle of asthma causing reflux and reflux causing asthma, and it took me months to get out!

    If your reflux appeared or got worse shortly after you started Symbicort, you might be better off with a plain inhaled steroid, instead of Symbicort.

    How long is too long to take a LABA? It depends. Some asthma patients need a LABA every day for many years, because they can't be controlled any other way. But FDA guidelines say that doctors should at least consider stepping down patients to an inhaled steroid alone, because inhaled steroids have fewer side effects than LABAs.

    Most of the time, a pulmonologist does spirometry without albuterol. He just wants to see what your lung function is like. (Sometimes they do perform the test, then have you inhale albuterol, then do it again. If lung function increases, it means you have a lung obstruction. This test is sometimes done if the diagnosis of asthma is in doubt.)
    Aqua14 replied to Sue1420's response:
    I totally agree with Mathchickie about the vicious circle of asthma-reflux-asthma-reflux. I've been on Symbicort 2 years and the reflux just kept getting worse and worse, and was pretty resistant to meds and lifestyle changes. I was coughing literally all day, and it was wrecking my life. And I agree, reflux can definitely cause a raspy voice (it did in me).

    How controlled is your asthma? If you rarely have asthma symptoms and your spirometry is good, you may want to suggest to your pulmo that he consider stepping you down from the Symbicort to a plain inhaled steroid (like Pulmicort, which is the steroid part of Symbicort) and see how you fare.

    I'm in the process of doing that step down (have been on Pulmicort ~ 2 weeks) and will see my allergist in 2 weeks for spirometry and a new test called FeNO that measures nitric oxide in the lungs (a sign of inflammation). I'm just mad at myself that I didn't suggest stepping down sooner. Oh well.

    Hope these additional thoughts help you -- take care & good luck. Judy
    pfnc400 replied to Aqua14's response:
    I am new to this thread. I also have asthma and GERD. My Gerd is getting worse and I think it is the LABA in Symbicort. I start to cough after eating and I bring up a lot of thick clear mucus. Sometimes there are white and pale yellow blobs of mucus. Does anyone else with the asthma /GERD j\have a problem coughing up mucus? I am very interested in how the srep-down is proceeding.

    Aqua14 replied to pfnc400's response:
    My symptoms were coughing after eating, too. It was really annoying, because it would go on and on despite my eating Tums by the handful. And since I would try to eat small amounts of food frequently (which is a reflux lifestyle rule), this meant that I was coughing more often than not. Yes, I would cough up mucus sometimes, but more often it was a dry cough. My theory about this (and I am not a medical professional) is that breathing in the refluxed acid irritates the lungs and causes the lungs to produce mucus to try and protect themselves from the acid.

    Hopefully you can work with your doctor to find a substitute for Symbicort that will control your asthma and not cause or exacerbate reflux. Good luck! Judy
    Sue1420 replied to Aqua14's response:
    Hello Mathchickie and Judy
    Thanks for your helpful responses. I did see them before my appointment with my pulmo on Wednesday. but was unable to reply sooner.
    I had my spirometry and the tech said It was good and she agreed that the symbicort was probably causing my hoarse, raspy, strained voice which I had that afternoon. She even said that would be good for him to hear it. Well it did not. I requested a change because I thought the symbicort might be causing my strained voice, more reflux and weight gain. He disagreed and went in to a long discussion that if I lost weight and got in shape my reflux and asthma would be fine. To get in shape he strongly recommended that I work with a personal trainer one hour a day for 3- 5 days a week and work up a good sweat. This was a similar lecture to the one he has given me over and over again that I replace the carpeting in my bedroom with hardwood floors. I know I need to lose the 20 pounds I have gained in the last 6 months and a personal trainer and hardwood floors would be nice but they are not in my immediate future. I lost 52 pounds in 2004/05 on my own and kept it all off for 5 years until this past winter and spring and I will try my best to lose this extra weight.
    Anyway I digress - he thought the symbicort was doing a good job for me and didn't think it was a good idea to switch but finally gave me a script for Asmanex (which I used to take before going on the Symbicort last year).
    He put me on the symbicort last summer because I had a terrible cough with phlegm that I could not shake and made me sound like a smoker or someone with a terrible disease. I was constantly telling people I was not sick it was only my asthma. I think my asthma is under control because I do not thank goodness have any asthma attacks like I did when I was first diagnosed in 1998 at age 48. I also had major nasal surgery in January which I think has helped get rid my post nasal drip which has alleviated most of my phlegm except for some int he morning when I wake up. So I'm anxious to give the Asmanex a try.
    Judy I just asked you a question on your other post about how to step down from symbicort to asmanex. My doctor did not give me any instructions so I'd appreciate how you did it.

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