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Maybe I wasn't doing as well as I thought...
_Keith posted:
A few weeks ago, I posted here saying that my "adult-induced asthma" symptoms were getting better. My doctor had put me on 2 types of steroids, with an emergency inhaler (Pro-Air HFA Albuterol sulfate, which was basically an ornament on the nightstand). When I went back to see her, she changed my diagnosis to "Reactive Airway Disease" and told me that I may be over my symptoms in the next couple weeks. I wasn't concerned what she called it, and loved the diagnosis.

A little over a week after seeing her, I took my son snowboarding. The first night after that, I had a horrible asthmatic fit - coughing and shortness or breath. I used the inhaler and that cleared my breathing significantly, but I felt extremely anxious thereafter (being out of town and in the mountain air didn't help). Early in the morning when I should have used the inhaler again, I wouldn't because I linked it with the anxiety. Anyway - the next day was my son's birthday and I took him on the slopes again. It was a warmer day, so I reasoned that the conditions wouldn't affect me the same. I was right, for the most part. I took a burst from the inhaler before I hit the slopes, then again that night. Things seemed fine.

Unfortunately, the coughing spells have returned a lot since that trip. Again - I'd been taking a puff from the inhaler and was good for 4-6 hours - something I did probably twice a day. Last night I read that if I need to use the inhaler more often than once every couple days, then my "asthma" isn't under control.

Anyway - so now there are a lot of questions going through my head. Have I possibly been misdiagnosed, or does that fact that it had nearly dissipated bode well? Would anyone recommend a maintenance inhaler? Could my trip snowboarding simply have retarded my recovery process? How bad is it for you to use the emergency inhaler too much? Is there something I should be sure to tell the doctor to check when I see her again?

I love this site for the wealth of information from people who know what it's like. Any and all comments/observations are welcome.

amcate responded:
1. Have I possibly been misdiagnosed? I don't know. In my case, I have asthma, but it was not discovered until years later I also have a rare disease of some joints that was resulting in some parts of the airway being obstructed. A person can have asthma but also have unrelated diseases as well. In general, this is what supports the diagnosis of asthma: 1. Onset at a young age (asthma can happen at any time of the lifespan, but if a person is young, it's less likely to be COPD, especially if they are a nonsmoker), skin rashes/sores, allergies, family history of allergies or asthma, pulmonary function test then take a rescue medicine and then pulmonary function test again with about a 10% increase on the second test in PEV, nighttime flares, sometimes breathe well and sometimes not (obstruction is reversible and not chronic), sinus issues with allergies, positive allergy tests, they give you allergy shots and you have an attack (don't ask me how I know this one-ha, ha).

2. Would anyone recommend a maintenance inhaler? Your doctor is the best for this, especially an allergist, pulmonologist, or internal medicine. Normally it is a inhaled corticosteroid, like Flovent. Typically, they'll start you on that and if that is not enough, they will go to a combination drug like Advair or Dulera. The combination ones have a long term bronchodialator as well as an inhaled corticosteroid. However, the combination ones also carry more risk of adverse effects due to the medicine, including death from asthma (ironically). I've never had that issue in the 12 years I've taken Advair 500/50. The corticosteroid reduces airway inflammation and the long acting bronchodialators are relatively selective to the lung with few cardiac effects.

3. Could my trip snowboarding simply have retarded my recovery? It depends on the triggers that were present. Cold air can in some people triggers asthma.

4. How is it bad for you to use the rescue inhaler too much? The bronchodialator in the rescue inhaler is not selective to the lungs. It has cardiac effects. In my case, in an emergency I've had to piggy back neb treatments. You normally don't do this because its hard on the heart. But, I couldn't get a peak flow, then after the first one, my peak flow was measurable but quite low, so I did a second one. The heart was beating so fast and hard that it felt like it was going to tear away and it hurt. I normally don't get that with just the rescue inhaler.

Also, asthma involves chronic inflammation as well as the smooth muscle tightening. The rescue medicine only addresses the smooth muscle tightening. Chronic inflammation in any tissue is not good and can lead to long term scaring. Also, without maintenance drugs the rescue medicine can start to fail to reverse the attack.

If the rescue medicine is fixing to fail, normally it won't last the full four hours. Then it will last 3 hours, then 2, then 1, then it can get to the point where it won't reverse an attack at all. That is a life threatening emergency.

5. Is there anything I should be aware of in telling my doctor? How often you use the rescue medicine is important. Is it lasting the full four hours? Also, the pulmonary symtoms you have as well as when you have them and if there was an identifiable trigger.

Hope all this helps.

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