Asthma Community

There are times when I have the same concern-ending up with a doctor who is not listening to me and then I suffer.

I don't know the doctor who wants to take you off of Advair, so I'm guessing here and filling in between the lines of what he or she might be thinking. Advair is a combination drug and as such it carries more risks than a drug like FloVent. Therefore, in general it is recommended that asthmatics be controlled with something like FloVent if possible. However, if it is not possible, then Advair is recommended. Some doctors will periodically try to get a patient off Advair as a trial to make sure the risks of the drug really are unavoidable. In my case, normally they'll take me off for 2-4 weeks and have me record my peak flow values every 12 hours and then make a return appointment in 4 weeks. They normally make sure I have all needed emergency meds in case things go south. If the peak flows gradually decline or symptoms gradually worsen, then they'll put me back on it in order to avoid excessive prednsione use. So, this attempting to downgrade a treatment regimen while someone is well controlled is not unusual in my experience, but the doctor should give you a plan of action in case things go haywire so you don't die.

Normally doctors I've seen don't look at only one symptom (ie wheezing), but at the whole picture-spirometry, peak flows, and all symptoms as well as when symptoms occur. So, it sounds unusual to me that he only focuses on one symptom.

If he is your only option of providers to see, I would ask him for a plan of action if things go south, which emergency meds to take, when you should go to Urgent Care or the ER, etc. I would also ask about getting a peak flow meter if you don't already have one and then document it every 12 hours. This might get him to listen if he sees a graph of declining peak flows. On my own, I would find out where the nearest Urgent Care center is in case you get into trouble. I would also ask the doctor who is trying to get you off of Advair if his or her office has a 24 hour call line in case things go bad.

Basically, you can't control the doctor or make them do something they don't want to do, but you can ask them for a plan of action of what he/she suggests if you end up in an emergency. Hopefully, the doctor will recognize that is a risk whenever you try to downgrade treatment.

I was thinking more of your situation. Again, I don't know the doctor you speak of, so could be wrong.

Normally, doctors I've seen who've tried to decrease my controllers do it gradually. So, I'm on Advair 500/50. They might try to do Advair 250/50 or FloVent 220 instead-basically the next step down. If he's trying to take you from something like Advair 500/50 to no controller medicine, that just sounds off to me. Also, when he says that asthmatics on Advair still wheeze, that's not been my experience. I do well about 75% of the time and the other 25% I have some type of symptoms requiring frequent use of rescue meds. However, during that 75% of the time there are no symptoms-no wheezing or anything. I do notice a great improvement with the Advair. So, he's wrong in that the majority of the time I don't wheeze with Advair. I only do that during the 25% of the time when I'm in an exacerbation.

Even before I was on controllers, when the PCP would listen to my lungs if I wasn't having an attack right then and there I was clear to ausculation. However, if I was having an attack, they would hear a lot of coughing with fluid coming up and see my chest wall going in and out uncontrollably and see retractions. I don't know for sure if they ever heard wheezing, but they would notice I could only say one or two words at a time and was using my neck muscles to breath. Between attacks, though, I am clear to ausculation even when I'm having attacks every day.

So, I don't know if he's a PCP or what his training is. I also don't know if he's trying to get you on another controller drug instead. I know you say you don't have the money to see someone else, but you might want to try if you end up having the money, especially if he's taking you from Advair 500/50 to no controller at all. But again, I don't know all the information of what happened, so I could be wrong.

Asking him for a plan if you destabilize is the only other things I can think of doing so even if your asthma does get worse, at least you won't die.