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    Smoking and asthma
    lissmeanstrouble posted:
    I know alot of the time smoking and asthma come hand in hand.
    I am a smoker, and I feel like Im asking a stupid question, and thats why I havent ever come here to talk cause I smoke, and feel like my asthma is my own fault.
    What are the best ways to treat asthma with smoking?
    I tried to quit, I was ready to quit I felt good about quitting and I DID quit for 2 months last year, and then my house got broken into, quite a few things were stolen right before christmas, and being that I have depression as well, I kind of felt like I needed to pull out some cigarettes as a crutch to lean on with all the bad feelings I was having about life. I worked on switching myself over to my electronic cigarette and now that Ive started smoking real cigarettes again, the e-smoke is not as satisfying!!
    To be quite honest, I do not have the want to quit smoking now. So I havent been able to, I wish I hadnt started again back in December.
    I honeslty cant say that my asthma got any better during the time I had quit though.
    I found out that I have asthma a couple of years ago, the doc ordered a spiromter test, and prescribed me ventolin and prevolin(sp?) i think it was prevolin, I ran out of that while ago, and never refilled it cause it was like 60 dollars and Im not even sure that it helped. I use the ventolin still, I like it as an emergent device for sudden onset asthma at work or something.
    I have been sick with a cough for over a month now, and I blame it on my asthma and smoking.
    Whenever I go to the doctor we dont talk about asthma very much, so I feel that I need to learn more, since ive been having a really hard time breathing, sleeping, feeling really tired. I can sleep about 14 hours and feel fine, and my CBC came back normal so im not anemic, I think its cause I cant breath.
    I have been feeling awful, I put my symptoms into the symptom checker, and the top idea it gave me was lack of exercise!!! I thought "id exercise more if I wasnt so tired and could breathe" Ive lost interest in doing things that can make me lose my breath, as it is too hard to breath while walking around at work.
    Thanks for reading!
    coughy16 responded:
    I understand that quitting is hard, but smoking would definitely contribute a lot to how you are feeling. I would keep trying & trying to quit until you do it, ask your doctor for help with this. In the meantime, if your asthma is causing you to feel bad, make an appt with your dr just to discuss this. Go in with a list of symptoms, how often they happen & what seems to set them off if you can tell. Also have a list of questions that you want answered about your condition. And it is crucial that you be entirely honest with your dr about your smoking, otherwise it will be difficult for him/her to know how to help. Good luck with quitting!
    amcate responded:
    Don't feel embarrassed about being a smoker. Sometimes difficult things happen in my life, and I end up forgetting to take the controller meds. That's one reason I take a higher dosage as I know if I forget a few times my asthma will still hold steady.

    You may want to explore other ways of coping with stress-like I'm one to talk . Then you could substitute other methods for the smoking.

    Learning about asthma makes sense, but if you are not ready right now to quit smoking the results with the medicines would be limited.

    Hopefully you can find a doctor who will not be condemning or judgmental of your smoking so you would feel comfortable letting them know. In general, what they would do is put a person on a controller medicine to decrease inflammation and maybe with a long term bronchodialator. They would also give rescue medicines. If it's an allergist, you probably would get tested for allergies, and they might try to do allergy shots. They would probably give you an asthma action plan of what to do when symptoms get worse and medicines you should add. They would also encourage you to look at things you are exposed to that could make it worse and to remove it-not just smoking, but cleaning products, that "new furniture smell" which seems to upset my lungs, or whatever.

    In the end, though, you need to find someone who you feel comfortable with telling them that you smoke and that you are having multiple stressors and don't have another method to deal and so you are not in a place to quit smoking right now. Hopefully they will work with you in a way that you don't feel judged or condemned.
    amcate responded:
    I was rereading what you wrote-you said your asthma did not get better during the time you were not smoking. I understand you are not in a position to want to quit right now, and I can accept that. Just to let you know, though, in asthma care it is generally recommended to avoid respiratory irritants as much as possible even if there is not an observable change in symptoms.

    At any rate, asthma can be treated even if you smoke and there are medicines out there. I would find someone who willing to work with you for what you are ready to do at this point in time. Good luck.
    lissmeanstrouble replied to amcate's response:
    Wow if this were facebook I would have liked all of your comments, thanks so much for the advice Amcate and Coughy! Thank you so much for letting me know its not completely dumb to be learning about treating asthma while smoking. But its also helping me towards wanting to quit again, its all for the greater good!
    One thing Im concerned about, is... that I may be leaving my current place of work for a better job opportunity, and I am worried about my insurance coverage, if I will be able to get any, and if it will matter that I have pre-existing asthma and depression. But thats kinda off subject. I hope that the benefits at the new job will be better then the ones I currently have, now that would be sweet.
    I think that right now my asthma has been worse cause my dad is painting his kitchen, and I live in the basement apartment, so my whole living room and all smells like fresh paint, and the smell really has made me sick, I am so glad he finally finished yesterday.
    I was supposed to have taken and allergy test a few years ago, and couldnt afford it at the time, now I wish I would have, maybe I'd have a better idea of what to stay away from.... Too bad I cant stay away from that paint smell...
    I am also taking antibiotics, for my wicked cough.
    I use my inhaler sparingly, mostly cause I forget I have it, but when I DO remember, it helps alot.
    I would like to get on some controller and bronchodilater, but there is the question of insurance with my possible job switch! all exciting!
    Thanks again! So much!
    coughy16 replied to lissmeanstrouble's response:
    If you have insurance with your job now, and the new job has insurance & you switch without a break in coverage, then they have to cover you. Also with the new affordable care act, there is a provision that they can not reject you on the basis of pre-existing condition, but I am not sure if that has already gone into effect or not. It is not too late to get allergy tested, just check on your insurance because it can be expensive it you aren't covered. Good luck getting the asthma under control, and don't let your smoking stop you from getting treated, that could be dangerous. I wish you well with trying to quit!
    amcate replied to lissmeanstrouble's response:
    Thank you for the comment. In terms of the paint, 3M does make a mask that absorbs volatile organic compounds like those found in paint and they follow the National Institute of Occupational Safety and Health. You will end up looking weird, but if you're alone in your place then maybe it won't matter. The mask is designed to neutralize paint vapors.

    In terms of insurance, the old insurer will give you a certificate of health coverage. Normally, if you go to the new one within a certain period of time, the wait period for pre existing conditions not being covered is reduced by the amount that you were covered under prior insurance-unless it's changed in the last few years.

    A friend of mine asked about it in our state, and they said the new health care laws regarding pre existing conditions don't go into effect until 2014.

    It's definitely safer to have the asthma treated with smoking as opposed to no treatment at all and still be smoking. This is why I hope you find someone who will still help you quit if and when you want to, but won't make you feel like an idiot if you don't.

    I have trouble because when I get stressed, I eat a lot. I am at risk for diabetes due to family history and my current medicines, so I really shouldn't do that. I've been better in the last few months. My point is that you are not alone in being less than perfect.

    Good luck with everything, and I do hope at some point you are able to quit smoking.....and pray for me that I won't overeat .
    lissmeanstrouble replied to amcate's response:
    Ive made an appt with a NEW doctor on my next pay day.
    I am thinking my job switch wont come as soon as Id like.
    I should write down all of my concerns for him.
    I work in a clinic, and some times patients come in and hand me a list of thngs they want to discuss with the doctor. I take it from them and paperclip it to their chart so that the doctor can review their questions before they go in with them.
    I think Ill make sure this new doctors assistant does that for me.
    I have been thinking maybe I should try a smoking cessation product. Friends have warned me not to try the rxs because they can make depression worse, and where im already being treated for depression that would be bad.
    I think I should try patches or gum.
    I am hoping the new doc will have good ideas and advice... I heard he is good from some other assistants I work with.
    amcate replied to lissmeanstrouble's response:
    I hope your appointment went well and its a doctor you feel comfortable with.

    From a pulmonary standpoint, getting the patches or quitting smoking is definitely recommended as the smoke contains particles that cause inflammation in the lungs. However, either way it is good you are getting care for the asthma aspect. Getting the asthma treated while smoking is safer than not getting it treated at all.

    Making a list of questions is good so you don't forget and also because a lot of doctors are in a hurry.

    In terms of the prescriptions making depression worse and your friends recommending to not take them: I had a prior anxiety diagnosis years before the asthma. When asthma came, I notice the psych status seemed to be made worse with the medicines. When I asked the allergist about it, he said there was nothing he could do because my lungs were not doing well. He said that breathing takes priority over that, and asked, "how does 15 minures of brain anoxia (the brain getting no oxygen) sound?" If not taking them means you can't get oxygen to the brain, then you have to still take them. At the time, I was not only taking oral corticosteroids, but also theophylline, which metabolizes to caffeine in the blood stream. It felt I was taking 9 cups of coffee at once.

    In my personal experience, I found the only way around it was to do serious control of triggers, including switching jobs and moving to another part of the country and now looking weird due the mask. In your case, hopefully it's not that bad. Most of the time people don't have to make THAT many changes.
    Now those medicines are less, and when I do take prednisone (oral corticosteroid) I normally just bear with the first few days of high energy when I start the burst and bear with the few days of low energy/depression like stuff when I stop. It fixes itself once the corticosteroid dose evens out. I no longer take the theophylline.

    I've learned in some courses I've taken that chronic inflammation in the lungs can also lead to brain issues, even without anoxia.

    Anyway, I hope it went well, and I hope your doctor doesn't make you feel stupid because you smoke.
    amcate replied to lissmeanstrouble's response:
    I thought of a few more things. I've found that exercising every day especially in the sun (but when it's less intense sunlight to help protect skin), helps with my mood. The exercise releases endorphins in the brain and their are some studies that show exposure to sunlight helps with depression.

    I have also found that doing activities I enjoy on a regular basis (can't do it all the time, of course, but regularly) also seems to help. In the case of depression, though, I don't know how this later suggestion would work. I've heard that with depression a person can lose all interest or joy with activities.

    Anyway, just some thoughts if you were ever interested in finding other strategies for responding to stress. Good luck with everything.
    lissmeanstrouble replied to amcate's response:
    Thanks again for your responses. I apoligize Ive been suspended from work and havent been here to check the responses!
    I am back to work, and my appt actually isnt until the end of this week.
    Im unhappy to report that I have been very sick with a head cold during the time I was suspended from work.
    I am hoping once my chest and nasal congestion clears up, I can get hiking on the mountain again, because I find that helps my depression alot. But being sick, with asthma I tried hiking and it was like drowning.
    I am especially glad I made an appt, now that I have a cold for the third time this year. But this one was especially nasty too!
    lissmeanstrouble replied to lissmeanstrouble's response:
    Tomorrow is my docotors appointment. I wrote him a note with all of my concerns.
    I talked with a nurse practioner I work with she said "he will just tell you, you have bronchitis and to tough it out."

    I need some kind of treatment for my symptoms! I am coughing so much, and food tastes horrible, my sinuses nose, ears and chest all feel plugged with mucous. I looked back in my records, and I have had this cough since september.
    I have been toughing it out, and Im done being tough.

    I really hope this new doctor is aggressive about my asthma treatment.
    I am even open to trying a quit smoking med, despite my depression, so I can stop coughing.
    amcate replied to lissmeanstrouble's response:
    I hope it goes well. Having a note is good so you don't forget anything.

    I'm confused by the nurse practitioner's response. I don't know you, so don't how the diagnosis of asthma was made or if you have any other pulmonary conditions.

    If you do have asthma, then someone who knows about asthma would typically increase or put you on corticosteroids and a short acting bronchodialator. The level of corticosteroids would depend on how bad the asthma is. If the person thinks you have a bacterial infection, sometimes they'll do an antibiotic, but in my experience normally that isn't tried first due to concerns with germs becoming resistant to antibiotics.

    I'm not sure of the specialty of the nurse practitioner either, so I don't know what to make of the comments.

    I do know some doctors are not competent in asthma management. I was seeing a family practice doctor for my asthma when the short acting bronchodialator (rescue medicine) failed to reverse attacks and I would lose consciousness for 5-10 minutes at a time. This happened more than once, so I went in. His conclusion was that there was nothing wrong, and to continue with medicines as previously prescribed.

    I was in graduate school at the Texas Medical Center at the time, so knew enough to seek a second opinion, but not enough to know to go to the ER or urgent care. The second opinion agreed with me, that there was something wrong, and put me on prednisone, a high level corticosteroid, for 5 days and then to return to see her in one week and go to urgent care/ER if rescue medicines fails to reverse an attack.

    The specialists that are good for asthma are internal medicine, board certified allergy/asthma/immunology, and pulmonology. These folks are good for both emergency and long term management.

    For emergency management, urgent care is good as they normally have ER doctors there, and they'll know how to pull you out of an emergency until you can get in to see someone. Normally, they'll offer to get you an injection of anti inflammatory medicine and may do a nebulizer treatment or prescribe a rescue inhaler to use once you go home.

    You described having a series of colds. If you have asthma, colds are viral infections that can trigger the asthma. When I get a cold, my asthma typically will deteriorate rapidly with life threatening breathing problems a week or two after the cold clears. I have therefore learned to take a short course of prednisone (3 days) 3-4 days after the cold clears, which prevents the fallout. Upper respiratory infections are a common trigger for asthma symptoms to get worse. However, triggers are different for everyone.

    In terms of asthma medicines that can worsen depression, the main culprit is oral corticosteroids, like prednisone. Normally if a doctor tells you to take prednisone then it's because the breathing is so bad that they are concerned that your life is in danger or might be in the near future. In that case, not dying takes priority over controlling depression. Then, once the breathing gets better, they'll try to get you off of the oral corticosteroids and transition you to an inhaled corticosteroid for long term control. Those are much less likely to cause problems with depression.

    The other drug, which might have been taken off the market in the US, but I don't know if it was, is Singulair. Singulair is not an emergency drug, though, so talk to the doctor if they want to put you on it.

    I hope this information helps you, and good luck tomorrow.
    amcate replied to lissmeanstrouble's response:
    I forgot to mention something. You may already know this since you work in the medical field, but in case you don't-the corticosteroids used for asthma management are not the same as steroids that athletics used. The body itself produces corticosteroids, and they are substances which decrease inflammation. In the case of asthma, they are used to decrease inflammation in the lungs, thereby helping to open the airway so air can get in and out.

    The bronchodialators help relax the muscle in the lungs also to help open the airway.

    Like I said, you may already know this, but I'm including it in case you don't.

    Good luck tomorrow.
    lissmeanstrouble replied to amcate's response:
    Thanks again for your response, its very nice of you to be helping me along my way.
    The new doctor I went to see, told me that the other inhaler I was initially prescribed was the same as the one I had, so that he had prescribed the same thing in two different forms and told me they work different ways. So I am glad I came to a new doctor, cause I felt my old doctor didnt know anything about asthma....
    The new doctor said maybe he wanted me to try them out and compare?
    I dont recall him telling me so, but I feel the albuterol may not be working in emergencys as well as Id like. Its only 5 dollar opposed to 60, and something
    Ive now started on Advair inhaler twice a day. Since I have started this on Friday, I noticed a slight difference, it could just be the weekend rest, or it could be the new medicine.
    He gave me Wellbutrin to help me quit smoking, and to work along side with my Zoloft to keep me from being irritable while quitting and to help me lose wieght.
    I havent started this med yet, I am waiting til next Friday when I get paid, but I am pretty excited to start it, and see how it goes.
    I havent bought a new pack of cigarettes since I went to the bar on Thursday night, so Ive done decent this weekend cutting down on my smoking.
    Ive been working on switching over to my e-cigarette.
    A friend of mine, actually makes his own e-cigarettes. They have a big switch box attached to the end of them, but he is actually pretty smart to figure it out, hes made like 3 of them. He wont sell me one, cause theyre "HIS", but they are stronger, and work better.
    Actually I think he offered to sell me the old beat up looking one, and I just dont want it cause his others are nicer.
    But the stronger e-cigarettes are more expensive. I will think about it more seriously in the future, if I still need help.

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