Q: “I have had asthma for years, but I haven’t had much trouble with it until the last six months. Now I’m using my inhaler about four times a day. I noticed that my allergies have been worse this last year, as well. So even though I don’t smoke and am not around anyone who does, can asthma just keep getting worse?”
A. Episodes of wheezing or cough or shortness of breath can become more frequent or more intense for several reasons. Allergies could certainly set off an exacerbation of your asthma, as can changes in weather or in your environment at home or work.
I think the real key to answering your question is to know what kind of medication you are using now.
The inhaler you mention is probably an albuterol inhaler.
Thought of as a rescue medication, albuterol is not intended for maintenance of asthma. Its effect on the Beta receptors in your lungs causes the lungs to relax and open, stopping the spasm so typical of asthma.
Unfortunately, this positive effect on the lungs does not last forever and helps less and less with chronic use of albuterol. The Beta receptors “down regulate” with regular use of albuterol, making your lungs more resistant and less willing to respond to your inhaler. This may be why you find yourself using the inhaler several times a day now.
If albuterol inhaler use exceeds one canister per month, then it is time to see your doctor. It is standard now to use an inhaled corticosteroid as maintenance to keep asthma under control and help prevent exacerbations. Taken regularly either once or twice a day, an inhaled corticosteroid has beneficial anti-inflammatory effects in the lungs without much in the way of systemic side effects.
Of course, the first thing to do when fighting asthma is to avoid whatever makes your asthma worse. Definitely don’t smoke and stay away from things that irritate your lungs. Has something changed in your environment in the past year? Molds, dust, cockroaches, trees, grasses, chemicals at work or in home repair can all cause sensitive lungs to spasm, cutting off needed air. Asthmatic spasms can be made worse in the presence of allergies and with the use of NSAIDS and aspirin.
Other medications including Leukotriene modifiers such as Accolate, Singulair, and the new Zyflo are good for asthma associated with allergies. They are easy to use as well, but do not replace the steroid inhaler that has become the standard treatment for asthma. They can also help with allergic rhinitis, but do not replace the steroid nasal spray that allergists recommend for this condition. For certain kinds of asthma, there is a new specialty drug known as an IgE inhibitor, named Xolair. Given subcutaneously, this injection can be a very helpful add on to regular therapy.
There are three important approaches to treating and maintaining asthma that should not be overlooked.
1. Although albuterol is a good medication for quick rescue, its beneficial effect lessens with repeated use in as short as a week. To keep albuterol working well for you, you should limit its use to exacerbations and not depend on it as a maintenance medication.
2. Maintenance of asthma and other chronic lung diseases should be done with a low-dose, inhaled steroid. Safe and effective, this medication acts as an anti-inflammatory and can decrease your use of albuterol as well as keep you from having problems with your asthma so frequently. It takes one to two months to reach the full benefits from corticosteroids.
3. Exacerbations of asthma should be treated with a few days’ increase in both your albuterol and steroid use, then an evaluation by your doctor and a treatment regimen that continues until your peak flow and forced expiratory volume are back up to 80 percent of what they usually run. If you don’t regularly check your numbers, you won’t be able to gauge your improvement accurately.
A peak flow meter in which you forcefully blow a quick, hard breath should be used to measure your expiratory flow of air every morning. Keeping a journal of your daily peak flow will help you predict when your asthma is starting to get worse and when it is finally back to normal after an illness.
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Ask the Doctor: Effect of asthma drug lost with use
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