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from Medscape: Highlights From the Annual Scientific Assembly: Patient-Centered Approaches to Asthma Management — Strategies for Treatment and Management of Asthma from Southern Medical Journal Posted 09/10/2002 R. Stokes Peebles, MD, and Tina V. Hartert, MD Introduction The purpose of this article is to review strategies for the outpatient treatment and management of asthma. In this review, we will examine the current recommendations for asthma treatment and focus on randomized, double-blind asthma pharmacotherapy trials published in 2001 that help us understand the role of the various asthma medications in the care of our patients. Although medical therapy is a cornerstone of asthma management, we will also detail current recommendations for nonpharmacologic approaches to asthma care and prevention. Before focusing on asthma therapy and management, it is first useful to review the current definition of asthma to provide a rationale for our recommendations for asthma treatment. The most recent National Asthma Education and Prevention Program outlines several components to the definition of asthma,[1] including (1) "asthma, whatever the severity, is a chronic inflammatory disorder of the airways"; (2) "in susceptible individuals, this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness, and cough, particularly at night and in the early morning"; and (3) that "atopy, the genetic predisposition for the development of an IgE-mediated response to common aeroallergens, is the strongest identifiable predisposing factor for developing asthma."[1] Obviously, other factors, such as tobacco smoke, air pollution, gastroesophageal reflux, and viral infections, can also contribute to inflammation of the airways and asthma symptoms; however, the fact that approximately 90% of children with asthma[2] and the majority of adult asthmatics have allergies[3] underscores the importance of allergic disease in asthma pathophysiology. Incumbent upon our recognition that inflammation and allergy are strongly related to asthma, minimizing the allergic inflammatory component in an overall asthma treatment strategy is, unfortunately, underutilized. Therefore, we propose a 4-step approach to asthma care: environmental control, pharmacologic management, immunotherapy, and vaccination. Environmental Control Many asthma patients can identify specific triggers that lead to the onset of chest tightness, wheezing, and shortness of breath. Such triggers might be seasonal, such as tree, grass, or weed pollens, or the triggers might be situational, such as exposure to animal dander.[4] In these instances, patients with mild symptoms when exposed to such allergens can either practice conscious allergen avoidance or increase medication use when exposure to known triggers is unavoidable. A subset of patients, however, experience seemingly random flares of asthma and are not aware of disease precipitants. Additionally, many patients experience perennial (year-round) symptoms and may or may not experience acute worsening of disease with specific triggers. It is these patients who are unaware of specific triggers or have perennial symptoms who may benefit most from allergen skin testing.[5] The presence of perennial symptoms does not rule out an allergic component to a person’s disease; instead, the allergic triggers are more likely to be from indoor allergens, such as dust mites, cockroaches, molds (such as Cladosporium, Penicillium, and Alternaria), or animal dander.[5] Allergen skin testing is a highly sensitive and specific method of identifying environmental factors that elicit the IgE-mediated degranulation of mast cells and basophils that are the cornerstone of the subsequent eosinophilic inflammation characteristic of the allergic response.[6] Allergen avoidance measures have been proven to be effective for both allergic rhinitis and asthma.[7] In fact, treating allergic rhinitis with environmental avoidance measures, as well as medical therapy, greatly improves asthma control. Without skin testing to prove that an allergic component may be a factor in asthma, however, patients and their families may needlessly spend considerable sums of money engaging in modification of the home environment that may make no difference in symptom control. Pharmacologic Management Since most asthma medications are given by inhalation, proper technique must be taught and, in most cases, a spacer should be used for inhaled medication delivery. Without proper technique and optimal medication delivery, no drug will be as effective as it could be, and the fault would not be necessarily be with the medication, but with the medical provider and patient for inadequate administration. The classification of asthma severity and the recommended treatment for each level of illness as recommended by the National Asthma Education Panel is outlined in Table 1.[1] For mild, intermittent asthma, the short-acting inhaled beta agonist remains the cornerstone of symptomatic control.[1] Beta agonists bronchodilate by relaxing smooth muscle that constricts the airways, and beta agonists are also reported to improve mucociliary function. The question of whether additional pharmacologic therapy is needed can be appropriately simplified by remembering the "rules of 2." If a patient has asthma symptoms and needs a short-acting beta agonist on more than 2 days per week, 2 nights per months, or needs more than 2 canisters of short-acting beta agonist per year, then a long-term controller medication is necessary.[1] A common error in asthma treatment is underestimating disease severity and not adding a controller medication when it is needed. Many randomized, double-blind studies indicate that inhaled corticosteroids are the initial controller medication of choice.[8-10] Other possible current choices for long-term controller medical therapy include leukotriene-receptor antagonists, such as montelukast or zafirlukast, long-acting beta agonists, such as formoterol or salmeterol, or the phosphodiesterase inhibitor, theophylline. The choice of inhaled corticosteroids as first-line controller therapy has been supported by numerous randomized, controlled trials looking at the impact of these medications on lung function and short-term morbidity, as well as observational studies showing an effect on both morbidity and mortality.[11-19] In addition, 3 studies published in 2001 have examined the efficacy of long-term controller regimens, comparing inhaled corticosteroids with alternative therapies.[8-10] Busse et al[8] examined the efficacy and safety of an inhaled steroid (low-dose fluticasone proprionate) compared with a leukotriene-receptor antagonist (montelukast) for first-line maintenance therapy in patients who were using short-acting beta agonists alone for persistent asthma. In this 24-week study of 533 patients 15 years of age, there was no placebo control. Compared with baseline, improvement in pulmonary function, need for beta-agonist rescue medication, asthma symptom scores, and nocturnal awakening was found in both the group using the inhaled steroid and the group using the leukotriene-receptor antagonist. The patients treated with the inhaled steroid had statistically and clinically significantly greater improvement in all of the aforementioned parameters, however, compared with those treated with montelukast.[8] Similarly, new evidence suggests that long-acting beta agonists should not be used as the sole first-line controller therapeutic agent. Lemanske et al[10] performed a randomized, controlled trial in 175 adolescent and adult asthmatics to determine whether the addition of a long-acting beta agonist might allow either elimination or dose reduction of inhaled corticosteroids. In this study, patients with persistent asthma who did not completely respond to 6 weeks of therapy with an inhaled corticosteroid (triamcinolone) were randomized to treatment with a long-acting beta agonist (salmeterol) or placebo, after which a trial of reduction in the inhaled steroid dose was attempted. Those patients treated with the long-acting beta agonist were able to reduce the corticosteroid dose safely, but there was an unacceptably high rate of treatment failure in the salmeterol group when inhaled steroids were totally discontinued.[10] Lazarus et al[9] tested a similar question in a trial designed to examine the effectiveness of a long-acting beta agonist (salmeterol) versus an inhaled steroid (triamcinolone) for controller therapy. In that study, 166 patients with persistent asthma that was well controlled on an inhaled steroid were randomized to either continue their inhaled steroid or switch to the long-acting beta agonist. There were more treatment failures, a greater increase in eosinophilic inflammation, and increased sputum tryptase level in those randomized to the long-acting beta agonist, compared with those who continued taking the inhaled steroid.[9] These last 2 studies suggest that patients with persistent asthma that is controlled by inhaled corticosteroids cannot be switched to monotherapy with a long-acting beta agonist without the risk of losing asthma control.[9,10] Thus, inhaled corticosteroids are preferred over long-acting beta agonists and leukotriene-receptor antagonists for controller therapy. The choice for additional therapy when a patient’s asthma is not well controlled on a substantial dose of inhaled corticosteroids is more complex. Nelson et al[20] compared the efficacy and safety of a combination of inhaled steroid and long-acting beta agonist (fluticasone and salmeterol) with an inhaled steroid and a leukotriene-receptor antagonist (fluticasone and montelukast). In this multicenter, double-blind, double-dummy, parallel-group 12-week study, patients were enrolled who remained symptomatic on a low dose of inhaled corticosteroid. All patients were then treated for 12 weeks with the same dose of inhaled corticosteroid, … read more »

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- Hide quoted text — Show quoted text – from Medscape: Highlights From the Annual Scientific Assembly: Patient-Centered Approaches to Asthma Management — Strategies for Treatment and Management of Asthma from Southern Medical Journal Posted 09/10/2002 R. Stokes Peebles, MD, and Tina V. Hartert, MD Introduction The purpose of this article is to review strategies for the outpatient treatment and management of asthma. In this review, we will examine the current recommendations for asthma treatment and focus on randomized, double-blind asthma pharmacotherapy trials published in 2001 that help us understand the role of the various asthma medications in the care of our patients. Although medical therapy is a cornerstone of asthma management, we will also detail current recommendations for nonpharmacologic approaches to asthma care and prevention. Before focusing on asthma therapy and management, it is first useful to review the current definition of asthma to provide a rationale for our recommendations for asthma treatment. The most recent National Asthma Education and Prevention Program outlines several components to the definition of asthma,[1] including (1) "asthma, whatever the severity, is a chronic inflammatory disorder of the airways"; (2) "in susceptible individuals, this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness, and cough, particularly at night and in the early morning"; and (3) that "atopy, the genetic predisposition for the development of an IgE-mediated response to common aeroallergens, is the strongest identifiable predisposing factor for developing asthma."[1] Obviously, other factors, such as tobacco smoke, air pollution, gastroesophageal reflux, and viral infections, can also contribute to inflammation of the airways and asthma symptoms; however, the fact that approximately 90% of children with asthma[2] and the majority of adult asthmatics have allergies[3] underscores the importance of allergic disease in asthma pathophysiology.

I’m surprised they didn’t mention that chronic sinusitis can trigger asthma symptoms–given that chronic sinusitis now afflicts many millions of Americans. And given that for many folks (like myself), it’s proven to be incurable, and thus becomes a chronic trigger of lower respiratory problems. Many asthma specialists have had to become knowledgeable at treating the sinus symptoms of their asthma patients.   — Steven D. Litvintchouk                  

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Question:

Asthma is usually described (I think) as a chronic inflammation of the bronchi and bronchioles, leading to hyperresponsiveness/bronchospasm. But can the trachea (windpipe) be inflamed too? I’m wondering how far up the inflammation goes. Or putting it another way–do asthmatics tend to suffer from tracheitis (inflamed trachea) as well? Steven D. Litvintchouk

If money, or love of money, is the root of all evil, then throat tickle is the root of all asthma.  This may be oversimplification, but anything that irritated the bronchi and bronchioles is likely to hit the throat and trachea first.  I think throat tickle with coughing and a choking sensation would be considered an asthma symptom even if not limited to asthma.

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– Hide quoted text — Show quoted text – Asthma is usually described (I think) as a chronic inflammation of the bronchi and bronchioles, leading to hyperresponsiveness/bronchospasm. But can the trachea (windpipe) be inflamed too? I’m wondering how far up the inflammation goes. Or putting it another way–do asthmatics tend to suffer from tracheitis (inflamed trachea) as well? Steven D. Litvintchouk If money, or love of money, is the root of all evil, then throat tickle is the root of all asthma.  This may be oversimplification, but anything that irritated the bronchi and bronchioles is likely to hit the throat and trachea first.  I think throat tickle with coughing and a choking sensation would be considered an asthma symptom even if not limited to asthma.

It may be a sign of cough variant asthma or it might be a sign of allergies or some other non-specific irritation of the throat. The distinction can be difficult because the allergies can trigger the asthma but it is important to make because the treatments would be different. If is asthma treat the asthma. If it is allergies triggering asthma treat the allergies. If it is just a non-specific irritation then treat it and consider the possible presence of asthma a separate issue. — CBI, MD

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Asthma is usually described (I think) as a chronic inflammation of the bronchi and bronchioles, leading to hyperresponsiveness/bronchospasm. But can the trachea (windpipe) be inflamed too? I’m wondering how far up the inflammation goes. Or putting it another way–do asthmatics tend to suffer from tracheitis (inflamed trachea) as well?

Asthma is traditionally described as reversible bronchospasm. Chronic asthma, as you have said, is an inflammatory disease. The respiratory mucosa is one organ: nasal and sinus mucosae, laryngeal and tracheal and bronchial mucosae. Though all areas may be inflamed, so that a patient may have sinusitis and bronchial inflammation as aspects of the same process, only that which wheezes carries the dictionary label "asthma." The wise clinician evaluates the respiratory system from the tip of the nose to the depths of the lung.      Larry

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Asthma is usually described (I think) as a chronic inflammation of the bronchi and bronchioles, leading to hyperresponsiveness/bronchospasm. But can the trachea (windpipe) be inflamed too? I’m wondering how far up the inflammation goes. Or putting it another way–do asthmatics tend to suffer from tracheitis (inflamed trachea) as well? — Steven D. Litvintchouk                  

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    Ipratropium (Atrovent) stops my occasional dry unproductive cough. Common medicIne for asthma & COPD.  Ask your physician.

I have used this medication since it hit the market with no side effect and very effective.

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One other thing to look at is whether or not you cough more after taking the inhaler.  At one time I was put on a Salbutamol inhaler because of a persistent cough (The doctor thought it might be asthma).  When I used the inhaler I immediately started to cough a lot.  I had to discontinue using the inhaler after 3 days. I have determined that it is the propellant in the inhaler that bothered me.  I can use a dry powder form without problems. Just a thought. Good luck. – Hide quoted text — Show quoted text – Thank you for your comments.  Here is more information. The cough is more in my throat than my chest. I tried the tesslon pearls and they did nothing. I cough more during the day.  More at work when I am more active, i.e. walking and talking.  I almost never cough after I go to bed.  Other than that, it seems to be random. My nose is dry from the Flonase, but the rest of the sinuses are flowing like a faucet. The doctor swears there is no infection. Does this make sense to anyone? Today I started taking Clariten. Sue I have recently developed both allergies and asthma, according to the Doctor.  I’m taking Advair 250/50 and flonase.  I still have a regular cough.  Could the cough be from my ragweed allergy or a reaction to the medicine or something else? In my case, when my cough gets worse, it often indicates that a bacterial sinus infection is getting started somewhere in my sinuses. Is your cough deep in your chest, or higher up in your larynx?  The latter may indicate inflammation from infected post-nasal drip secretions.  That could be a sinus infection.

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Cough is a common manifestation of bronchial asthma. However, it could due to many other problems as mentioned previously. The symptoms of asthma usually worsen at bedtime, early morning, or during exertion. Sometimes, specific situation may trigger the attack of asthma. Thus, you should record the situation your cough occurs and try to find out the trigger factors. If any trigger factors was identified, discuss with your physician and try to avoid it in the future. Maybe you should undertake a lung function test to confirm your diagnosis. If the cough is due to asthma. Inhaled bronchodilator or steroid will help.

– Hide quoted text — Show quoted text – Ever since I had asthma, I have coughed, my doctor said that "asthmatics cough" when i tell her about it, she said its normal but if its a problem that she could give me a medication to use as needed.  She gave me some kind of little capsules called Tessalon Perles.  They do work very well for me, and have an extremely low occurance of side effects.  May ask your doctor for something like that? Hope that might help a bit, Mwhii I have recently developed both allergies and asthma, according to the Doctor.  I’m taking Advair 250/50 and flonase.  I still have a regular cough.  Could the cough be from my ragweed allergy or a reaction to the medicine or something else? I’m trying to learn as much as I can, but there is not much information about coughing and asthma and how to cope. Thanks for you help. Sue

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Ever since I had asthma, I have coughed, my doctor said that "asthmatics cough" when i tell her about it, she said its normal but if its a problem that she could give me a medication to use as needed.  She gave me some kind of little capsules called Tessalon Perles.  They do work very well for me, and have an extremely low occurance of side effects.  May ask your doctor for something like that?

Another possibility is cough variant asthma.  Here the cough is an asthma symptom. If using your inhaler makes the cough go away – find another doctor. "With Confidence in our Armed Forces –  with the determination of our people –  we will gain the inevitable triumph –  so help us god."   Franklin Delano Roseveldt, 8 december 1941

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     Ipratropium (Atrovent) stops my occasional dry unproductive cough. Common medicIne for asthma & COPD.  Ask your physician.

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Thank you for your comments.  Here is more information. The cough is more in my throat than my chest. I tried the tesslon pearls and they did nothing. I cough more during the day.  More at work when I am more active, i.e. walking and talking.  I almost never cough after I go to bed.  Other than that, it seems to be random. My nose is dry from the Flonase, but the rest of the sinuses are flowing like a faucet. The doctor swears there is no infection. Does this make sense to anyone?   Today I started taking Clariten.   Sue – Hide quoted text — Show quoted text – I have recently developed both allergies and asthma, according to the Doctor.  I’m taking Advair 250/50 and flonase.  I still have a regular cough.  Could the cough be from my ragweed allergy or a reaction to the medicine or something else? In my case, when my cough gets worse, it often indicates that a bacterial sinus infection is getting started somewhere in my sinuses. Is your cough deep in your chest, or higher up in your larynx?  The latter may indicate inflammation from infected post-nasal drip secretions.  That could be a sinus infection.

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Ever since I had asthma, I have coughed, my doctor said that "asthmatics cough" when i tell her about it, she said its normal but if its a problem that she could give me a medication to use as needed.  She gave me some kind of little capsules called Tessalon Perles.  They do work very well for me, and have an extremely low occurance of side effects.  May ask your doctor for something like that? Hope that might help a bit, Mwhii

– Hide quoted text — Show quoted text – I have recently developed both allergies and asthma, according to the Doctor.  I’m taking Advair 250/50 and flonase.  I still have a regular cough.  Could the cough be from my ragweed allergy or a reaction to the medicine or something else? I’m trying to learn as much as I can, but there is not much information about coughing and asthma and how to cope. Thanks for you help. Sue

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I have recently developed both allergies and asthma, according to the Doctor.  I’m taking Advair 250/50 and flonase.  I still have a regular cough.  Could the cough be from my ragweed allergy or a reaction to the medicine or something else?

In my case, when my cough gets worse, it often indicates that a bacterial sinus infection is getting started somewhere in my sinuses. Is your cough deep in your chest, or higher up in your larynx?  The latter may indicate inflammation from infected post-nasal drip secretions.  That could be a sinus infection. — Steven D. Litvintchouk                   Disclaimer:  As far as I am aware, the opinions expressed herein             are not those of my employer.

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The cough could be from a number of things….asthma, drainage, bronchitis etc. I would htink the Flonase would help with the drainage.   I would ask the doctor….coughing isn’t good. Maybe he/she can give you something to stop the cough. Also, you might try to figure out when you cough most? Morning? When you lie down? What is the pattern with the cough. I typically cough quite a bit when I first get up but once my lungs clear I stop. Denise Indianapolis

– Hide quoted text — Show quoted text – I have recently developed both allergies and asthma, according to the Doctor.  I’m taking Advair 250/50 and flonase.  I still have a regular cough.  Could the cough be from my ragweed allergy or a reaction to the medicine or something else? I’m trying to learn as much as I can, but there is not much information about coughing and asthma and how to cope. Thanks for you help. Sue

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I have recently developed both allergies and asthma, according to the Doctor.  I’m taking Advair 250/50 and flonase.  I still have a regular cough.  Could the cough be from my ragweed allergy or a reaction to the medicine or something else? I’m trying to learn as much as I can, but there is not much information about coughing and asthma and how to cope. Thanks for you help.   Sue

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Question:

When you say breathless, do you mean you’re having difficulty getting air in and out of your lungs – or do you mean it feels like you’re short of oxygen even though you can breathe OK ? i’m beginning to think it’s anxiety… i feel like i can breath ok, but i always feel like i need to breath more.. i have to tke really deep breathes every few minutes, and sometimes i can’t reach the breathlessness.

GO AND SEE YOUR DOCTOR.   Sorry for shouting but I think it’s really important you get a proper assessment.  Yes you may be anxious – in which case seeing the doctor might help to calm your nerves.  However it really does sound like you have some asthma symptoms (you don’t have to be wheezing to have asthma) and could do with correct assessment and treatment. — Five Cats

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When you say breathless, do you mean you’re having difficulty getting air

Could be like me. I got breathless and thought that I was going to move on when I walked into my kitchen and confronted a snake. I could hardly breathe or move. I used pursed lip breathing and did not move until I got my breathing under control.

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When you say breathless, do you mean you’re having difficulty getting air in and out of your lungs – or do you mean it feels like you’re short of oxygen even though you can breathe OK ?

i’m beginning to think it’s anxiety… i feel like i can breath ok, but i always feel like i need to breath more.. i have to tke really deep breathes every few minutes, and sometimes i can’t reach the breathlessness. — James Kerr Lochgelly, Fife, Scotland WEB: jameskerr.cjb.net ICQ:41149795 "It’s nice to be important, but it’s more important to be nice"

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Hello, James, so sorry to hear of your ;;difficulties you have been given some good and sound advice from a variety of sufferers, I have COPD, not nice but we get on with life, may I make a suggestion , ask your GP or Pulmonary Consultant if you might benefit from a session with a Clinical Psychologist, trust me I went through same phases you appear to be (your current post seems to bear this out) can’t do you any harm it will be good for you and you may do well to join in a group therapy session with the CP Good luck young man Keep smiling and Breathe Easy William ( a Brummie)

– Hide quoted text — Show quoted text – When you say breathless, do you mean you’re having difficulty getting air in and out of your lungs – or do you mean it feels like you’re short of oxygen even though you can breathe OK ? i’m beginning to think it’s anxiety… i feel like i can breath ok, but i always feel like i need to breath more.. i have to tke really deep breathes every few minutes, and sometimes i can’t reach the breathlessness. — James Kerr Lochgelly, Fife, Scotland WEB: jameskerr.cjb.net ICQ:41149795 "It’s nice to be important, but it’s more important to be nice"

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i’ve got a salbutamol inhalor, but it doesn’t seem to work…unless i get wheezy (this rarely happens though, only sometimes after a lot of constant hash smoking) i’m taking one efexor tablet a day for my anxiety/depression. if i’m sitting doing something intensive where my mind is occupied…i seem to forget about the breathlessness, but as soon as i realise i’ve forgotten…it comes back, this made me think it was the anxiety…but

When you say breathless, do you mean you’re having difficulty getting air in and out of your lungs – or do you mean it feels like you’re short of oxygen even though you can breathe OK ? Get a peak flow meter, if you haven’t already got one, and use it to decide whether you need to take (more) asthma medication or not. If your peak flow is good, perhaps the breathlessness is caused by anxiety, smoking, anaemia or whatever. You need to tackle the problem from the right cause. Jo.

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I suggest he goes back to the doctor and gets re-evaluated.  It’s much better to live a life with an inhaler than half a life without one. it feels like half a life…i want to go out and do things, but don’t often, because i almost feel trapped by it.

Doctor.  Next week.  If the receptionist is unhelpful tell her / him you are having breathing problems – not that it’s any of their business. — Five Cats

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Jay-ums!   Must you be  s m o k i n g   a n y t h i n g ?  Find someone who knows how to make the cookies (or the brownies)   They really work if you use enough canabis or hash in the preparation.  Easier on the lungs. You wouldn’t sit on a  Roto-Rooter if you had hemorrhoids, would you?

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– Hide quoted text — Show quoted text – Do you still have a prescription for your inhaler?  Do you get any relief when you use it?  Anxiety can also make ones chest feel tight.  Are you taking any medication for anxiety?  If so, does breathing get easier after taking the medication?  I guess the most important question is, have you discussed any of this with a physician?  If you haven’t I would do so as soon as possible. i’ve got a salbutamol inhalor, but it doesn’t seem to work…unless i get wheezy (this rarely happens though, only sometimes after a lot of constant hash smoking) i’m taking one efexor tablet a day for my anxiety/depression. if i’m sitting doing something intensive where my mind is occupied…i seem to forget about the breathlessness, but as soon as i realise i’ve forgotten…it comes back, this made me think it was the anxiety…but i can’t beleive that anxiety alone can make me this breathless.

I am even more sure you need to go back to the doctor and get sorted. It sounds like you still have asthma and it needs treatment with preventer inhalers, not relievers which is what the salbutamol is. — Five Cats

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I suggest he goes back to the doctor and gets re-evaluated.  It’s much better to live a life with an inhaler than half a life without one.

it feels like half a life…i want to go out and do things, but don’t often, because i almost feel trapped by it. — James Kerr Lochgelly, Fife, Scotland WEB: jameskerr.cjb.net ICQ:41149795 "It’s nice to be important, but it’s more important to be nice"

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- Hide quoted text — Show quoted text – i’m 18 now, and i first got asthma when i was about 8.  the doctor gave me a brown inhalor (it started with a "b") to take morning and night  …and a salbutamol for when i got attacks. now, i thought my ashtma had gone away in the last 3-4 years, but what i did feel…was breathlessness, although i thought it was just tiredness up until very recently. now, i’m a very nervous person as well…i’m anxious all day long. my question is: can i have asthma without feeling wheezy? it feels like i’m always out of breath, and i need to keep taking deep breathes every 10 or so minutes, sometimes i can’t even reach the breathlessness…it’s like at the very last bit of my lungs. it also makes yawning difficult…it sort of feels like there’s always a yawn in there, and it seems to built up…and sometimes i’ll open my mouth to yawn, but it’s like my lungs are too tight to let air in, it’s (obviously) worst at night, i just can’t stop yawning (or trying to yawn…and it’s quite uncomfortable)

It is not uncommon for people to have active asthma symptoms without any detectible wheezing.  You should regard shortness of breath as an asthma symptom and treat it accordingly. If this occurs more than a few times a week, then you need to see your doctor about modifying your asthma treatment program. another quick question… not long after i first got my inhalor (salbutmol) i remember taking a lot of puffs of it one time…maybe 20-30 (i was young and silly) i don’t think i even inhaled them properly…but… could that have caused anything?

Nothing serious, but I bet your hands were shaking real hard.   "They laughed at Galileo. They laughed at Newton But they also laughed at Bozo the Clown." Carl Sagan

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i’m 18 now, and i first got asthma when i was about 8.  the doctor gave me a brown inhalor (it started with a "b") to take morning and night  …and a salbutamol for when i got attacks. now, i thought my ashtma had gone away in the last 3-4 years, but what i did feel…was breathlessness, although i thought it was just tiredness up until very recently. now, i’m a very nervous person as well…i’m anxious all day long. my question is: can i have asthma without feeling wheezy?

Yes you can. it feels like i’m always out of breath, and i need to keep taking deep breathes every 10 or so minutes, sometimes i can’t even reach the breathlessness…it’s like at the very last bit of my lungs. it also makes yawning difficult…it sort of feels like there’s always a yawn in there, and it seems to built up…and sometimes i’ll open my mouth to yawn, but it’s like my lungs are too tight to let air in, it’s (obviously) worst at night, i just can’t stop yawning (or trying to yawn…and it’s quite uncomfortable)

Sounds like my asthma when it’s not well-controlled. another quick question… not long after i first got my inhalor (salbutmol) i remember taking a lot of puffs of it one time…maybe 20-30 (i was young and silly) i don’t think i even inhaled them properly…but… could that have caused anything?

No, don’t worry. — James Kerr Lochgelly, Fife, Scotland

Nice bit of the world to live in.  I like the walk up West Lomond. WEB: jameskerr.cjb.net ICQ:41149795 "It’s nice to be important, but it’s more important to be nice" Do you still have a prescription for your inhaler?  Do you get any relief when you use it?  Anxiety can also make ones chest feel tight.  Are you taking any medication for anxiety?  If so, does breathing get easier after taking the medication?  I guess the most important question is, have you discussed any of this with a physician?  If you haven’t I would do so as soon as possible.

He may well not get any help from the brown inhaler until he has been using it for up to 4 weeks. I suggest he goes back to the doctor and gets re-evaluated.  It’s much better to live a life with an inhaler than half a life without one. — Five Cats

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Do you still have a prescription for your inhaler?  Do you get any relief when you use it?  Anxiety can also make ones chest feel tight.  Are you taking any medication for anxiety?  If so, does breathing get easier after taking the medication?  I guess the most important question is, have you discussed any of this with a physician?  If you haven’t I would do so as soon as possible. i’ve got a salbutamol inhalor, but it doesn’t seem to work…unless i get wheezy (this rarely happens though, only sometimes after a lot of constant hash smoking)

It sounds like you may have a combination of asthma [exacerbated by smoking] and anxiety/panic disorder. Either can cause breathing problems. You can differentiate the 2 by observing when the salbutamol works [works for asthma] or doesn’t work [may make anxiety worse]. i’m taking one efexor tablet a day for my anxiety/depression.

The Efexor could make the ‘breathing problem’ worse. See side effects below. if i’m sitting doing something intensive where my mind is occupied…i seem to forget about the breathlessness, but as soon as i realise i’ve forgotten…it comes back, this made me think it was the anxiety…but i can’t beleive that anxiety alone can make me this breathless. — James Kerr Lochgelly, Fife, Scotland WEB: jameskerr.cjb.net ICQ:41149795

Links: http://www.effexorfx.freeuk.com/ EffexorFX The aim of this website is to document the side effects and  withdrawal symptoms associated with the antidepressant drug Venlafaxine Hydrochloride, which is marketed as Effexor or Efexor  and in it’s sustained release form as Effexor (Efexor) XR. Venlafaxine is one of the newer antidepressant drugs known as SSNRIs  (Selective Serotonin and Norepinephrine Reuptake Inhibitors). It is a structurally novel antidepressant drug and is  chemically unrelated to any other available antidepressant. http://www.rxlist.com/cgi/generic/venlafax.htm venlafaxine http://www.rxlist.com/cgi/generic/venlafax_ad.htm adverse effects One of the side effects of Efexor is yawning [3%] vs placebo [0%]. [You mentined yawning in your original post.] Also nervousness [13%] vs placebo [6%]. Anxiety [6%] vs placebo [3%]. You really ought to try to get off the Efexor. Ellis          More links below: http://www.remcomp.com/asmanet/edit9702.html  Hyperventilation Syndrome & Asthma (Asmanet) Chronic hyperventilation syndrome is characterized by a large variety of somatic symptoms induced by physiologically inappropriate hyperventilation and usually reproduced in whole or in part by voluntary hyperventilation. The respiratory symptoms associated with this syndrome include shortness of breath, usually described as "air hunger" – a need to take a deep, satisfying breath, accompanied by a feeling of difficulty in inflating the lungs-, a small dry cough, the impression of a tickle in the throat. Most hyperventilators tend to sigh or yawn frequently and typically adopt a pattern of thoracic instead of diaphragmatic breathing. http://www.ama-assn.org/special/asthma/library/readroom/oc4154.htm  Asthma/Panic Disorder 1-97 JAMA

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Do you still have a prescription for your inhaler?  Do you get any relief when you use it?  Anxiety can also make ones chest feel tight.  Are you taking any medication for anxiety?  If so, does breathing get easier after taking the medication?  I guess the most important question is, have you discussed any of this with a physician?  If you haven’t I would do so as soon as possible.

i’ve got a salbutamol inhalor, but it doesn’t seem to work…unless i get wheezy (this rarely happens though, only sometimes after a lot of constant hash smoking) i’m taking one efexor tablet a day for my anxiety/depression. if i’m sitting doing something intensive where my mind is occupied…i seem to forget about the breathlessness, but as soon as i realise i’ve forgotten…it comes back, this made me think it was the anxiety…but i can’t beleive that anxiety alone can make me this breathless. — James Kerr Lochgelly, Fife, Scotland WEB: jameskerr.cjb.net ICQ:41149795 "It’s nice to be important, but it’s more important to be nice"

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i’m 18 now, and i first got asthma when i was about 8.  the doctor gave me a brown inhalor (it started with a "b") to take morning and night  …and a salbutamol for when i got attacks. now, i thought my ashtma had gone away in the last 3-4 years, but what i did feel…was breathlessness, although i thought it was just tiredness up until very recently. now, i’m a very nervous person as well…i’m anxious all day long. my question is: can i have asthma without feeling wheezy? it feels like i’m always out of breath, and i need to keep taking deep breathes every 10 or so minutes, sometimes i can’t even reach the breathlessness…it’s like at the very last bit of my lungs. it also makes yawning difficult…it sort of feels like there’s always a yawn in there, and it seems to built up…and sometimes i’ll open my mouth to yawn, but it’s like my lungs are too tight to let air in, it’s (obviously) worst at night, i just can’t stop yawning (or trying to yawn…and it’s quite uncomfortable) another quick question… not long after i first got my inhalor (salbutmol) i remember taking a lot of puffs of it one time…maybe 20-30 (i was young and silly) i don’t think i even inhaled them properly…but… could that have caused anything? — James Kerr Lochgelly, Fife, Scotland WEB: jameskerr.cjb.net ICQ:41149795 "It’s nice to be important, but it’s more important to be nice"

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– Hide quoted text — Show quoted text – i’m 18 now, and i first got asthma when i was about 8.  the doctor gave me a brown inhalor (it started with a "b") to take morning and night  …and a salbutamol for when i got attacks. now, i thought my ashtma had gone away in the last 3-4 years, but what i did feel…was breathlessness, although i thought it was just tiredness up until very recently. now, i’m a very nervous person as well…i’m anxious all day long. my question is: can i have asthma without feeling wheezy? it feels like i’m always out of breath, and i need to keep taking deep breathes every 10 or so minutes, sometimes i can’t even reach the breathlessness…it’s like at the very last bit of my lungs. it also makes yawning difficult…it sort of feels like there’s always a yawn in there, and it seems to built up…and sometimes i’ll open my mouth to yawn, but it’s like my lungs are too tight to let air in, it’s (obviously) worst at night, i just can’t stop yawning (or trying to yawn…and it’s quite uncomfortable) another quick question… not long after i first got my inhalor (salbutmol) i remember taking a lot of puffs of it one time…maybe 20-30 (i was young and silly) i don’t think i even inhaled them properly…but… could that have caused anything? — James Kerr Lochgelly, Fife, Scotland WEB: jameskerr.cjb.net ICQ:41149795 "It’s nice to be important, but it’s more important to be nice"

Do you still have a prescription for your inhaler?  Do you get any relief when you use it?  Anxiety can also make ones chest feel tight.  Are you taking any medication for anxiety?  If so, does breathing get easier after taking the medication?  I guess the most important question is, have you discussed any of this with a physician?  If you haven’t I would do so as soon as possible.

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Question:

a lot of times, before an attack, jupiter gets really congested and breathes faster, but is not truly wheezing.  sometimes it escalates, sometimes it lasts a  while but i can nurse him into calming down and the congestion goes away.  is this actually an asthma attack or something else?  if i give him the inhaler at the beginning of this, it makes it better.   i’m already giving him 2 puffs almost every 4 hours which is the max i am supposed to give him.  we do have an appointment scheduled to review his meds, and possibly change what he’s getting (albuterol currently) or add to it.

The lung congestion implies mucus is building up in the lungs as a result of the inflammed bronchial tubes. This is common with asthma. Wheezing is only one possible asthma symptom. Albuterol does not treat congestion; it’s just a short acting bronchodilator drug. Known as the ‘rescue’ drug. Sounds like he needs an anti-inflammatory inhaler added; Intal [cromolyn] by nebulizer would be the first to try [Intal by MDI is not very effective due to low dose] The next step would be inhaled steroids. Budesonide by nebulizer or fluticasone by Aerochamber spacer and mask. The next step is oral steroids, but this is to be avoided unless absolutely necessary. Ellis

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I’ll take all this info to our appointment!

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thanks for all your advice so far, everyone.  i have another question… a lot of times, before an attack, jupiter gets really congested and breathes faster, but is not truly wheezing.  sometimes it escalates, sometimes it lasts a  while but i can nurse him into calming down and the congestion goes away.  is this actually an asthma attack or something else?  if i give him the inhaler at the beginning of this, it makes it better.   i’m already giving him 2 puffs almost every 4 hours which is the max i am supposed to give him.  we do have an appointment scheduled to review his meds, and possibly change what he’s getting (albuterol currently) or add to it.

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Question:

Hi — My Doctor recently switched my inhaler — I’m not using MaxAir. What can anyone tell me about this type of inhaler — is it more effective than say Proventil?  (It’s a little cheaper)

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Hi — My Doctor recently switched my inhaler — I’m not using MaxAir. What can anyone tell me about this type of inhaler — is it more effective than say Proventil?  (It’s a little cheaper)

About 6+ years ago, I ended up in the ER and consequently was admitted to the hospital for an asthma attack. When I got out, my Dr. gave me a sample of Maxair to try (I was using Ventolin at the time). The first day I used it, I thought I was going into another attack because my breathing wasn’t improving. I finally said "This is it!" and I used my Ventolin. Almost immediately, my breathing improved! Something about Maxair didn’t agree with me. I’ve been afraid to use it ever since. Obviously, YMMV–other people have said they like it. …Carly…

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My asthma doc just gave me MaxAir because albuteral gives me the shakes. I haven’t had to use an inhaler since last March. I didn’t have a single asthma symptom since then. A cold front hit Texas and we finally got some rain. Lo’ and behold ….. asthma. I can’t take steroids because of a hormone imbalance. I have never seen MaxAir mentioned on here. Is anyone using it? What’s the difference between this and other rescue inhalers? Lynda

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I have never seen MaxAir mentioned on here. Is anyone using it? What’s the difference between this and other rescue inhalers?

I have been using it for 5 years.  It is pirbuterol, as opposed to albuterol and is molecularly is fairly similar.  I believe it is sometime given instead of albuterol to those people who have heart complications.

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My asthma doc just gave me MaxAir because albuteral gives me the shakes. I haven’t had to use an inhaler since last March. I didn’t have a single asthma symptom since then. A cold front hit Texas and we finally got some rain. Lo’ and behold ….. asthma. I can’t take steroids because of a hormone imbalance. I have never seen MaxAir mentioned on here. Is anyone using it? What’s the difference between this and other rescue inhalers? Lynda

MaxAir [pirbuterol] is one of the four beta2-agonist inhalers recommended for asthma, short-term fast-acting relief. See: http://www.ama-assn.org/special/asthma/treatmnt/drug/drug1.htm Reliever Medications: Inhaled Short-Acting Beta2-Agonists "albuterol (Proventil, Proventil HFA, Ventolin) bitolterol (Tornalate) pirbuterol (Maxair Autohaler, Maxair Inhaler) terbutaline (Breathaire)" Albuterol is the most common of the 4 and is available in generic form. Those sensitive to albuterol can try one of the other 3. [With MDIs, use a spacer to minimize side effects] The Maxair Autohaler may be easier to use for those who have trouble taking a deep breath. http://www.3m.com/market/healthcare/pharm/maxair/more.html Ellis

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Question:

since i moved the leather couch into the garage this afternoon……. asthma symptoms have lessened considerably, and the chest/lung pain also disappeared.  i cant believe leather furniture is capable of making a person this sick. i can almost breath normally again, and hopefully the next few days it will get better…

thank you to every one for their advice (private emails and on this group)…. i decided to removed the new leather furniture from the house and storing it in the garage ($1300.00 down the drain), i think the chemical on the furniture was making the symptoms worse, and it seemed that my asthma past two days i was getting some pain in the lungs/chest area, is pain in the chest a normal asthma symptom?  a heavy, dull achy

feeling……feels my – Hide quoted text — Show quoted text – lungs have taken a heck of a beating lately. The pain can be due to coughing (though usually that is a sharper pain in the ribs), sore muscles from hard breathing, indigestion, or several other things.  If the pain doesn’t go away, or your other symtpoms don’t abate, within a few more days then you should see a doc.

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: since i moved the leather couch into the garage this afternoon……. asthma : symptoms have lessened considerably, and the chest/lung pain also : disappeared.  i cant believe leather furniture is capable of making a person : this sick. : : i can almost breath normally again, and hopefully the next few days it will : get better… Be glad you found what was causing your trouble. Most of us aren’t that lucky. I doubt is the leather causing the problems. It is much more likely the treatment on it to prevent soiling or outgassing of the stuffing in it. A call to the dealer and the factory should identfy anything that was used to coat the leather. Once you find out what it is you can contact the manufacter and find out how to get it out. Time in the garage will probably help a lot. A decent furniture dealer would let you trade it for something else. Just make sure that something else doesn’t trigger you as well. — Gordon    W5RED www.couger.com/gcouger "You miss 100 percent of the shots you never take."   – Wayne Gretzky

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thank you to every one for their advice (private emails and on this group)…. i decided to removed the new leather furniture from the house and storing it in the garage ($1300.00 down the drain), i think the chemical on the furniture was making the symptoms worse, and it seemed that my asthma past two days i was getting some pain in the lungs/chest area, is pain in the chest a normal asthma symptom?  a heavy, dull achy feeling……feels my lungs have taken a heck of a beating lately.

The pain can be due to coughing (though usually that is a sharper pain in the ribs), sore muscles from hard breathing, indigestion, or several other things.  If the pain doesn’t go away, or your other symtpoms don’t abate, within a few more days then you should see a doc.

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past two days i was getting some pain in the lungs/chest area, is pain in the chest a normal asthma symptom?  a heavy, dull achy feeling……feels my lungs have taken a heck of a beating lately.

I get pain in my chest that feels like a very large tight rubber band is wrapped around my chest.  It is very difficult to take a deep breath. Pam

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: thank you to every one for their advice (private emails and on this : group)…. : : i decided to removed the new leather furniture from the house and storing it : in the garage ($1300.00 down the drain), i think the chemical on the : furniture was making the symptoms worse, and it seemed that my asthma : : past two days i was getting some pain in the lungs/chest area, is pain in : the chest a normal asthma symptom?  a heavy, dull achy feeling……feels my : lungs have taken a heck of a beating lately. : : again, thank you to everyone, you were all very helpful. : The furniture should quit outgassing in a few weeks in the garage. The heat will help it. You can probably move it back in in a month or two. I would saddle soap it first to get any scotch guard or what ever off it. — Gordon    W5RED www.couger.com/gcouger "You miss 100 percent of the shots you never take."   – Wayne Gretzky

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thank you to every one for their advice (private emails and on this group)…. i decided to removed the new leather furniture from the house and storing it in the garage ($1300.00 down the drain), i think the chemical on the furniture was making the symptoms worse, and it seemed that my asthma past two days i was getting some pain in the lungs/chest area, is pain in the chest a normal asthma symptom?  a heavy, dull achy feeling……feels my lungs have taken a heck of a beating lately. again, thank you to everyone, you were all very helpful. will – Hide quoted text — Show quoted text – i was recently diagnosed with asthma, and am now on flovent, serovent, and proventil. currently, i’m trying to find what is the source that is causing my asthma symptoms…….lately it has been pretty scary, i’ve been having severe attacks that are causing mental confusion, heart pounding, weakness, and extreme breathing difficulties. also, i cant take claritin anymore because its causing a thickening of the mucous which i cany expel from my lungs. i’m narrowing down the cause of my symptoms to the new leather couch and chair that i recently bought….or the monitor kerosene heater……. Poorly vented kerosene heaters can cause CO poisoning and the fumes can act as an asthma trigger. It would be better to use electric heat. Links: http://www.extension.iastate.edu/Pages/communications/CO/co1.html What you need to know about the leading cause of poisoning deaths  in America            Carbon Monoxide http://www.helioshealth.com/asthma/control_environment.html Asthma – Control Your Environment Smoke, Strong Odors, and Sprays "If possible, do not use a wood-burning stove, kerosene heater,  or fireplace. Try to stay away from strong odors and sprays, such as perfume,  talcum powder, hair spray, and paints. can the chemicals released from the leather be creating my symptoms??  and why all of a sudden i cant seem to tolerate the claritin? It’s possible leather chemicals are triggering asthma; try removing the leather furniture. Many asthmatics cannot use antihistamines like Claritin due to thickening of mucus. Use a nasal spray instead; like Nasalcrom, or prescription steroid nasal sprays; saline nasal washes may help. Ellis anyone else having symptoms caused by leather furnitures??  and what do you do for the thickening of the mucous? thanks for any replies,   will

Response:

: hi, : i was recently diagnosed with asthma, and am now on flovent, serovent, and : proventil. : : currently, i’m trying to find what is the source that is causing my asthma : symptoms…….lately it has been pretty scary, i’ve been having severe : attacks that are causing mental confusion, heart pounding, weakness, and : extreme breathing difficulties. : : also, i cant take claritin anymore because its causing a thickening of the : mucous which i cany expel from my lungs. : : i’m narrowing down the cause of my symptoms to the new leather couch and : chair that i recently bought….or the monitor kerosene heater…….can the : chemicals released from the leather be creating my symptoms??  and why all : of a sudden i cant seem to tolerate the claritin? : : anyone else having symptoms caused by leather furnitures??  and what do you : do for the thickening of the mucous? : : thanks for any replies, : will Will, Leather could be causing the problems as well as kerosene. The kerosene is more likely than the leather. The bad part is your head can play games with you when you are finding triggers. What you think it is may or may not be the problem. You can clean the leather with saddle soap this will get any chemicals off it. It is not uncommon for new furniture to out gas for a while. Leather is not as bad as most things. Try getting more fresh air in the house. Modern houses are sealed very very well. Does the heater vent to the outside? If it vents in the house it can be a real problem. Since it is July you can store it some where else and see if it helps. If you need it in July I’ll come visit and see if I can help you find your problem:) It sound like you may be having panic attacks along with your asthma. I have had them too and it is real scary. Find out about the panic attacks. They feed on themselves and the longer you have them the harder it is to get rid of them. Low blood oxygen will cause the symptoms as well. Panic attacks and asthma can feed on each other. Getting peak flow meter helped me tell when I was doing well and not so well before I had a full blown attack. It has helped identify a few things that cause me problems. It also has helped my confidence in separating asthma and panic attacks. Talk to your doctor about one. I am not a doctor and only know what works for me. If I were you I would get to a doctor while I was having an attack and see if they think you are having a panic attack as well. For some people just knowing they have panic attacks help a lot. There are also some very effective medications for them. Good luck — Gordon    W5RED www.couger.com/gcouger "You miss 100 percent of the shots you never take."   – Wayne Gretzky

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i was recently diagnosed with asthma, and am now on flovent, serovent, and proventil. currently, i’m trying to find what is the source that is causing my asthma symptoms…….lately it has been pretty scary, i’ve been having severe attacks that are causing mental confusion, heart pounding, weakness, and extreme breathing difficulties. also, i cant take claritin anymore because its causing a thickening of  the mucous which i cany expel from my lungs. i’m narrowing down the cause of my symptoms to the new leather couch and chair that i recently bought….or the monitor kerosene heater…….

Poorly vented kerosene heaters can cause CO poisoning and the fumes can act as an asthma trigger. It would be better to use electric heat. Links: http://www.extension.iastate.edu/Pages/communications/CO/co1.html What you need to know about the leading cause of poisoning deaths  in America            Carbon Monoxide http://www.helioshealth.com/asthma/control_environment.html Asthma – Control Your Environment Smoke, Strong Odors, and Sprays "If possible, do not use a wood-burning stove, kerosene heater,  or fireplace. Try to stay away from strong odors and sprays, such as perfume,  talcum powder, hair spray, and paints. can the chemicals released from the leather be creating my symptoms??  and why all of a sudden i cant seem to tolerate the claritin?

It’s possible leather chemicals are triggering asthma; try removing the leather furniture. Many asthmatics cannot use antihistamines like Claritin due to thickening of mucus. Use a nasal spray instead; like Nasalcrom, or prescription steroid nasal sprays; saline nasal washes may help. Ellis – Hide quoted text — Show quoted text – anyone else having symptoms caused by leather furnitures??  and what do you do for the thickening of the mucous? thanks for any replies,   will

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For the mucous try an expectorant, plus drink plenty of water and fruit juice.  Cut back on caffeine if you’re currently using a lot as it can cause the confusion/pounding/weakness symptoms and can dehydrate you. I suspect that a part of your problem is panic — cutting back on caffeine will help, but partly you have to just use "mind control" to calm yourself whenever you feel the symptoms coming on. (Technically, it isn’t what most people consider "panic" but a reaction of the autonomous nervous system to asthma triggers, gearing up its "fight or flight" responses inappropriately.  But by consciously calming yourself you can to some degree control this and turn off those responses.  Your conscious brain doesn’t cause the problem, but it can control it.) I would guess that it’s not the Claritin, leather couch, or kerosene heater per se causing your problems, but rather a general overload of the senses such that you’re hitting your trigger point.  Try to get a little fresh air in the place if you’re not too sensitive to outside pollen, etc. – Hide quoted text — Show quoted text – hi, i was recently diagnosed with asthma, and am now on flovent, serovent, and proventil. currently, i’m trying to find what is the source that is causing my asthma symptoms…….lately it has been pretty scary, i’ve been having severe attacks that are causing mental confusion, heart pounding, weakness, and extreme breathing difficulties. also, i cant take claritin anymore because its causing a thickening of  the mucous which i cany expel from my lungs. i’m narrowing down the cause of my symptoms to the new leather couch and chair that i recently bought….or the monitor kerosene heater…….can the chemicals released from the leather be creating my symptoms??  and why all of a sudden i cant seem to tolerate the claritin? anyone else having symptoms caused by leather furnitures??  and what do you do for the thickening of the mucous? thanks for any replies, will

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Will, For starters, if you suspect what is causing the problem, why don’t you either isolate the problems from you (either close off those rooms or remove them from your environment) and see if you slowly start to improve?  Then re-introduce one at a time and see if you start to get worse again. I would suspect the kerosene but don’t know enough about your situation.  Is it new?  Is it currently in use?  Is it portable (can you remove it from your environment to see if you improve)?  Have you read the brochure that comes with it and using it as recommended?  Is there a warranty with it?  Have you asked the dealer about it? Seems like if you can find the definite source and remove it, this if the better option rather than taking all those meds.  IMO (and I’m not a doctor) Don’t know about Claritin except I believe it is an OTC and the other are prescribed meds.  Perhaps an interaction?  What does your physician say about all this? Regards J – Hide quoted text — Show quoted text – hi, i was recently diagnosed with asthma, and am now on flovent, serovent, and proventil. currently, i’m trying to find what is the source that is causing my asthma symptoms…….lately it has been pretty scary, i’ve been having severe attacks that are causing mental confusion, heart pounding, weakness, and extreme breathing difficulties. also, i cant take claritin anymore because its causing a thickening of  the mucous which i cany expel from my lungs. i’m narrowing down the cause of my symptoms to the new leather couch and chair that i recently bought….or the monitor kerosene heater…….can the chemicals released from the leather be creating my symptoms??  and why all of a sudden i cant seem to tolerate the claritin? anyone else having symptoms caused by leather furnitures??  and what do you do for the thickening of the mucous? thanks for any replies, will

Response:

hi, i was recently diagnosed with asthma, and am now on flovent, serovent, and proventil. currently, i’m trying to find what is the source that is causing my asthma symptoms…….lately it has been pretty scary, i’ve been having severe attacks that are causing mental confusion, heart pounding, weakness, and extreme breathing difficulties. also, i cant take claritin anymore because its causing a thickening of  the mucous which i cany expel from my lungs. i’m narrowing down the cause of my symptoms to the new leather couch and chair that i recently bought….or the monitor kerosene heater…….can the chemicals released from the leather be creating my symptoms??  and why all of a sudden i cant seem to tolerate the claritin? anyone else having symptoms caused by leather furnitures??  and what do you do for the thickening of the mucous? thanks for any replies, will

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Question:

Gloria: Thank you so much for the info you posted.  It is very informative.   I do not know how this would affect my asthma though because the only onset I usually get of asthma is when I get a cold and then it continues until it runs its course.  Otherwise I am usually asthma symptom free and do not experience wheezing or anything from allergies.  It appears the only thing I am allergic to is viruses/infections/flu/colds etc. Anyway, thanks again and I know there are a few others in the group that are also asthma suffers.  Blessings, Jeannette

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Ooooh, I could of bought Immunex 4-5 years ago for 11 dollars a share. and they are marching on with it. Harv – Hide quoted text — Show quoted text – I’ve been reading the posts of Jeanette’s trials with her asthma and I’ve seen others on here who post about having asthma.  Did any of you know that Immunex is conducting clinical trials on their new asthma drug?  It works on the same principle as Enbrel in that it is a biologic response modifier.  It is called Nuvance and it is a nose spray administered once a week.  It works by turning off the cells that cause asthma and does not bother any other cells. Read this,  there is a toll-free number to call if you are interested in participating in the clinical trials for Nuvance.  Hope this helps someone. I copied and pasted this from Immunex’s web site: Results of NUVANCE(TM) Phase I/II Asthma Trial Presented at European Respiratory Society Meeting Once-a-Week Inhaled Treatment Helped Stabilize Lung Function and Was Generally Well Tolerated MADRID, Spain, Oct. 12 /PRNewswire/ — Results of a Phase I/II trial of NUVANCE(TM) (soluble IL-4 receptor), an investigational once-a-week inhaled asthma treatment, suggest the drug was generally well tolerated and helped stabilize lung function for up to 12 weeks following discontinuation of inhaled corticosteroids, Immunex Corporation (Nasdaq: IMNX) announced today. These results were presented today at the European Respiratory Society meeting in Madrid, Spain. "Asthma has reached epidemic growth levels. IL-4 inhibition may change the way physicians think about asthma," said Dr. Larry Borish, associate professor in medicine, University of Virginia Medical Center and principal investigator for the NUVANCE trial. "The data presented today provide the foundation for further study of NUVANCE and IL-4 inhibition in asthma." NUVANCE, a recombinant human version of a naturally occurring protein, represents a novel investigational approach to treating asthma. NUVANCE acts by binding to Interleukin-4 (IL-4), a protein that is present in asthmatic lungs. The binding of NUVANCE to IL-4 renders the bound IL-4 biologically inactive, which may reduce the IL-4 driven signs and symptoms of asthma. This placebo-controlled, randomized, double-blind, Phase I/II trial was conducted in 62 adults with moderate persistent asthma, in which symptoms such as wheezing, shortness of breath and coughing occur regularly. Prior to the study, all patients were dependent on inhaled corticosteroids, daily medication intended to relieve inflammation of the airways. All patients discontinued inhaled corticosteroids when study treatment was started. The study assessed the safety and pharmacokinetics (absorption, distribution and elimination) of inhaled NUVANCE following discontinuation of inhaled corticosteroids. Investigators compared three doses of NUVANCE, 0.75 mg, 1.5 mg or 3.0 mg, to placebo and administered each treatment by inhalation once weekly for up to 12 weeks. Overall, treatment with NUVANCE was generally well tolerated. No serious adverse events related to study drug were reported. The most frequently reported side effects were headache (13%), mild nausea (13%), respiratory infection (11%) and pain (11%). Following discontinuation of inhaled corticosteroids, patients in the 3 mg NUVANCE group experienced continued asthma control over the 12 week treatment period with minimal decline in forced expiratory volume (FEV1), a mean of -2.2%, compared to a greater decline in FEV1 in the placebo group, a mean of -13.2%. FEV1 is a standard measurement of lung function that measures how much air a person can expel in one second. It is a clinical marker used to evaluate asthma severity, with a reduction in FEV1 indicating a worsening of asthma. The results described herein are based on investigational data analyzed by Immunex. These data have not been reviewed by the U.S. Food and Drug Administration (FDA) as part of an application for regulatory approval. The results reported today are consistent with the findings of an earlier single-dose pilot study with NUVANCE in moderate persistent asthmatics that was presented at the 1998 American Academy of Allergy, Asthma and Immunology Conference (AAAAI). A Phase II clinical trial of NUVANCE is currently underway to evaluate the safety and efficacy of the drug for longer-term control of asthma. The study will include 180 people with asthma at 19 leading asthma clinics in the United States. People with asthma interested in participating in the clinical trial program for NUVANCE should contact the Immunex Professional Services Department at 800-IMMUNEX. About Asthma Asthma is a chronic inflammatory disorder of the airways, with periodic acute worsening that can significantly limit a patient’s normal activities. Symptoms include coughing, wheezing, and tightness in the chest. Approximately 17 million Americans have asthma, and more than half of these people are candidates for a long-term control therapy, meaning they need to use their rescue therapy twice or more a week. Asthma results in millions of emergency room visits per year and more than 5,000 deaths annually, according to the U.S. Centers for Disease Control and Prevention. Projected to cost more than $14.5 billion annually in both direct and indirect costs to the U.S. economy by the year 2000, asthma causes more than 100 million days of restricted activity among people with asthma, and there are more than 500,000 hospitalizations related to asthma each year. About IL-4 Interleukin-4 (IL-4) is a naturally occurring cytokine, or immune system protein, that has been commonly associated with the development of asthma and allergies. It binds to specific IL-4 receptors (IL-4R) on the surface of cells in the body or to naturally occurring soluble receptors that circulate throughout the body. Increased levels of IL-4 appear to be related to increased severity of asthma that results in difficulty in breathing. IL-4 promotes the differentiation of naive T helper lymphocytes into Th2 lymphocytes. Th2 lymphocytes secrete cytokines such as IL-4, IL-5, IL-9 and IL-13, which are key mediators of asthmatic inflammation. IL-4 is one of the molecules that induce mucous production by lung mucous glands, contributing to airway obstruction. IL-4 regulates expression of the adhesion molecule VCAM-1 which interacts with the VLA4 molecule on the surface of eosinophils. This interaction allows eosinophils to migrate from the blood and into the lung tissue resulting in inflammation. IL-4 induces B cell proliferation and the production of antigen-specific IgE that is required to trigger allergic response. Antigen-specific IgE causes mast cells to release inflammatory "mediators," such as histamines and leukotrienes, and these create bronchoconstriction. Immunex scientists used recombinant DNA technology to produce a soluble IL-4 receptor, a molecule the company named NUVANCE. When IL-4 binds with NUVANCE (soluble IL-4 receptor) instead of cell-surface IL-4R, the effects of IL-4 may be blocked. Immunex Corporation is a biopharmaceutical company dedicated to developing immune system science to protect human health. The company’s products offer hope to patients with cancer, inflammatory and infectious diseases. American Home Products Corporation owns a majority interest in Immunex. AHPC is one of the world’s largest research-based pharmaceutical and health care products companies and is a leading developer, manufacturer and marketer of prescription drugs and over-the-counter medications. It is also a leader in vaccines, biotechnology, agricultural products and animal health care. NOTE: This news release contains forward-looking statements that involve risks and uncertainties, including risks associated with clinical development, regulatory approvals, product commercialization and other risks described from time to time in the SEC reports filed by Immunex, including the most recently filed Form 10-Q. An electronic version of this news release — as well as additional information about Immunex of interest to investors, customers, future employees and patients — is available on the Immunex home page at www.immunex.com. SOURCE Immunex Corporation —-

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I’ve been reading the posts of Jeanette’s trials with her asthma and I’ve seen others on here who post about having asthma.  Did any of you know that Immunex is conducting clinical trials on their new asthma drug?  It works on the same principle as Enbrel in that it is a biologic response modifier.  It is called Nuvance and it is a nose spray administered once a week.  It works by turning off the cells that cause asthma and does not bother any other cells. Read this,  there is a toll-free number to call if you are interested in participating in the clinical trials for Nuvance.  Hope this helps someone. I copied and pasted this from Immunex’s web site: Results of NUVANCE(TM) Phase I/II Asthma Trial Presented at European Respiratory Society Meeting Once-a-Week Inhaled Treatment Helped Stabilize Lung Function and Was Generally Well Tolerated MADRID, Spain, Oct. 12 /PRNewswire/ — Results of a Phase I/II trial of NUVANCE(TM) (soluble IL-4 receptor), an investigational once-a-week inhaled asthma treatment, suggest the drug was generally well tolerated and helped stabilize lung function for up to 12 weeks following discontinuation of inhaled corticosteroids, Immunex Corporation (Nasdaq: IMNX) announced today. These results were presented today at the European Respiratory Society meeting in Madrid, Spain. "Asthma has reached epidemic growth levels. IL-4 inhibition may change the way physicians think about asthma," said Dr. Larry Borish, associate professor in medicine, University of Virginia Medical Center and principal investigator for the NUVANCE trial. "The data presented today provide the foundation for further study of NUVANCE and IL-4 inhibition in asthma." NUVANCE, a recombinant human version of a naturally occurring protein, represents a novel investigational approach to treating asthma. NUVANCE acts by binding to Interleukin-4 (IL-4), a protein that is present in asthmatic lungs. The binding of NUVANCE to IL-4 renders the bound IL-4 biologically inactive, which may reduce the IL-4 driven signs and symptoms of asthma. This placebo-controlled, randomized, double-blind, Phase I/II trial was conducted in 62 adults with moderate persistent asthma, in which symptoms such as wheezing, shortness of breath and coughing occur regularly. Prior to the study, all patients were dependent on inhaled corticosteroids, daily medication intended to relieve inflammation of the airways. All patients discontinued inhaled corticosteroids when study treatment was started. The study assessed the safety and pharmacokinetics (absorption, distribution and elimination) of inhaled NUVANCE following discontinuation of inhaled corticosteroids. Investigators compared three doses of NUVANCE, 0.75 mg, 1.5 mg or 3.0 mg, to placebo and administered each treatment by inhalation once weekly for up to 12 weeks. Overall, treatment with NUVANCE was generally well tolerated. No serious adverse events related to study drug were reported. The most frequently reported side effects were headache (13%), mild nausea (13%), respiratory infection (11%) and pain (11%). Following discontinuation of inhaled corticosteroids, patients in the 3 mg NUVANCE group experienced continued asthma control over the 12 week treatment period with minimal decline in forced expiratory volume (FEV1), a mean of -2.2%, compared to a greater decline in FEV1 in the placebo group, a mean of -13.2%. FEV1 is a standard measurement of lung function that measures how much air a person can expel in one second. It is a clinical marker used to evaluate asthma severity, with a reduction in FEV1 indicating a worsening of asthma. The results described herein are based on investigational data analyzed by Immunex. These data have not been reviewed by the U.S. Food and Drug Administration (FDA) as part of an application for regulatory approval. The results reported today are consistent with the findings of an earlier single-dose pilot study with NUVANCE in moderate persistent asthmatics that was presented at the 1998 American Academy of Allergy, Asthma and Immunology Conference (AAAAI). A Phase II clinical trial of NUVANCE is currently underway to evaluate the safety and efficacy of the drug for longer-term control of asthma. The study will include 180 people with asthma at 19 leading asthma clinics in the United States. People with asthma interested in participating in the clinical trial program for NUVANCE should contact the Immunex Professional Services Department at 800-IMMUNEX. About Asthma Asthma is a chronic inflammatory disorder of the airways, with periodic acute worsening that can significantly limit a patient’s normal activities. Symptoms include coughing, wheezing, and tightness in the chest. Approximately 17 million Americans have asthma, and more than half of these people are candidates for a long-term control therapy, meaning they need to use their rescue therapy twice or more a week. Asthma results in millions of emergency room visits per year and more than 5,000 deaths annually, according to the U.S. Centers for Disease Control and Prevention. Projected to cost more than $14.5 billion annually in both direct and indirect costs to the U.S. economy by the year 2000, asthma causes more than 100 million days of restricted activity among people with asthma, and there are more than 500,000 hospitalizations related to asthma each year. About IL-4 Interleukin-4 (IL-4) is a naturally occurring cytokine, or immune system protein, that has been commonly associated with the development of asthma and allergies. It binds to specific IL-4 receptors (IL-4R) on the surface of cells in the body or to naturally occurring soluble receptors that circulate throughout the body. Increased levels of IL-4 appear to be related to increased severity of asthma that results in difficulty in breathing. IL-4 promotes the differentiation of naive T helper lymphocytes into Th2 lymphocytes. Th2 lymphocytes secrete cytokines such as IL-4, IL-5, IL-9 and IL-13, which are key mediators of asthmatic inflammation. IL-4 is one of the molecules that induce mucous production by lung mucous glands, contributing to airway obstruction. IL-4 regulates expression of the adhesion molecule VCAM-1 which interacts with the VLA4 molecule on the surface of eosinophils. This interaction allows eosinophils to migrate from the blood and into the lung tissue resulting in inflammation. IL-4 induces B cell proliferation and the production of antigen-specific IgE that is required to trigger allergic response. Antigen-specific IgE causes mast cells to release inflammatory "mediators," such as histamines and leukotrienes, and these create bronchoconstriction. Immunex scientists used recombinant DNA technology to produce a soluble IL-4 receptor, a molecule the company named NUVANCE. When IL-4 binds with NUVANCE (soluble IL-4 receptor) instead of cell-surface IL-4R, the effects of IL-4 may be blocked. Immunex Corporation is a biopharmaceutical company dedicated to developing immune system science to protect human health. The company’s products offer hope to patients with cancer, inflammatory and infectious diseases. American Home Products Corporation owns a majority interest in Immunex. AHPC is one of the world’s largest research-based pharmaceutical and health care products companies and is a leading developer, manufacturer and marketer of prescription drugs and over-the-counter medications. It is also a leader in vaccines, biotechnology, agricultural products and animal health care. NOTE: This news release contains forward-looking statements that involve risks and uncertainties, including risks associated with clinical development, regulatory approvals, product commercialization and other risks described from time to time in the SEC reports filed by Immunex, including the most recently filed Form 10-Q. An electronic version of this news release — as well as additional information about Immunex of interest to investors, customers, future employees and patients — is available on the Immunex home page at www.immunex.com. SOURCE Immunex Corporation —-

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Question:

My brother has type 1 diabetes.  A year ago, he started taking Cozaar (losartan) for diabetic kidney disease.  Since then, he has experienced extreme reactions (loss of breath) from high altitude and cold weather.  We suspect it may be tiggered by Cozaar.  Has anyone else who is taking Cozaar experienced this kind of reaction? Terry

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Terry,  I have a much different history, but did take Cozaar 50mg x 2. It was for high BP and really didn’t do much for me. After a time on it, I developed Asthma symptoms, wheezing, coughing, shortness of breath, and subject to all of the "triggers." MID (My Idiot Doctor), an internist and pulmonary specialist, declared that I had Asthma and put me on an inhaler, SEREVENT. It got progressively worse. I also had eczema on both arms that would not clear up.  After my complaining that my BP was averaging 150/100, MID took me off Cozaar and put me on AVAPRO. Results: BP of 155/110. I don’t remember the effect on the Asthma symptoms because they vary daily and I was only on it for a week. MID then put me on NORVASC, 10mg X 2. Results: immediately before first pill – BP of 153/105, three hours later BP of 122/85! I only take 10mg a day and BP has stayed that way for 8 months. I have had doctor’s office readings as low as 116/70. But, important for your consideration, I have never had so much as a hint (And, I mean the smallest trace!) of an Asthma symptom since that first pill. Also, my eczema cleared up within a week with no return.  It was my cardiologist who cut me down to 1/day and when I told him of the amazing results, he was not surprised. He attributed it all to the high BP. Whether he knew of a relation to Cozaar or not, I don’t know. He is the type that would not mention it.  I don’t know if this helps, but together with other’s experiences maybe it will. Regards, J

– Hide quoted text — Show quoted text – My brother has type 1 diabetes.  A year ago, he started taking Cozaar (losartan) for diabetic kidney disease.  Since then, he has experienced extreme reactions (loss of breath) from high altitude and cold weather. We suspect it may be tiggered by Cozaar.  Has anyone else who is taking Cozaar experienced this kind of reaction? Terry

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Thanks J.  Your note was very helpful.  I’ve been doing some Medline research, and it seems that Angiotensin II (which Cozaar blocks) is an important enzyme to stimulate respiration, especially when the body is not getting enough oxygen (e.g., in high altitudes and in cold weather).  So there may be a connection. Terry

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Question:

Hi Nancy, I get the same thing.  In fact I have it today.  I always though when I get it that it must be from the acid reflux or heartburn.  I told my doctor about it and there is nothing wrong with my heart so it has to be related to the acid reflux.  I get like a headache and my throat and chest hurts and my ears.  It usually goes away as I take Maelox tablets or Zantac.  Let me know

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I added serevent to my drugs 9 days ago and have had some horrible cramps also , (I have had cramps for ten years or longer even before the asthma was diagnoised) my doctor has put me on a spasm drug because one day I had 21 and had had it.  but these new ones are harder and longer, they hit in the flectures just in the corner of the base lung area and I cannot breathe for the pain , cold sweats and nausia follows sometimes, today so far I have been free, maybe it will lighten up  but I have never had them in the lungs  usually I grab a LevBid and they get better.  I truely hope you are  not like this, but should you be, I have made it 10 years and plan to keep on trucking.   frannymae.  good luck.

FRAN’SHOME

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No I cannot put my finger on a specific part.  It is all across my upper back,  I do have problems with the 2 floater ribs tho, my last trip to the emergency room, the emergency room dr. thought i had a cracked rib because of the amount pain i was in,  i couldn’t lay down or even lean back on the table they had me on.  I didn’t have a cracked rib. Yes Deep breathing makes it worse,  feels like when i walk to fast or take in to much cold air.  Short breaths feels better. It did feel better once i got into a HOT shower.  I think i stayed in their for 30 minuets….  Symptoms are not as bad to day,  i have a nebulizer which i have used for the past couple days. I will tell my Dr. (Pulmonary Specialist).  When i see him. Thank you…. Nancy

– Hide quoted text — Show quoted text – it would help if you cna better quantify and qualify your pain…..so here goes 1. can you point with one finger where it hurts, or is it more generalized 2. does it get worse with deep breathing? if the pain is more generalized then it is more than likely cardiac in origin and I would not want to see you waiting for two weeks to see your doctor. If the pain is localized and gets worse with deep breathing, and lessens with tiny breaths a likely consideration would be "parenchymal" pain.  this can be casued by pneumonia, rib or muscle injury, pleirisy and a num,ber of other things that are non-cardiac.  Again, i would not wait two weeks, but I would try to differentiate the pain and let your doctor know your symptoms in detail. Scooby RCP, EMT-P Perinatal-Pediatric Respiratory Specialist This mail is a natural product.  The slight variations in spelling and grammar enhance its individual character and beauty and in no way are to be considered flaws or defects.

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No I cannot put my finger on a specific part.  It is all across my upper back,  

Sometimes gallbladder problem can cause back pain.  Do you still have your gallbladder? I’m just guessing here (G)…if I were you I’d go to the doctor as soon as possible. CarolR

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I have been having a "New" Symptom to my Asthma.  I wake up in the middle of the night with pains in my lungs,  what feels like muscle spasms, the spasms get so bad that i can barley catch my breath. My lungs feel clear, No wheezing. Has anyone ever felt this before.,  I have a standing appointment to see my Dr. in 2weeks.

Call your doctor NOW; this is not a typical asthma symptom. Chris Owens

Response:

it would help if you cna better quantify and qualify your pain…..so here goes 1. can you point with one finger where it hurts, or is it more generalized 2. does it get worse with deep breathing? if the pain is more generalized then it is more than likely cardiac in origin and I would not want to see you waiting for two weeks to see your doctor.  If the pain is localized and gets worse with deep breathing, and lessens with tiny breaths a likely consideration would be "parenchymal" pain.  this can be casued by pneumonia, rib or muscle injury, pleirisy and a num,ber of other things that are non-cardiac.  Again, i would not wait two weeks, but I would try to differentiate the pain and let your doctor know your symptoms in detail. Scooby RCP, EMT-P Perinatal-Pediatric Respiratory Specialist This mail is a natural product.  The slight variations in spelling and grammar enhance its individual character and beauty and in no way are to be considered flaws or defects.

Response:

I have been having a "New" Symptom to my Asthma.  I wake up in the middle of the night with pains in my lungs,  what feels like muscle spasms, the spasms get so bad that i can barley catch my breath. My lungs feel clear, No wheezing. Has anyone ever felt this before.,  I have a standing appointment to see my Dr. in 2weeks. I take Serevent and Flovent 2xdaily and Albuterol PRN. Confused and in pain Nancy

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