Friday, April 29, 2016

Experiment results are in: Advair works best

If you continue to have trouble with your breathing despite being on a combination inhaler like Advair, Symbicort, or Dulera, you might want to try Breo. It's essentially the same type of medicine, but the theory is that each new long acting bronchodilator is a tad stronger. Breo worked great for controlling my asthma, with one caveat: it was a little bit too powerful, causing jitters and nervousness.

Truthfully, if there weren't other options I would probably stick to Breo. Here's a rundown of the product. Actually, allow me to compare it with Advair.

Advair
  • Inhaled Corticosteroid: Fluticasone
  • Long Acting Bronchodilator: Salmeterol
  • Doses: 250/50, and 500/50
Breo
  • Inhaled Corticosteroid: Fluticasone
  • Long Acting Bronchodilator: Vilanterol
  • Doses: 25/100, and 25/200
So, they both have the same inhaled steroid, although they both offer differing doses of each. So both should work the same for controlling chronic underlying airway inflammation. The only difference here is that Advair offers the 500/50 dose, and that's what I'm trying right now. 

The problem I had with Breo was vilanterol. It makes me feel as though a constant current was flowing through my body. Actually, that's the same feeling that I had when I tried Symbicort and Dulera, both of which have the same long acting bronchodilator (formoterol). 

I used to take the salmeterol (Serevent) metered dose inhaler (MDI) back in the late 1990s in combination with fluticasone (Flovent), the side effects were the same as with vilanterol and formoterol. However, for some reason, when taken as a dry powder inhaler (DPI) via the Advair Diskus, it doesn't cause this side effect. So, sometimes the delivery device makes a difference. And this is not uncommon for a medicine to offer a little different effect simply due to how it is delivered. 

I took Advair from around 2002 to 2014, when my doctor decided he wanted me to take another combination inhaler. I don't know what his bugaboo about Advair is, perhaps the link between pneumonia. I tried Dulera, Symbicort, and Breo. I tried the low and high doses of Breo. 

They all worked nice, but all made me jittery and nervous, except Advair. Therefore, I am going to end my combination inhaler experiment for the time being. I'm going to stick with Advair. I will continue to alter between Advair 250/50 and Advair 500/50, depending on how my asthma is doing. 

Now, let me say this. Just because Breo didn't work for me, that's no reason for you not to try it. Symbicort and Dulera caused jittery and nervousness in me too, although it works great for many of my friends. Asthma is a heterogenous disease, so what doesn't work for one person may work for another, and vice versa. 

Thursday, January 21, 2016

Breo is great... or is it???

What if.. what if... what if the side effects of the medicines used to control your breathing aren't worth it. What if... What if... what if something that has been ailing you for years isn't caused by aging, or by some other chronic condition, but is just a side effect of some medicine you've been taking for years.

Worded another way: Surely all those medicines you're on are helping you breathe easier, but are they worth it.  Are the side effects simply causing another problem that is making your life more difficult.

This is a tough thing to think about, but it's worth thinking about.  I mean, as a respiratory therapist, I brush off claims by doctors that ventolin has side effects.  I brush off concerns that albuterol caused that lady in room 212 to jump into atrial fibrilation.  I tell doctors all the time that it's just a coincidence, that ventolin won't do it.

But what if I'm wrong? What if everything we know about asthma medicines is wrong? What if all the other problems that ail us are (ahem!!!) caused by the very medicines that are helping us.

Let me just give you an example, For the past year I have been shaking almost uncontrollably every time I attend a code in the ER. I usually am able to prevent others from noticing by stabilizing my hand on some surface. I'm able to draw ABGs in such situations simply by taking my time and drawing the blood until my hand calms down.

Recently a doctor questioned me.  He even went as far to tease me by saying, "So, do you have a drinking problem?" Now, he was joking.  But it still is bothersome to some degree?

So, theories abound my mind.  Is it that I drink too much coffee?  Well, I've been drinking coffee since 2010, and it never did this to me before.  Is it aging? I know my mom and grandma suffer from anxiety, and it seemed to get worse as they aged.  So is that happening to me? Is this just genetics?

Now that I think about it, I also suffered from a few bouts of some sort of abnormal rhythm. I never told my wife about it because I didn't want to concern her.  Or, better yet, I didn't think it was that big of a deal. But, if it was the Breo...????

Yes, it is true that my mom, dad, and a couple of my brothers suffer from shaky hands. So, the idea that this is genetics has crossed my mind.  So this is what I was thinking two days ago as I laid on my bed to take a nap.  And then, voila, an idea crossed my mind that had never occurred to me before: Maybe, just maybe, it's the BREO.

I have bragged about this medicine up and down.  I was on Advair before Breo, and Advair worked great with negligible side effects. So when I switched to Breo, it never even occurred to me that there would be side effects. So there was a bias to Breo.

I tried Symbicort and Dulera before that, and there was no bias.  Within days of both medicines I noticed that I was increasingly jittery.  In fact, I remember a coworker made fun of me one day when I was trialing Symbicort, and I quit taking it the next day and went back on Breo.

So, that said, why did it take me over a year to realize Breo was doing the same thing.  Bias, I say. I held a b bias to Breo. I was no better than a biased journalist. Bias accomplishes nothing other than a repeat of stupidity and failure.

My theory now is that my body is overflowing with adrenaline due to the Breo, the ventolin, the coffee, and the natural increase in adrenaline at a code.

So now I'm trialing no Breo. It's on day 3 now and I can tell a remarkable difference. Surely I can't breathe as well, but, man, I just couldn't go on feeling so jittery.  It was stressing me out. I'll give it a few more days, and if I continue to feel more normal sans Breo, a call to the doctor to change to Flovent will be imminent.

Will keep you posted on how this experiment goes.  Yes, I do know I'm going against all expert advice, including my own, to never change your medicine on your own without doctor approval.  But sometimes you just gotta do what you gotta do.

Monday, December 21, 2015

Happy New Year's Day

Well, not really. But I'm pretending it is so I can start eating better...

I explained yesterday how I'm getting back on the John for Life treadmill. That's actually not completely true.  I have been exercising on a regular basis since July.  I actually lost 20 pounds within the next two months.  The problem is that, once the kids started school, my diet took a back seat.  So, the truth is, I'm actually getting back on the diet. It's the diet I've been sucking at. 

But, like I said, it's the diet, I think, that gets screwed up when you work swing shift.  Now that I'm on all days I'm hoping I should be able to stick to my diet better.  I mean, I know it's going to be a lot of work, but hopefully it should be somewhat easier now.  

So, the good news is I'm not terribly out of shape. It's not like I'm starting from scratch.  I just need to motivate myself to avoid the chips, the cookies, the cakes and the pies.  And this is hard -- another excuse -- when you have kids and they get to eat normal. 

That said, today is my New Year's day.  Today is the day I'm getting back on the workout and eat healthy wagon, rather than waiting for 2016 to get here. If I don't do this I'm probably going to gain five more pounds before I start, and that would not be good.  

Sunday, December 20, 2015

Back on the John for Life treadmill

So I'm sitting on the couch all pumped up to watch the Lions (I'm a dedicated fan), only to realize they don't play at their usual 1 p.m. time slot.  In fact, they don't play at all today: they play on Monday night. Yes, they have played well enough lately to deserve this prime time slot. 

Anyway, that said, I've decided I'm going to start my New Year's Resolution a week early.  I figure this should work considering I work on Christmas anyway. And, of course, as usual, my resolution once again this year is to lose 50 pounds. That should put me at 170 pounds. So you can do the math to determine what I weight now. 

I've done this before, believe it or not.  Of course having children does not bode well for maintaining weight loss.  That's my excuse. Another viable excuse I have is that I have been working the swing shift for the past five years. That's done now. I am working only day shifts now.  I have never worked the day shift full time before.  I am finding it's very nice. 

I actually have another viable excuse that I have never mentioned to anyone outside this post, and this is the fact that I'm on a small, chronic dose of steroids. Sure it's inhaled, but enough gets to your system to cause certain side effects, like an increased appetite. 

That said, I think that just working that swing shift made it very hard to stick to any diet. According to Alice Burron at nursetogether.com: 
There are many hormones that are affected by sleep, and most of them control our appetite, fat, carbohydrate metabolism and the growth of lean muscle.
The kicker here is that every time I lost weight in the past I did so while working night shift.  Still, I think that swing day, the one day a week I worked nights, really wore me out more than working nights regularly.  When your body gets used to working days, and then you have to quick turn around and stay up all night, I think that messes up your body, making it harder to stick to any diet.

I found this to be true nearly every week, as I'd eat good Monday to Thursday, and then tank on Friday after working Thursday night.  Of course, maybe this is just one big excuse.  So be it.  It's a New Year starting today.  It's back to the John for Life.

Saturday, December 19, 2015

The Confounding Asthma Information Packet

I just got this package in the mail from my health insurance called, "Welcome to our Asthma Program."  It came complete with tips on managing my asthma symptoms, what triggers to be aware of, and the importance of avoiding triggers, It also comes with tips on how asthma is treated, and a 
copy of my very own Asthma Action Plan I can work on with my doctor.  

I don't know what to think when I get this kind of stuff.  I mean, a part of me thinks it's good, considering most asthmatics could benefit from this kind of wisdom.  But a part of me, the part that took over when I received the pamphlet, wanted to make fun of it.  And, of course, this is what I did. I mean, this is just public relations junk as far as I'm concerned.  Allow me to explain. 

1.  Avoiding Triggers.  Here I'm encouraged to work with my doctor to learn my triggers, and then to avoid them.  Yeah, it's easier said than done.  Here they say if I'm allergic to dust mites I'm supposed to allergy proof my home.  Well, this would be fine and dandy if they'd be willing to pay for the things they suggest, like air conditioning.  I'd love to have it.  Maybe they'd like to come and remodel my basement to to get rid of the dust mite infestation down there.  I should stay indoors when the pollen counts are high, they say.  So, what do they want me to do, live in a bubble in the spring, summer and fall.  Fat chance that's going to happen.  

2  Signs your asthma could be better controlled.  
  • Do you have nighttime symptoms more than twice a month
  • Do you need quick-relief medicine more than two times a week? 
  • Do you need more than two canisters of quick-relief medication a year?
Yes, yes, and yes!  Those are my answers.  So they recommend: "If you answered 'yes' to any of these questions, your asthma may not be as well controlled as it could be.  Talk to your health care team about bla bla bla. 

You see why I hate this stuff.  I hate the criteria that you have poorly controlled asthma based on how often you have symptoms and how often you use your inhaler.  I'm already on all the best controller medicines in the world, I already try to avoid my triggers, but, for the sake of God I HAVE SEVERE ALLERGIC ASTHMA. MY ASTHMA CANNOT BE TREATED THE SAME WAY TYPICAL ASTHMATICS ARE TREATED, AND CONTROL FOR ME IS WHAT THEY SAY IT SHOULDN'T. 

I think the whole notion of asthma guidelines are going to change very soon.  I think gone are the days -- or leaving are the days -- when all asthmatica are treated the same.  I think asthma subtypes are going to be further defined, and asthma guidelines created for each subtype.  For instance, my subtype is Severe Allergic Asthma. 

Truly, the only medicine I'm not taking that might benefit me is Xolair, and my doctor has never even suggested I try it.  Still, I'm not even sure my health insurance, the same one that is so concerned about me that it sends me this generic asthma information packet, would put out the $3,000 needed to cover each dose. I mean, they already don't want to pay for Advair and Breo. So, I suppose they care so long as they don't have to pay for it. 

Thursday, November 12, 2015

400 B.C.: Did Hippocrates recognize allergies?

While hay fever was not mentioned until the 19th century, and allergies not defined until the 20th century, the signs and symptoms of allergies were well known to physicians of the ancient world.  Perhaps the first allusion to this was by Hippocrates during the 5th century.

Claude Lenfantt, in his introduction to the book "The Immunological Basis of Asthma, quotes Hippocrates as saying: 
Cheese does not harm all men alike, some can eat their fill of it without the slightest hurt, nay, those it agrees with are wonderfully strengthened thereby.  Others come off badly.  So the constitution of these men differ, and the difference lies in the constituent of the body which is hostile to cheese, and is roused and stirred to action under its influence. (1, page introduction)
Since Hippocrates probably obtained his medical wisdom from his ancestors, who were probably teachers at the Asclepion at Cos, we can probably surmise that physicians going back to the early ancient world observed the symptoms of allergies.

Surely allergies caused grief and suffering for those afflicted with it, this would have been minor compared to all the diseases that plagued the ancient world.  So allergies, even more so than asthma, was essentially ignored by the medical community.  The symptoms were probably recognized and brushed aside as catarrh, or the common cold.

References:

  1. Lenfant, Claude, author of introduction, Bart Lambrecht, Henk Hoogsteden, Zuzana Diamant, editors, "The Immunological Basis of Asthma," Lung Biology of Health and Disease, Volume 174, Claude Lenfant, executive editor, 2003, New York, Marcel Dekker, Inc. 

Saturday, October 17, 2015

What's it like to have asthma, part 54

In response to my post, "What's it like to have asthma," a friend of mine sent me the following description of how she describes what it's like.
I have taught classes on what it is like to not be able to breathe well, and this demonstration seems to get my audience attention. inhale deeply and let half of the air out, then inhale again and let half of the air out, then do it again. I have never gotten beyond the third breath before my classes starting saying, "oh my gosh, I had no idea,
I think that's pretty good. To this I responded.
And not only does asthma feel like that, but your breath doesn't come back for several hours, even after hitting on your inhaler hundreds of times, or taking 3-4 breathing treatments. You have to sit in front of the TV, panicked to some extent, until your breath comes back. Then a sort of euphoria takes place. You never truly know what euphoria is like until you can't breathe, and then you can breathe.

But asthma is more than just being short of breath, it's knowing that if you do certain things, you will get short of breath. It's knowing you cannot really be normal. It's knowing you can't do what you want to do without consequences. Yes, I could talk about this ad nauseum, which is why I started my asthma blog.
This is how good asthma quotes come about.  Right there I amazed myself:
 You never truly know what euphoria is like until you can't breathe, and then you can breathe. 
So, how do you describe what it's like to have asthma?