What it's like spring cleaning with asthma

I have attempted to explain to my readers what it's like to have asthma. My contention that having asthma is more than just being short of breath, mainly because you're not short of breath most of the time. Still, even on good asthma days -- which most days are these days -- I still have to work to avoid asthma triggers. And I have another good example I wanted to share. Although, with this one, I might be walking on a fine line. I will try not to cross it.

I have said that asthma is all about explaining to those around you why you do things the way you do. For instance, I have learned that, if I want to clean my house, I have to do it in short spurts. I have to do a little bit at a time Technically speaking, I usually follow two unwritten rules.

1. Clean for a half hour and take a break to re-assess how you feel. If you sense any of your early warning signs of asthma, it's time to quit.
2. Clean until you observe your early warning signs of asthma, and then quit. 

I find that both of these rules are violated somewhat every time I clean. I don't intentionally violate them, but it's just that when you get into a cleaning funk, you get on a roll, you want to finish. It's not like you feel like cleaning every day. It's not like you have time to do it every day. It's not like you're motivated every day. So, when you are on a roll, you want to go with it. 

When we were kids, my brothers and I would observe this in our mother, and we referred to it as "cleaning tangent." Mom is on a "cleaning tangent. Watch out!" When we saw this, it was our cue to get out of her way, or we would be plowed over. By that, I mean she would say something like, "John, why don't you pick up those blocks behind the couch." See, she'd suck you up, maybe even make you feel guilty for sitting around watching TV while she was on a cleaning tangent. 

Anyway, there isn't a lot of time around my house to clean. I work three twelve hour shifts a week, and much of my free time is spent right here working on my little Chrome book writing about asthma, COPD, respiratory therapy, or creating newsletters for the local chapter of the Knights of Columbus. This is my home job; my part time job; my side job. Any free time is spent with my wife and kids, and they are a priority when they are home. This job gets moved down the priority list. 

So, yesterday I decided to clean. And, keep in mind here that I have four kids. And if you have kids, you know darn well that it gets hard to keep your house clean when you have kids. So, that said, just think of worse case scenario, and that's what my house looks like. I actually have a small house, so the piles of stuff look a lot worse in my house as compared to, say, a capacious house. 

So, I decided I wanted the mess to end, so I started digging under couches and chairs and tables and pulling out all the junk that collected in those places. There were books scattered all over the room, and Lego's, and magazines, and homework brought home from school. You would be amazed at how many papers were scattered around my living room alone. It was a mess. 

So I took (and I realize I just started three paragraphs in a row with so, but we'll just ignore that for now) all this stuff and I made a big pile in the middle of the living room. I started cleaning behind the TV and behind the desk, but I realized those places were replete with dust and cobwebs, and probably contained millions or trillions of dust mites. So, (and there it is again) I decided to skip those areas for now. I would focus on the mess in the middle of the room. 

I have to clean this way. Okay? I have to clean this way because of my allergies. I know that once I start cleaning I don't have much time. I cannot pick up a toy, take it to where it belongs, and put it away. I have found in the past that all this does is result in me being exposed to even more dust mites. It makes it so I get very little done. So, I make the pile in the middle of the room. Then I sort through the stuff one at a time. 

Trust me when I say that my wife has gotten mad at me more than once because I have left the pile in the middle of the room. Why do I just leave it? Well, according to her it's because I'm lazy. She sometimes gets mad at me. And I find myself having to explain all over again to her what it's like to have asthma. I explain that I have to do it this way. 

But, anyway, yesterday she didn't get irritated with me. So, a part of me wants to think that she finally understands. In fact, not only did she not get irritated, she actually finished the job. I did not explain to her why I quit. I did not tell her that I was feeling the sniffles, and head congestion that often start up as soon as I'm exposed to dust mites. And, sad to say, they are even in our living room. They are under the couches and chairs. They are on the carpet. 

My house does not look dirty, it's just messy. Dirty means the furniture looks trashy. That's not the case at all. However, messy means there's stuff scattered about in a sloppy fashion. Messy means you have kids, for example. Okay? So, by telling you there's dust mites everywhere in my home I don't want you to think I'm white trash or something like that. I'm not. At least I don't think so. 

Anyway, yesterday I did not have to explain why I quit. My wife didn't get irritated with me. My daughters didn't complain because I piled all their shoes in a bin. Well, until this morning anyway. This morning my teenage daughter got upset that she couldn't find her shoes. Then she and my wife, in a hurry to get off to school, were openly irritated with me. 

My son is home from college. When the women were gone, I said to him, "They get mad at me when the house is messy, and then they get mad at me when I clean." He laughed. But it's true.

Keep in mind this is not a criticism of my wife and daughter. It's natural to get frustrated when you can't find something, and it's natural to blame the person who cleaned, or the person who got half way through the job and quit. That's just natural. But, because they don't have asthma, they can't fathom what it's like. So they forget. Or, in the case of my daughter, I probably never told her. 

So, as I get older and wiser, I find myself not explaining myself as much. Yesterday I didn't explain what it's like to have asthma. I didn't say why I quit cleaning, even though there is much to be done. And that is my job when I get done with this: to spend another half hour or so cleaning. 

I want to finish with the living room today, and perhaps move into the kids room. And, you would be amazed at how many dust mites I will get exposed to in there. My Laney, my special Laney, when I said yesterday that she should clean her room, she did. She is a pleaser. I was so happy she did that. So, this should make it that much easier on the asthmatic dad on a cleaning rampage.

The fact that I didn't have to explain myself yesterday brought joy to my heart, in a way. Finally I didn't have to explain why I left the job half undone. It was so nice to get help from her and from my daughter. And I think this is even more so true when you have an invisible chronic illness and your mission in life is to avoid those invisible asthma triggers. So, thanks, family. 

Why do we set goals anyway?

So, I have been talking about goals. Why do we set goals? Some people don't. Some people don't know any better. Some people are satisfied with where they are at. That's fine. I'm not. I'm never satisfied. And I don't think that's bad. 

I have this idea imbedded in my head that if I lose weight I will feel better. Actually, even if I don't accomplish my ultimate goal of weighing 170 pounds, it feels good trying. So, that in and of itself is the big picture isn't it? To be feel good. To be happy. 

So many of my friends keep saying, or implying, "I'm satisfied with myself." That's fine. But to me, I think they get happy confused with being satisfied. Are you really satisfied living in your body the way it is? Or are you just saying that so you feel better. 

I mean, I'm not judging others. I'm obese myself. Really. I am. If you look at the body fat chart, I'm a guy and my body fat is about 30%. This puts me in the above average section. Now, for those of you living in the political correct world, I'm just going to tell you that above average is a really nice way of saying that I am obese. I am overweight. I am fat. I mean, if you are going to tackle a problem, you ought to identify it for what it is. 

This brings me to another point. I do not try to lose weight to look good. I am married. I am in my 40s. I don't care what I look like anymore. No. That's not why I work out. I do it so I feel better. I do it because when you work out your body releases more endorphins into your bloodstream, and these are natural morphine-like proteins that make you feel better. I do it to feel good. I do it because I want to be happy. That, to me, is the big picture: to be happy. 

Endorphins: God's gift to runners

If we get back to our Christian example, we can consider our body's as temples of the Lord. We use our temples to spread the word. That's the ultimate goal for Christians, to spread the word and get to Heaven. So, in this way, it's our duty, it's our responsibility to take care of our bodies, which are essentially on loan from God. 

So, if you take care of your body, you're naturally going to feel better. You are naturally going to be happier. I mean, it's in the science too. The more you exercise, the more endorphins are released into your bloodstream. These endorphins are your bodies natural morphine. They make you feel good. 

Ever hear of runners high? People, after they run, experience a feeling of euphoria. This is why they get addicted to running. That is why I run. It is to experience this natural euphoria. The reason for it is because of the release of endorphins. 

It's God's way of thanking us for taking care of His body; His temple. 

Here's why I think goals are good

There's a lot of people who hate resolutions. They say that setting resolutions is essentially setting yourself up for failure. You fail, and you feel bad. So, the logic is you shouldn't set them. I disagree with this. In fact, I think this is a stupid notion. The idea that setting goals is bad?

It's almost like telling people that the economy right now is as good as it's going to get, that it's the new normal, and we might as well just get used to it. Of course, then Trump comes along and he tells people to think big. He tells people to expect the economy to improve. He set the goal high. And this sort of optimism was a big hit with Americans and helped him get elected. 

I don't want to knock Obama, but he kept telling Americans that this was the new normal. He did. He said this over and over again. He said that we should just be happy with where we are. This was important, as to obtain his goal of giving everyone healthcare, we were all had to make sacrifices. We all had to make less money. Heck, I went five years without even having a raise. 

Then Trump comes along and told us to think big. I mean, he might not be able to accomplish his goal of creating an economic boom, but at least he's going to try. And if he doesn't try, we will not get there. If he doesn't try, our economy will be blah. You can go back to any point in our history and say the same thing. 

What if the founding fathers said, "A war with England will be too bloody, too hard. If we fight and lose, we will feel bad." What if Ronald Reagan said, "It will be too hard to lower taxes and cut regulations. Look what happened to Goldwater when he said that's what he wanted to do. So, I might fail. Why should I try?"

You see. They didn't think this way. They all set goals, and they set them high. Reagan never fully accomplished his goal. Some people were not better off at the end of the 80s. However, many people were better off. They were better off because Reagan set a goal and he kept reaching for it. He worked hard at it. He kept trying. 

Same with the founders. They did not create a perfect nation, but they tried. They created a country that was better than England. They created a country that future generations could make better. They set the goal, and they kept reaching for it. We are still reaching for it. 

Think of it this way. Life is hard. So, are we just supposed to say, "Well, I might fail, so I shouldn't go to college to better my life?" It's too hard. I might fail. I shouldn't take risks, because it might result in me failing. I might feel bad if I fail. I actually think this is why some people hate capitalism, because some people get shoved under the carpet; some people fail. 

Well, think of it this way. If Thomas Jefferson didn't fight for our freedom, most people would still live in poverty. If the founders didn't set a goal, no one would have healthcare except the elites. Their dream, their goal, was not to give people freedom, because they couldn't do that. Their goal was to create an environment where people could utilize their God given freedoms and accomplish any goals they set. This is what embodies the American Dream; what made it possible. What makes it possible. 

Capitalism is the economic system that came out of the founding dream. Sure some people fail, some people remain poor. But, if you go back to the old system, everyone is poor (except for the elites). Capitalism, at the very least, creates an environment where everyone can at least set goals and aim for them. If they fail, they can get right back on the wagon; they can set new goals; or they can just keep shooting for their original goals. 

Sure, you can and should be happy where you are. But that doesn't mean you should be satisfied. Just imagine if the founding fathers decided to just be content with their lives. Okay, so goals are good. Resolutions are good. If you don't set them, you have no chance of succeeding, of making yourself better. However, if you set them, at least you have a chance. 

Keep aiming for your goals

Yesterday I wrote about my opinion on goal setting. We all set goals. Some goals we set we don't even think about it: they just exist. They are just there, lingering over us and we don't even consider them goals. So, you want examples, well, what is the ultimate goal of Christians? It's to get to Heaven. Right? 

So, all Christians have a goal to get to Heaven. So, how do you get there? You try to be like Jesus. Jesus was perfect. Is is possible to be perfect? Is it possible for any of us to be perfect? No. But does that stop us from trying to obtain this goal? No.Well, it does for some people. But for most of us, it doesn't stop us.  We keep going. We keep yearning for this ultimate goal. 

You have good days. You have great days. But I can say with relative certainty that we all have bad days as well. We have bad moments. We have bad days. We have bad weeks. And some of us probably have bad years. But you wake up in the morning, each morning, and you make another gallant effort to be like Jesus so you can get to Heaven. You may not think of it that way, but that's essentially what you are doing. You are reaching for your goal. 

So, why do other goals have to be any different. Last year, for instance, I set a goal to lose weight. I wanted to at least get under 200 pounds. I have many friends who had the same goal, but they made no efforts to get there, to get to their goal. So, at the end of 2016, they weighed the same as the beginning of the year. 

I decided I was going to accomplish my goal. I decided this over the overwhelming pessimism over it by others in my social group. They weren't mean to me, they were just being "realistic." I'm fine with that. My wife, for instance, said that I should just be happy with the way I am. Well, I am happy with the way I am. I just would be happier if I was 199. My asthma would be better controlled. And there are loads of advantages of losing weight. The studies are so overwhelming in this regard I don't think I even need to site any as evidence. It just is. 

So I set this as a goal. And I decide I am going to accomplish it. There were times I was stuck on a certain weight for weeks. For instance, I was stuck on 205 for so long it was frustrating. My wife told me I should just be happy with my weight as it is. My doctor even told me to just not weight myself anymore, that's what he does. I think that was cook my doctor said that. Some doctors are obsessed with weight, and mine tells me just not to bother looking at the scale. 

Still, you can be happy with with your life, but you don't have to be satisfied. So, you just get back on the wagon and you move forward. You begin a new day. And then, after a week of working hard, the scale shows something you like. Then you are happier. You still didn't accomplish your goal, but you are constantly moving in that direction -- or at least you try. 

You may not get there, but it feels good trying. 

My opinion about setting goals

I know some people who won't tell you they set a goal out of fear they might not succeed. For instance, I have a friend who is going back to school to get her Bachelor's Degree in nursing, but she doesn't want anyone to know (except for me of course) because she's afraid she might fail. I know she won't, but that's beside the point. 

I'm not sure I agree with this strategy, although it is what it is. On the contrary, I had another friend several years ago who was obese. She decided she was going to go on this diet. To me the diet seemed a little extreme, as it was far more restrictive than the diet I live by. However, it is what she decided to do and I wasn't going to begin playing devil's advocate with her self esteem. 

This was her New Year's resolution. I remember talking to her about it. She was so excited she was giddy. A week later she stopped talking about it. It was never brought up again. She did not lose any weight. As a matter of fact, she is heavier now than she was then. 

I'm not criticizing her. I don't judge other people. I'm just making an example to prove my point. My point is that I believe that you should find a path someplace in between gloating about your goal and keeping your goals a secret. 

Last year I told my friends I was going to lose weight. They all told me I would fail. My wife didn't say I would fail, but she gave me that look of annoyance. I think she gets annoyed because, when I'm dieting, I eat foods that aren't things that she usually buys, such as cottage cheese, cheese sticks, protein powder, and other sources of protein. They are expensive, or more expensive than what she normally buys. 

But that was a year ago. My brother in law was more blunt, as he said: "Most New Year's Resolutions fail, and so you're probably going to fail too." He wasn't being mean, he was just saying. He was speaking the truth. He was being a literalist. He was being a realist. And, as a guy capable of reading another guy's intent, I was fine by it. 

But his words became my inspiration. I was going to prove him wrong. I was going to set an example for everyone else. And I did it. I accomplished my goal. I lost 30 pounds last year. And my wife bought some stuff for me, and sometimes I had to go to the store and get it myself. But I made it through the year. 

I think it was the 9th grade when my English teacher had everyone write a goals on a note card for one year, five years, and 20 years. I don't remember what I put down for the other goals, but for 20 years I wrote: "I want to be a writer."

At the end of the year she passed out these cards again. She asked us to turn the card over and write goals again. We did. For 20 years I wrote, "I want to be a writer." When everyone else read their old and new goals, I was the only one who did not change my goal. Her point was that most of us have goals that change throughout the course of our lives. We all set goals, although, as life moves forward, most of us fail at our goals -- yet we keep going. We set new goals. 

I decided right then and there that I was going to accomplish my goals. I was going to be a writer no matter what it took.  I was thinking about a novel, but I will settle with blogging. I will settle with writing for COPD.net and Asthma.net. 

So, last year I set a goal of losing weight. I was going to succeed no matter how hard it was. I started at 226. I got down to 220. I was stuck there for a while. It was hard to stick to it because I love to drink beer or whiskey and cokes. I decided I was going to have to incorporate this into my diet. I would have to plan and limit. I got down to 193 by November. 

I stuck with it, all the while the pessimism of my wife and brother in law were recited over and over again in that niche in the back of my mind. I used them as words of motivation. 

I don't know if I my point came across in this blog post or not. It was that, I think, it's good to set goals, and it's good to tell people about your goals -- or at least a few people. And, rather than beating yourself over the head when you fail, you should use them -- or at least their words -- as motivation to keep going. 

Rather, you are going to have set backs. You are going to have bad days. You are going to have days when you weight yourself and you gain five pounds over the past week (or in the case of January 1, 2017, ten pounds over the holidays). But then you consider the BIG PICTURE. A new day begins and you hop right back on the wagon. You keep moving toward your goal. 

Losing weight and alcohol

Sometimes the analytical data does not match the scientific data. When it comes to health and fitness, this is so true so often. For example, so many times we are told that you should not drink alcohol, for one reason or another. It slows down your metabolism, and this effect may last up to 3 days. If your goal is to lose weight, you should cut out the drinking.




So, if that's true, then how the hell did I lose 30 pounds last year. Between January and April, 2016, I lost 25 pounds. At least one day a week I took a free day. On nearly every one of those free days I consumed alcoholic beverages. My beverage of choice was whiskey last year. I like whiskey and coke. On most of those occasions, I drank on average 3 drinks, or more.




Okay, so, if the theory that alcohol prevents weight loss, then how the hell did I drop 30 pounds.


Now, let's use this year as an example. On January 1 I weighed in at 207 pounds. I set a goal to lose 5 pounds on week one. On January 4, it was my birthday. I took a free day. That night I decided it's my birthday, and I can drink if I want to. So I did.




Today, January 8, was my weigh in. My goal was to weigh 202 today, right? Well, the verdict is in: I weight 202.4. That is pretty darn impressive. I did it despite eating an unlimited number of calories and alcoholic beverages on Wednesday.




Yay!!!!   If you go read my other blogs, I have given plenty of evidence to bash the science. I have proven that salt does not raise blood pressure, it actually lowers it. I have proven that running is not bad for your joints. I have proven that man-made global warming is a myth (try me on this one).  I have proven albuterol does not treat pneumonia and CHF. I have proven that taking extra puffs of albuterol does not kill... (speaking of this, I'm going to make this the topic for tomorrow's post). 




Anyway, I think if you quit doing the things you love to do, and you try to lose weight too fast, you are going to just crash on your diet. That's what I believe. I think that alcohol gets a bad name by the plight of a few who abuse it. I don't see any evidence that responsible drinking prevents weight loss. Sure, the numbers may say one thing, but the analytical data says otherwise.

John-for-Life 2017: Week #1 Success

Okay. I accomplished my New Year's Resolution last year and dropped 30 pounds. I did did it by April. This year my goal is to drop another 30 pounds. I gained 5 pounds the rest of 2016. So, the sum total, if I succeed, will be 55 pounds. So, that's the goal. I think goals are good.

You know how there's commercials for weight loss products claiming they'll give you you're money back if you don't lose five pounds in the first week. Well, it's almost guaranteed, if you're not dieting and want to lose weight, that you probably at least have 2-3 pounds of food in your stomach. If you eat the recommended calories for the week, you should lose 2 pounds over that.

So, based on this theory, I set a high goal of 5 pounds for week #1. Of course, I did take my first free day on my birthday, which was Wednesday. So..... No matter. Today. Goal Accomplished. Yay. I also drank plenty alcohol on my birthday and still lost 5 pounds for the week

Hope you folks are feeling good to end week #1 also!!!!!

The first order of business: Get In Shape!!!!

The first order of business is to get the body in shape. My first weigh in was June 14, 2015, and I weighed 225.6 pounds. That was the most I had ever weighed, and you can bet I felt fat and out of shape. I needed to make a change.

I started working out regularly, although I did not commit to a diet. By Thanksgiving that same year I lost only 5.6 pounds. This was good, but not good enough. This kind of proved my theory that exercise has nothing to do with weight loss, what you need to do is diet, and make sure your calories burned is greater than the calories you consume.

So, I decided to put myself on a diet. What I needed was some sort of motivating factor: I needed the motivation to succeed. This was where my wife and brother-in-law came in.

I told my wife that my plan for 2016 was to lose 30 pounds. She said bluntly, "You won't do it." A few hours later, while the Lions were on TV and Turkey dinner was ready, I put only a serving of turkey and mashed potatoes on my plate.

My brother in law observed this, and said, "That's all you're going to eat?"

I said, "My goal for 2016 is to lose 30 pounds. I need to get a head start."

He said, "Most everyone makes that resolution, and most everyone fails."

That was it! Those two pessimistic statements would roll through my mind many times during the course of the next year, as I worked out, and ate little. Today, one year later (almost a year later) I weigh 196 pounds. I have succeeded. I have made myself one of the few people who accomplish their New Year's Resolutions to lose weight.

The neat thing about it is that I did it on my own. I did it without the support of my wife, who would often cook foods I was not allowed to eat. I did it despite the fact that, during the month of October, our department was flooded with candy, cookies, cakes, donuts, candies, etc. I did not eat any of it, as my goal was in reach.

Okay, so that's kind of a neat feeling. My goal for the rest of the year is to get down to 186 pounds. My ultimate goal is 170 pounds, yet I had to save something for next year's New Year's Resolution.

The full fledged Body-for-Life (like, without alcohol)

It was a little over a year ago I made the commitment to do my version of the Body-for-Life Program. This entails the combination of an exercise routine and a low calorie diet. It also involves a weekly free day where you can eat anything you want. As I look back on this blog I gave weekly reports, and I did very well through August, before I tanked.

I started out at 226 pounds, and got down to 210 pounds, then by the end of the year I was back up near where I started. But, the good thing is that, while the diet wasn't so easy, especially since I was working a swing shift at the time, I never stopped the exercise portion of the program.

In January I was finally on the day shift. I told those who were closest to me that I was going to lose weight this year, and I was going to keep it off. Nearly every one of those people were skeptical that I would do it. My brother in law said, "Yeah, that's what most people wish for, and hardly any succeed at it."

Too me, that was my motivation. And, six months later, I am proud to report that I am now down to 197. I keep track of my weights, and I plugged them into an app, that tells me that I have lost an average of 0.5 pounds per week over the past year. Or, since January, I have lost an average of 1 pounds per week.

On July 16 I gave a report on my diet and alcohol. This was when a study was released showing that those who drink alcohol are more likely to stick to their diets. So, I took this as proof that I could lose weight and not give up alcohol. I did, however, switch to Whiskey so I could consume fewer calories when I did decide to drink.

Basically, I enjoy drinking from time to time. What I wanted to do was to lose weight, but I didn't want to stop doing what I enjoy. I cut back significantly, but I didn't want to give it up. And, based on what I have read, this is actually the best way to lose weight. If you give up everything you are not supposed to eat, then you are going to crave it, and you are going to crash, or fail your diet.

Plus, most experts I've ever read suggest that the slower you lose weight the more likely you are to keep it off. So, as you can see, I have lost an average of 0.5 to 1 pound per week, depending on how far you go back. And, I did this while never giving up alcohol. So, despite the critics, it works. You can make anything work.

I read an article recently by Jillian Michaels of "Biggest Loser" fame, and she said you cannot drink alcohol and lose weight. However, as with anything, analytical data does not always match the scientific data. This is once again true here, as the study mentioned above, and my own experience, shows that you can drink alcohol and lose weight.

Now, here is the kicker. I have experimented on myself, and have determined that the weeks where I have a few drinks (a few whiskey and cokes) I lost about one pound. However, on the weeks I did not drink, I lost about 2 pounds. So, you see, alcohol does slow you down.

This is good, in a way, as it makes the weight loss slow. However, it is frustrating in a way too, as the weight is coming off frustratingly slow.

My point here is that, if I were to continue what I have been doing since January, I will meet my goal of 170 pounds by right around Christmas of 2016. However, if I were to quit drinking between now and Halloween, I should be pretty close to my goal weight by October 31, and then I will be done.

Another thing I was thinking is this: in July of 2015 I started exercising. Six months later, in January of 2016, I started eating healthy and exercising. Now, six months after that, I've decided to do the full fledged Body-for-Life, which entails quitting drinking.

Basically, all I have to do is the Body-for-Life for one session, meaning for only 84 days, and I will be done with this. I should lose about 2 pounds a week. And, if that happens, I will be very happy come Halloween. I should be able to pig out on candy that night without fret.

My thoughts on Advair

If you've been reading my blog the past month or so I've mentioned Advair quite a bit. Here I would like to give you my unadulterated opinion of it. Here goes. 

So, the two ingredients in Advair are salmeterol and fluticasone. Salmeterol is a long acting bronchodilator and fluticasone is a inhaled corticosteroid. Let me tell you about these.

Salmeterol: It was approved by the FDA in 1994. It was in a little green inhaler called Serevent, a little shorter than the albuterol inhaler. Dr. Oliver prescribed this inhaler for me, telling me to take two puffs two times a day, once in the morning and once at night. He said it's basically the long acting version of albuterol. 

Back then my asthma wasn't as controlled as it is today. This was mainly because the inhaled steroid I was on at the time was Azmacort, and it was not very strong, and needed to be taken as four puffs four times a day. So, needless to say, that wasn't possible for a busy 24 year old. 

Most of the time I used it as instructed, but there were times I would use it instead of albuterol as a rescue inhaler. I didn't really do this intentionally, but I remember one night I was having trouble, and I puffed on my inhaler frequently during the night. Then in the morning I realized the inhaler I was using was Serevent. Needless to say, I did not die. 

So this is how I discovered that salmeterol does not kill, as one theory suggests. You know that some asthmatics died clutching a Serevent inhalaler. So, rather than blame the asthma, the inhaler gets blamed. So that's how a black box warning got on long acting bronchodilators like Serevent. 

Now you have warnings on these: "Do not use more than twice a day. Do not use more than instructed." I am fine with this. However, if you go to Canada, they use the Symbicort inhaler as a rescue medicine. It's a program called Symbicort Smart. So, apparently, it's only in the U.S. that LABAs kill. 

My point here is you should not be afraid to use Advair and Symbicort. They are very effective for helping asthmatics obtain ideal asthma control. I'm not saying you should use them more than prescribed. 

I do not like Symbicort or Dulera or Breo. Formoterol makes me too jittery. It is the active LABA in Symbicort and Dulera. Vilanterol, which is in Breo, is also the same. Only salmeterol like me. The disadvantage of salmeterol is it takes 15-20 minutes to open airways, unlike the other LABAs that work immediately. But this is fine with me, because I don't like to feel jittery and shaky. 

Now, I am going to say something that you should never do without talking with your asthma doctor. That is my disclaimer. That said, I have not taken formoterol and vilanterol enough to know if they are safe to use more frequently than most American doctors suggest. Obviously, based on the Symbicort Smart program, Symbicort probably is. but I know from my own personal experience that salmeterol is safe. 

Think of it this way, as my doctor said long ago, all salmeterol is is a long acting version of albuterol, and side effects of albuterol are negligible. It might give you the tremors, but it won't kill you. The same is true of salmeterol. If you need to take an extra puff to end a severe asthma attack, go for it. 

No. Don't go for it if you didn't talk to your doctor. Actually, I personally have never discussed this with my doctor. And this is because I rarely do it. In fact, I have only done it one time in the past five years. One night I was at hunting camp, having a severe allergy/asthma attack, and that extra puff of Advair pulled me out of it.  It took about a half hour, but all of a sudden I could take a deep breath. 

Would I make a habit of doing this. NO. Would I take many puffs of it. NO. Not intentionally, anyway. But the inhaler is not going to kill you. Now, as other experts have noted, the people who die with an Advair or Serevent inhaler in their grasps are those who relied overly on their inhalers when they should have sought for help. So, seek help when you need it! 

I have had this disease for 44 years. I know what works for me. I know that my asthma attacks are not going to kill me. I know an extra puff of Advair will pull me out of my attacks. If they didn't, well then I would seek help. But they almost always do. Plus, because I use it regularly as instructed, my asthma attacks, when they do occur, are relatively mild and easily controlled. 

So, there, that is my personal opinion of Advair. My doctor has this bug up his butt about getting me on something different. So I tried all the other combination inhalers, and they all made me jittery and nervous. So, I am back on Advair, and I will forever be on it -- lacking a cure of course. 

Again, do not use your inhalers the way I do. I just do it the way I do because I am a professional asthmatic. I do not get arrogant and cocky with my medicine. I used to, but that wasn't smart. It wasn't smart to take many puffs on serevent back in 1994. 

What do allergic asthmatics do to pass the time?

A question I pondered this morning was this: "What do people with allergies do to get through the day?" Well, you all know I write. But what do you do when the writing is done for the day? 

Okay, so there are kids to play with. There is a wife to hang out with. There are people to see, and work to be done. Well, when I say work I say that lightly too, as much of the regular "guy" duties are not done by me. They all involve dust and other allergens. So, that said, what do people with allergies do?

I, for one, played with baseball cards when I was a kid. Most of the cards I had were new. I sorted them out. I opened packs. I traded with my friends. I went to flee markets and bought old ones. I had quite a collection. Okay, so this occupied a lot of my time. When my brothers and dad were out doing guy things, and my asthma prevented me from going, my baseball cards occupied me.

So, after I met my wife in 2000 I put my baseball cards aside. Fifteen years later I brought them out. I bought a nice collection at a yard sale. This was going to be a hobby brought back to life. But then the allergies hit.  

Just to give you an example. It was very slow today at work. So, I decided to bring my baseball cards in. They are 1980s Topps baseball cards. They belonged to my brother. I managed to sort them out earlier in groups such as the following: 1-99, 100-199, 200-299, 300-399, 400-499, 500-599, 600-699, and 7-726. 

Today's job was to finish sorting them out. So, I started with an easy job: 7-726. That got done really fast. Note that I am breathing fine. I am on 500mcg of Advair, so I should breathe easy. Not so fast. 

I managed to sort through the 600s without much of a problem. But by the time I got to the 500 my chest started to burn. Those little bugs were in my lungs. They were in there already by the 700s. It took my immune system that long to register an immune response. My airways seem to be quite twitchy, despite 500mcg twice a day of fluticasone. 

See my point. So, I ask: What do allergic asthmatics do to pass the time?

You know, it's really neat that I get to run. When I was a kid I couldn't do that. I can run as much as I want and I have no asthma symptoms. I can take the kids about anywhere. I can go for walks in the woods. I can go on dates. I can do pretty much any of that. 

So, what can't I do? Well, obviously I can't (or shouldn't) go to my dad's cabin. I obviously can't (or shouldn't) play with my baseball cards. But I will. I know I'll go to my dad's cabin again. It's just too fun. I will just have to figure out what to do at night, when others are sleeping. I will also play with my cards again. I want to right now. But I better not. (Chest is starting to feel somewhat better. The longer I stay away from those cards, the better it will feel, even if I don't treat it).

Look, I just love baseball cards. I would love to open up a little online shop. But, I'm pretty sure that goal might be dashed. No. It won't.  Only, most of the time I limit myself to 30 minutes. I went way past my limit today, like four hours past. I violated my own rule. In the future, which will probably be tomorrow, I will have to limit myself.

Or, I might be able to wear a mask. But I tried that before, and those little buggers still managed to get into my airway somehow. 

Still, I had to be at work for eight hours today, and there literally is nothing to do. I wanted to take a break from writing, but here I am. I am only writing here because my twitchy, burning airways told me to quit. 

It's kind of neat that I have had this disease so long, and I don't let it stop me from doing anything. But, that's not necessarily true. I mean, I cleaned my bedroom the other day, even cleaned in the closet, but I did it fast while holding my breath. Today, I did not hold my breath. I breathed normally while enjoying my collection. I even enjoyed the smell of the cards, that dusty smell of cardboard, not the new, fresh smell of Bazooka Bubble Gum. 

Don't get me wrong, I'm not feeling sorry for myself. This is just what I have been dealt.

I'm kind of nonchalant about it. I've always been that way about my asthma. Ironically, I'm not sniffling or sneezing, it's just the chest tightness today. I wonder why that is. Usually the dust mites give me both allergies and asthma symptoms. Usually they make my eyes itch long before my lungs, but my eyes seem to be fine right now. Go figure. 

And, also interesting, I'm not really short of breath, it's just the chest tightness. And I know it's my airways spasming, mainly because this is the same every time I inhale little critters. Okay, so I'm a little short of breath, but so far not horribly bad. Just bad enough I know I need to quit. 

It almost feels as though someone has feathers in my chest, millions of them (hmmm, how about millions of little legs from dust mites crawling all over my airways), rubbing them on the walls of my airways. And so my immune system attacks them, causing my airways to spasm (twitch), and mucus to increase (causing the itch). 

As I've written before, the symptoms I feel right now are more annoying than they are deadly. I know I'm not going to die from dust mites. I might die of boredom (well, not really, because I just moved on to the next assignment). 

Which is also interesting. I have also written before that I never feel sorry for myself, just learn to cope. You have to realize I've had this disease for 16,987 days. So, that's long enough to learn how to cope. When there's something I can no longer do, I just move on. That's the way you deal with a chronic disease. 

Actually, I am starting to feel tight now. I have taken three breathing treatments so far.

You know what is going to hit tonight, or what might? That late phase reaction. Those late phase reactions are usually the worse. It might hit around midnight, or it might hit around 2 a.m.  It's pretty bad I've had this so long I know what's going to happen later. Pretty cool, hey? I don't regret it though, as I had fun sorting through those cards. Just wish I could have finished the project (which brings me to tomorrows post, finishing projects with allergic asthma).

The late phase reaction. I could write a post on that too. I will probably wake up sometime tonight feeling very dyspneic. Or, it might just be a severe allergic reaction. It will hit like a mack truck. It won't kill me, just make fee feel very uncomfortable. When it hits, I'll take a Benadryl, and wait it out. I might fall asleep propped up. I like Benadryl because it acts sort of like a sedative, taking the edge off, allowing me to fall back asleep. 

But, I think my motive right now is to find another hobby. Something besides writing that I can do. This brings me back to that original question. Now that I shouldn't (but still will) sort through my baseball cards (or at least the time doing this will be severely limited from now on) what will I start doing (besides writing, considering I already do that) to pass the time? Hmmmm.

A letter from my health insurance

I received a letter from my insurance company that said, as of July 1, they will no longer be paying for my Advair or Breo. The letter said, "If you tried Symbicort and Dulera within the past year, and this insurance paid for it, you do not have to do anything. Otherwise, you will have to have your doctor write a prescription for one of these medicines, or have your doctor contact us with a good reason."

I gave the letter to the secretary at my doctor's office, so I don't have it in front of me, but that is the gist of what the letter said. My pharmacist (Mr. Prick) said my insurance sends these letters every year, meaning I will have to have my doctor contact them every year.

 It's kind of another one of those medical regulations (this one created by my insurance) where every asthmatic is treated as though they are all the same. And, if we are all the same, that means none of us are exceptional, meaning we are all stupid. So that's why they have to send these letters out every year. That's also the reason my doctor has to "educate me" about my medicine every year, even though I'm an asthma expert. 

Maybe we are all stupid. A study came out recently showing that 90% of asthmatics use poor inhaler technique. Even experts like me use poor technique. I know I use poor technique, and I don't care: the medicine still works. My friend Shauna and I used to joke about how we both use poor technique, but that's what we want to do. That's what works for us.

So my insurance company is aware of this, and they took this study as a reason why they should annoy asthmatics every year, and lecture them about proper asthma technique, because we are all stupid. 

I'm kind of on a tangent on this lately, aren't I. Yes, I am. As a respiratory therapist I know that much of what we do in the hospital setting is not what doctors want to do, but what insurance companies, what Medicare, makes them do. For example, in order for someone with pneumonia to qualify for admission, they have to have three failed breathing treatments, even though breathing treatments have no effect on pneumonia. But doctors, like you and me, are stupid as far as Medicare is concerned, and this is why the regulation is how it is. They treat every patient the same, because being creative, trying something different, costs more.

Oh, and by the way, that's the bottom line to these changes. The reason my insurance company sends my doctor letters like this, the reason my pharmacist has to "educate me" is not because the insurance company wants to keep me healthy. Well, that is part of the reason, because a healthy me is a less expensive me. But the true reason is cost. The true reason is they have a contract for Symbicort and Dulera, so they are cheaper than Advair. 

The irony is that, even though Advair works better for me than Symbicort or Dulera, they want me to be on Symbicort or Dulera because that saves them money. Plus I'm too stupid to figure that out on my own, so they have to send these letters to my doctor, forcing him to remind me, the stubborn asthmatic that I am.

A normal situation for an asthmatic

Yesterday my kids were busy playing with the neighbor kids and my wife went out with her friends. So it was an ideal night for sorting out my baseball cards. I set up a table in the garage, and enjoyed the evening. I even cracked open a beer.

My brother Bob gave me the cards he collected in 1980, which included Topps, Donruss, and Fleer. It also included some baseball cards, and a 1978 Dr. J Card. That was a cool find. I sorted the cards out earlier, and had one box of star cards I wanted to put into plastic cases. 

Because I know these cards are older, and that they were stored in my brother's basement, I have been limiting myself to no more than a half hour a day sorting them. But I was having fun last night, so I spend several hours doing this. It was fun, and when you are having fun you keep doing it, right?

Well, not when you have severe allergies along with asthma. Not when you have allergic asthma. When you have a lung disease, you either don't do it or you limit your time doing it. So, I had a mild asthma attack. I took a breathing treatment and was fine. 

I was smart enough to quit at this time. It was about 10:30 p.m., and I went to bed. Then my wife came home around 1 a.m., and this was when the late phase reaction occurred. I wasn't severely short of breath, but just enough so that it was uncomfortable. I had to get up and deal with it. 

The bummer was that my Advair was empty, and I had no albuterol inhalers. So, this meant I had to get out of bed and use my nebulizer. I also don't have any sudafed, something that works well for allergies, and doesn't cause drowsiness. So I had no choice but to take a Benadryl 

Needless to say, this entire event impacted my next day. It was hard to get up considering the Benadryl effect. It also made it so there was no way I was going to be able to play with my baseball cards. This was no fun, because I had the whole day off and pretty much nothing else to do. Plus, after the job done last night, I had the baseball card itch. 

This is not that big of a deal, as I always find ways to cope; there are other things to do. It's just that, despite asthma experts always saying it, you really can't live a normal life when you have severe allergies to go along with asthma. You can cope, you can adjust, but you really can't live a normal life. This is, however, a normal situation for an asthmatic. 

New Asthma History Blog

Depiction of Rene Laennec using the stethoscope he invented.
For the first time those asthmatic wheezes could be heard.

Another thing I need to make a note of here is that I started my asthma history on this blog. Then I moved it over to Respiratory Therapy Cave, and then I decided to just start a new blog called "Asthma History."

So, if you are interested in reading the history of asthma, click on over to my new blog. Keep in mind that this is a living history, meaning that I'm adding to it on a regular basis. So, if your'e interested in the history of our disease, check out my new blog: "Asthma History." 

Why I started drinking coffee

Kerri MacKay wrote an excellent article recently at asthma.net called "Coffee and Asthma: What's the Deal?" She even referenced this blog, and made my ego go up a notch, from zero to one. If you delve deep into my blogs you'd know I was chronically dependent on theophylline for over 30 years, only to finally be weaned off it in 2000 thanks to another great asthma medicine called Advair. It was at this time, and I was 40, that I started drinking coffee. 

A theory that arose in my mind was that I started drinking coffee because I quit taking those two little white pills every day. I knew that both theophylline and caffeine come from the same family: they are both Xanthines. Kerri taught me something that I did not know: that theophylline is a byproduct of the breakdown of caffeine. That, in effect, I am still on theophylline, albeit a low dose of it. 

I never had any desire to drink coffee before I was off theophylline. I drank a cup here and again, although never really cared for it. I hated the taste. And I hated that it made me jittery. I remember telling people I didn't drink coffee because it made me feel like a jolt of electricity was flowing through my vessels, and this was probably because I was already on theophylline, so this made the side effects doubly strong.

And for the record, I do not drink coffee because it has a mild bronchodilating effect. I would imagine if you had very mild asthma it might prove useful, but my asthma is not mild. I don't like to refer to my asthma as severe, although that's how my wife refers to it. 

Anyway, nice article. Go read it!

Pharmacists now required to annoy asthmatics, part 3

(Editors Note: Read Part 2 here)

Just as an aside here, I love the cartoons in my header, although it looks so gloomy. Even the name "hardluck" resonates gloom. I had actually changed the name once to "Gallant Asthmatic," and I think I should have kept it that way, as it offers a more positive tone. If you see a change in the future, this should explain it.

So, that said, I had finally had a run in with the pharmacist at Meijer. I went there to pick up my prescription for prilosec, and that's when he accosted me. He was nice, very nice. And he started asking me about my other medicines, the ones that put up a "red flag," so he said, from my insurance company.

The red flag was that I need to set up an appointment with him to discuss my medicine, side effects, and how to take them properly. He said, "Your wife said you are a respiratory therapist, and an asthma blogger, so I knew you would be a tough nut to crack."

He said all it takes is an hour. He said he has to do it once a year, unless I refuse. But if I refuse the red flag comes up every three months, and he has to ask me if I'm ready to set up my appointment.

He said it has nothing to do with Obamacare that he knows of. He said it's a policy of Medicare, and my insurance picked it up from that. Then he just started asking me questions about my medicine, the ones the red flag was in reference to, not the one I was picking up.

I explained to him that I tried Symbicort, Dulera, and Breo, and that the long acting bronchodilator in these medicines (I named them by their chemical names as though to show how deep my knowledge of these medicines went), formoterol and vilantnerol, were too powerful and caused me to become jittery and nervous.

I explained to him that I took Advair for 10 years and it worked great. But for some reason my doctor got a bug up his butt about getting me off Advair and on to one of the other combination inhalers. I tried them all. They all worked great, but had side effects I couldn't tolerate.

I even told him that I used to take salmeterol, the LABA in Advair, by itself back when it first came in the early 1990s. Even that made me jittery and nervous. But, for some reason, the dry powdered salmeterol doesn't cause that effect.

He shrugged as if to indicate, "That doesn't make any sense." But it does make sense. DPIs don't distribute the medicine as deep as MDIs, so it does make sense. Every asthmatic is different, and respond differently to different medicines, even different forms of the same medicine. So it does make sense. But I didn't want to get off the subject as I am here. 

So I realized I was going into a lot of detail, so I said, "Can we consider this our discussion?" He said, "No!"

What a prick. Sorry, but that's what I've decided he is. He was nice, very nice. But he is a prick. I say this because, over the past month, I have asked many of my fellow asthmatics if their pharmacist bugs them about their medicine. They all said that they ask, but when they say, "No. I'm a nurse", or "I'm a respiratory therapist," and they drop it.

This guy is one of those rule followers. He has no ability to use his common sense to walk around the rules. He is not able to think on his own. He may not like the rule, but it is how it is, so he follows it, even if it means annoying the crap out of me and my wife every time one of us picks up a prescription form Meijer Pharmacy in Ludington, Michigan, when he is working. 

That's how I define prick. Sorry, I will not tell him that to his face. I am political when we are face to face. But here, at "Hardluck Asthma," soon to be "Gallant Asthma" as soon as I get time and energy to make the change, I am not politically correct. I will not be politically correct. I do not have to be "Nice!"

And there's another aside I'd like to mention here real quick. A part of me wants to start over: a new blog, that is. I'm seriously pondering making a new blog, combining Respiratory Therapy Cave and Hardluck Asthma. But, for the life of me, I cannot think of a good name. When it comes, I will make the change. So, in the meantime, breathe easy.

Pharmacists now required to annoy asthmatics, part 2

Prior to my introduction to Advair I went through about one rescue inhaler a week. I was on all the best asthma medicines, and still had poorly controlled asthma. So, as a matter of default, I had to accept satisfaction with my level of control. I didn't like it, but it was what it was. Sometimes, though, a pharmacist would bug me about this, "It's gonna kill you," he would say.

I would say, "If albuterol was going to kill me, it would have killed me in 1984, when I was going through one Alupent a month. Actually, there were times I went through one in a week, or, worse, one in a day. And that was Alupent, which actually had cardiac side effects; strong cardiac effects. There were times I'd go to bed after puffing on it, my heart would be pounding, and I'd be afraid to fall asleep fearing I wouldn't wake up the next day. But I always did wake up. If my rescue medicine overuse was going to kill me, it would have killed me then. But it didn't. I'm still alive."

"Well, you need to see your doctor and get on better asthma medicines."

"Look," I'd say, "I see my asthma doctor every six months, if not more often than that. I spent six months in an asthma hospital. I doubt even you read as much as I do about asthma. It's my passion, by the way. I read about asthma every day. I read every book that comes out."

Okay, so that is why I fired Walmart. That is why, before I got married in 2002, I got my prescriptions at Rite Aid, where the pharmacists wouldn't bug me. They might mention it once, but then I'd explain I have hardluck asthma and they'd leave me alone. 

But the pharmacists at Walmart kept bugging me. Every time I picked up my albuterol they'd questions me. It got to the point I'd just listen to them and wouldn't say anything. My blood would boil, but I wouldn't say anything. So, finally, I decided I was the customer, the boss, and I didn't have to deal with this crap. So I fired Walmart. I asked for my prescriptions so I could take them to Rite Aid, and that's exactly what I did. I fired Walmart.

So now, in 2016, I learn an Obamacare initiative forces pharmacists to do this. So now, every time I pick up my prescriptions, I'm lectured. It doesn't matter that I say I'm a respiratory therapist, that I'm an asthma writer, that I know more about asthma inhalers than any pharmacist. It doesn't matter what I say. 

Furthe rreading:

• Pharmacists now required to annoy asthmatics, part 1

Pharmacists now required to annoy asthmatics

So, my wife explained to me how she gets lectured about my medicine by the Meijer pharmacist every time she picks up one of my prescriptions. And she said its gotten really bad since my doctor wrote prescriptions for two different combination inhalers. "Those inhalers could kill you, if you don't use them right." 

I said to my wife, "I wish I was there. I would have said, 'If my asthma was going to kill me, I would have died in childhood."  

"It wouldn't have mattered,' my wife said to me. "The pharmacist said it's part of Obamacare that they have to review all your medicine and sit down with you every three months. Since you never pick up your prescriptions, it's me that gets hammered."

"Well," I said, "tell them that I"m a respiratory therapist and asthma writer.  That will shut him up."

"I did," she said.

"So what does he say?"

"What he's really concerned about is you have two combination inhalers." It's true. Actually, I have three: one for Advair 500, one for Advair 250, and one for Breo.  "He said he has to review my medicine, and talk to me especially if you have prescriptions for two medicines that don't go together.  He said those inhalers, if used improperly, could kill you."

I shook my head in disbelief. 

She continued, "He said if you don't call and sit down with him, he has to bug me about it every time I pick up a prescription. 

Sigh. 

"And I told him you won't."

This is a perfect example of what is wrong with Obamacare. So now I'm stripped of my liberty to take the medicine my doctor prescribes for me without a lecture. 

"I'll do it," I said.

"Really?"  she said.

"Yes. I will do it. And I will make an interview out of it.  I'll give that pharmacist some of his own game. I will sit there and let him tell me stuff I already know, and then I'll interview him. I'll ask him questions about this stupid program, and I'll ask him questions about other things I want to ask pharmacists."

"That'll work."

I doubt that a lot of people read as much about asthma as I do. It's my job. It's my passion, by the way. It's blog prep. That's what I would like to say to this pharmacist. 

So, after this discussion with my wife, I talked to a variety of my friends and asthmatic friends, and they said they do not get inundated by their pharmacist. They said they just say, "I'm a nurse," or "I'm a respiratory therapist," and the pharmacist lets it go at that. 

I'm going to learn more about this and get back to you. 

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.