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walthenf
New Member


Date Joined Apr 2009
Total Posts : 10
   Posted 4/29/2009 12:20 PM (GMT -6)   
I have a question to all of you that I'm hoping you can help me with.  about two years ago I was diagnosed with Excercise-Induced asthma.  Being the avid Cross Country runner that I am, my doctor prescribed me albuterol (now proair), and to take 4-6 puffs 15-30 minutes before running.  Over the course of the last two years, that helped out some.  However, when I hit this last Cross Country season, I went into my first race with a decent cold.  Therefore, combining that with the side aches that had still been plaguing me (probably a side-affect of my poor breathing with the asthma, according to the doctor), I took more medecine than I had been prescribed, just to see how it would affect me.  Before that race, instead of taking 4-6 puffs, I took about 5 "double" puffs where I pressed down on the inhaler twice in quick succession and then breathed in.  Long story made short, I had the fastest race ever of my life for that early in the season, despite the cold, and felt more like I could breathe than ever before.  So, I kept on doing that, taking 4-6 "double" puffs 15-30 minutes before running, and it really does seem like this has changed my running career.  I dropped my best time down 1:15 in the 8k to really help my team at conference, and I seem to be a stronger runner.  I don't seem to burn out as much as I used to with my running, and I don't get as sore as I used to after some workouts (I'd always be more sore than anyone else the next day, and I have since attributed that to my difficulty in getting enough O2 in - Thus, my body relying on the lactic acid more quickly). 
 
Here's the problem:  I had been told by my doctor that it may take some "experimenting" to find out exactly what my body requires from my asthma medication to run most efficiently, although he never specifically told me to do what I'm doing (with the "double puffs", so I always figured that what I was doing was fine.  However, recently I became aware of the "danger" of taking more proair than your doctor recommends, even the danger of death.  Now I've checked all the symptoms, and I've never really had any of them, despite doing this for months now.  And it just makes sense to me that since the 4-6 regular puffs weren't completely getting my airways open, there can't be too much danger going with these "double" puffs (which I don't really think gets a full 2 puffs into you anyways), because if the "single" puffs" didn't do the job, how can the "double" puffs be bad if they do indeed open up my airways more.  Plus, the doctor said that just by taking the medcine through an inhaler without a medium, you often don't get anywhere near a full dose in you.  But, what would you guys advise?  This is the only time I take proair during the day, and I take advair once a day at night to help with the asthma. Am I putting myself in danger?
 
Thanks ahead of time for the responses!
--Nate

Aurora60
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Date Joined Jul 2006
Total Posts : 1249
   Posted 4/29/2009 1:07 PM (GMT -6)   

Nate, I was alarmed when I read your post.  Albuterol is meant to be a rescue inhaler only. When I was taking it a lot before I got my long term inhaler I was taking 2 puffs X 4 times a day, or 2 puffs every 4-6 hours apart.  I saw a pulmonoligist who prescribed symbicort for me as my long term inhaler.  I now only use albuterol on a rare occasion such as if there is a lot of mold in the air.  I maybe use it once or twice a month at the most as the symbicort keeps me breathiing freely.  You say you have advair and you only take it once at night. Is your dr. a pulmonologist?  If not you really need to see a pulmonologist and have all the lung function tests.  You might get switched to a better long term inhaler.  If you are a runner and you are taking so much albuterol you could easily have a heart attack.  Albuterol is not good for your heart if over used which it sounds like you are doing.  Your PCP will not know enough about breathing problems to properly diagnose you and prescribe the correct meds. And if your PCP is telling you to use so much albuterol I would run as fast as I could and get a new dr.  But your best bet it to see a lung specialist who can properly diagnose your condition and tell you what you should be doing.  Not meaning to upset you but I think you need some really good advice on how to treat your problem. Post again so we know what you are doing and if you have been helped. And by the way, I have bad asthma and that is why I know about these meds.  I see my pulmonologist every 6 months.

Aurora


Aurora60
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Date Joined Jul 2006
Total Posts : 1249
   Posted 4/29/2009 1:15 PM (GMT -6)   

P.S. Nate, you mentioned a medium.  I assume you are tallking about a spacer which delivers the med to your lung instead of most of it going in your mouth.  It is very important to use a spacer with your inhaler in order to get the med into your lungs directly.  You also need to rinse your mouth out after using an inhaler.  If you are having such breathing problems you really do need a long term inhaler.  When I got my symbicort I started to breathe freely from the first day. Before that I used my pro air and couldn't wait for the four hours to be up so I could use it again.  So I hope you will see a lung specialist and if you get a different inhaler you need a spacer and the dr or pharmacist will show you how to use it.  It is very easy and will give you the correct dosage without you haveing to take extra puffs. Please take care.

Aurora, again


walthenf
New Member


Date Joined Apr 2009
Total Posts : 10
   Posted 4/29/2009 5:42 PM (GMT -6)   
I am very surprised to hear your response, Aurora, although I do appreciate it.

While the doctor who prescribed me this may not be a lung specialist, I don't understand how any doctor could prescribe such a medicine so erroneusly. That just doesn't make sense to me. I guess what confuses me about your reply is that proair is advertised for the prevention of exercise induced asthma. If it's for the prevention of asthma, how can it only be a “rescue inhaler” While I’ve only checked this out online, many times it is mentioned that one should use this before exercise to prevent Exercise-Induced Asthma. Although I may be concerned about my dosage, I’m struggling to understand why I can’t use this before I run when everything else says I can.

In terms of the Medium, I was talking about a spacer. Again, I wasn’t told that I needed to use this with albuteral and proair. In fact, the little sheet that comes with proair with medicinal information says nothing about a spacer. In fact, it shows pictures of people using their inhaler without one.  Now, that might not mean much - Maybe with a spacer I'd get the correct amount on the 4-6 puffs that I was recommended, instead of taking these extra puffs that don't all get to my lungs.

So anyways, I’m trying to understand this, but I am having a little trouble understanding where you’re coming from Aurora, with all due respect. Could I get some other input on this?

Post Edited (walthenf) : 4/29/2009 4:57:56 PM (GMT-6)


Aurora60
Veteran Member


Date Joined Jul 2006
Total Posts : 1249
   Posted 4/29/2009 8:01 PM (GMT -6)   

Nate, I will say this again.  If it is input on the albuterol you are looking for the best advice you can get is from a lung specialist.  You can read all kinds of things on the internet. That doesn't mean what you read is correct.  Only a qualified dr. can give you the answers you are looking for. And yes, I know the pictures from the pro air show using the inhaler itself, you will be surprised at what good a spacer will do to get the med directly into your lungs.  I will repeat, albuterol is for rescue, not long term. If you don't have a reliable dr. you can run this by, then go to your pharmacy and ask the pharmacist about the number of puffs of albuterol that is safe to take in one day. Also, if you read the dosage instructions that come with your pro air it will tell you no more than 2 puffs, 4 times a day.  I would rather you pursue this and be safe than sorry. Others out there who have asthma, how about giving your input on this situation? I feel qualified in giving you this info as I have been seen by 2 pulmonologists and told exactly what I have told you. Also, I have landed in the ER from the amount of albuterol I had taken which then led me to having to see a cardiologist.  All to the tune of over $10,000.

Aurora


Aurora60
Veteran Member


Date Joined Jul 2006
Total Posts : 1249
   Posted 4/30/2009 4:51 PM (GMT -6)   

Nate, I keep rereading your post and I guess I am having trouble understanding why you say you wonder where I am coming from. You mentioned that you know the dangers of too much albuterol, that it can cause death.  You also mention that you are taking more puffs that your dr. did not prescribe and he is "experimenting" with your dosage.  This is not a med where there should be experimentation unless done so by a specialist.  You say you have no symptoms yet about what you have read. But could this eventually catch up with you? You posted questions but you do not seem to want to look into any advice that was given. I wish that others on this forum with asthma would reply to you.  Let me give you an example of what you are doing:  If a person takes one pain pill and it works well then why not take two - that should work even better. The drs. that treat me are specialists from a very large teaching hospital - I live in the 2nd largest city in the US so I trust these drs. What I see you doing is self medicating, worrying or wondering, asking questions and then not hearing what you want to hear. I am trying to give you the benefit as someone who has had bad asthma all my life.  That is where I am coming from.

Aurora


walthenf
New Member


Date Joined Apr 2009
Total Posts : 10
   Posted 4/30/2009 8:58 PM (GMT -6)   
Aurora, this is not at all what I'm thinking. I should clarify myself:
(I apologize, I blame myself for my lack of clarity)

1) I do not have any misgivings using albuterol to prevent Excercise Induced Asthma, and this point here is where I don't understand where you're coming from. You say that it's only used as a rescue inhaler. Yes, I know that I've only been reading things on the internet that say that it is used to prevent Excercise Induced asthma, but my EVERYTHING I read says it can be used as a preventitive for EIA - And this includes very well-respected Health sites such as the Mayo Clinic and countless others - Plus my doctor (who may not be a lung specialist, but I have trouble believing he's that that terrible uninformed about the medicine). This is why I'm having trouble understanding where you're coming from, because while you say it's ONLY a rescue inhaler, everything else disagrees with you. I'm sorry, but unless you can tell me why exactly this is wrong, I'm going to have a hard time believing that proair is only used as a rescue inhaler. Seriously, I don't mean that in a bad way, but that's how it is.

2) However, What I am concerned about is the dosage, which is why I'm throwing that out here. I made the mistake of mentioning that I am not using a spacer without asking how much less effective it is making the medecine. What I'm wondering is whether what I ended up doing for the past half a year was really dangerous, or not so much, especially since I may not have been getting too much of the medecine in my lungs without using a spacer. You might think this question is pointless, and that I should just switch over to a spacer and stop worrying about my past dosage, but it took my two years to figure out where my lungs would run most efficiently and openly, and I've only got a year left of Cross Country. So, while I do want to be safe, I don't want to go completely into the "figuring out" stage again IF I don't have to - I don't have the time. Sure, I could go see a lung specialist, but that's difficult for me right now with traveling I have all summer and a tiny budget (yes, I may have to end up doing this, which I am willing to do, I'm going to avoid it if possible). Now, obviously, if what I'm doing now with these 4-6 "double" puffs (without a spacer) is dangerous before running, and if I am indeed getting the large amounts of albuterol in my system (which I AM currently concerned about), I WILL want to stop, because I don't want to put myself in danger.

So I guess my question is this: How much albuterol am I getting into my system my just using a MDI and by using this"double puffs" in quick succession (I've noticed the second puff isn't as strong as the first when used like this). I understand that dangers of albuterol can be fatal, and if I am doing that, I want to stop. Right now, I suspect that I AM using too much, and have cut back for the meantime. But if this system, ironically, is getting the correct amount of albuterol into me through a combination of medicine lost by just using the MDI, and my not using it in the correct manner (you've said yourself that a person gets far less albuterol into their lungs without using the spacer) - I have no compelling reason to change it. Unless, of course, you guys can tell me that it definitely is wrong. Therefore, while your post alarms me, and even DOES makes me more cautious (I am listening, I cut back on my intake today, and will continue to do so because of my concern), I have trouble taking it completely to heart when you're denying the fact that I should even by using my inhaler as a preventative measure, when everything else says that I can.

So, I too would appreciate anyone else's advice on the matter.

Aurora60
Veteran Member


Date Joined Jul 2006
Total Posts : 1249
   Posted 4/30/2009 9:30 PM (GMT -6)   

Nate, I guess I have lead you to misunderstand me.  I do realize that the pro air is used for exercise induced asthma and I do understand why you are using it and that is fine. If it works for you then you should use it. My concern is only with the amount you use. If you could go back to your information leaflet and check out the dosage instructions it clearly says 2 puffs every 4-6 hours. If I am correct you are actually using from 8-10 puffs at a time.  And that is what I believe is dangerous.  However, I do not actually know what a dr. would prescribe for a runner.  One thing I can say is that if you were to use a spacer you would definitely get more of the med in your lungs and then it would be far more effective and maybe you wouldn't need as many puffs.  A spacer is truly easy to use. And after I started to use mine I got over the hoarseness that I had in my voice as the med was no longer wallowing in my throat.  Another tip that should help you which my dr. told me is after you take the first puff you should wait about 4-5 min before using more. The reason for this is that the first puff opens up the bronchial tubes and if you wait then your lungs are now more open and the other puffs will give you greater relief and even work better. I assume you only use the pro air when you are running, but I don't know if you run every day.  I was hoping someone else would come on the forum and help you out too.  I usually post on another forum where I get so many replies and so much help that I am surprised no one else has taken the time to give you some insight. I stll think if you have the time you could ask your pharmacist about dosing for exersize.  Most pharmacists are very willing to give you information so that would be my suggestion if no one else here has any answers. I think part of the problem is that so many of us (me included) have other illnesses that are more serious so we tend to concentrate on those.  I truly hope I have not offended you and I do wish you the best of luck with your running.  I think it is great that you have a sport that gives you so much pleasure. Take care.

Aurora


walthenf
New Member


Date Joined Apr 2009
Total Posts : 10
   Posted 4/30/2009 10:58 PM (GMT -6)   
You know what? I think we were talking past each other for a while there, but I feel like we're on the same page - because after reading your last post, your concerns seem like my concerns. :) Thanks for working with me! I also am sorry if I have come off offensively. My running means so much to me, and at this point in my life, being able to run competitively does too. Because that is so important to me, I wouldn't be surprised if I sounded rather heated with the isssue. Thank you for sharing your concerns along with me, that means a lot to me.

The dosage is my concern, and if I find out that my current method ironically works and is safe, I'd just stick with it because it would be the easiest way for me to get a consistent performance for my final year of competitive running. However, I am also concerned that my dosage right now is too much, and then I need to change that. I definitely was not aware of that first puff thing - I will have to try that, thanks for the info! Right now, I'm just taking my medicine straight through with a minute rest in between the first, second, third, etc..., as I was recommended. I really wonder right now if a combination of that and using an MDI without a spacer is giving me the correct dosage (if not wasting extra medecine), but it's not something I want to gamble my health on. So, I'll repeat my question from another post, and ask the rest of the community to give me their input: With the above described situation, can anyone tell me if I'm getting a dangerous amount of albuterol in my system?

Even if I find out "my" method is relatively safe, I think I want to switch to a spacer once my competitive running is over. Then, I can take whatever down time I need to figure out how my body will take the medicine, and at a safe level.

I am currently working on contacting my doctor as well...

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7157
   Posted 5/1/2009 4:26 PM (GMT -6)   
Hi walthenf,
I was reading yours and Aurora's posts, and thought I'd weigh in.

I have had asthma for years, and can speak to the use of albuterol. Yes, if you have exercise-induced asthma, it is appropriate to take albuterol before running. The very most I've ever heard a doctor recommend (in the case of an asthma attack) is one puff, then wait ten minutes, another puff, then wait ten minutes. He said that a third puff after ten minutes may open your lungs a bit more, but after that, additional puffs will not have an effect on the lungs.

My fear for you is the drug's effect on your heart. Albuterol, you may have noticed, has an affect on your nervous system, and can dangerously increase your heart rate if you overuse it. You may feel great running, but you don't want to keel over mid race someday.

Aurora is saying that albuterol is a rescue inhaler, and this is so. If you see a specialist, he/she will evaluate your asthma needs, and probably recommend an anti-inflammatory inhaler (inhaled steroid), to reduce any inflammation that is causing your asthma problems. If you need to use albuterol a lot, it may mean that you have underlying inflammation, which is the real reason for your asthma.

A space is extremely important, and allows your medicine to get to your lungs most effectively.

Please go to a lung specialist. I have never heard of anyone taking the amounts of albuterol you are using. Aurora is completely right when she compares it with taking more of any medication, just because it works well. It's a dangerous road you're running on!

I wish you lots of luck with this problem, and also hope you continue to be successful running.
Denise

Aurora60
Veteran Member


Date Joined Jul 2006
Total Posts : 1249
   Posted 5/1/2009 6:00 PM (GMT -6)   
Denise, thank you for helping out with your thoughts on Nate's post. To all the other members of this forum there are more than 90 of you who have read this post. When someone is new and writes their first post to a forum I think it is our duty to give that person the benefit of our experiences. If this were you wouldn't you want to get as many answers as you can to your problem? Would you like it if you were new and no one responded to your questions? I know that there are many of you who have asthma or you wouldn't be on this forum. So how about some others out there giving your thoughts or replies to Nate. He deserves the courtesy of some answers to his questions.

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7157
   Posted 5/1/2009 7:55 PM (GMT -6)   
Hi Aurora,
I'm also on the Heartburn/GERD forum, and it's much more active than this one. It's too bad. Many people suffer a great deal from allergies and asthma, and a more active forum conversation would be really helpful.
Hopefully people will start contributing more.
Thanks for your participation!
Denise

walthenf
New Member


Date Joined Apr 2009
Total Posts : 10
   Posted 5/2/2009 12:14 AM (GMT -6)   
Dencha, thanks for weighing in, and thanks for the well-wishes with my running!
 
Is the increase in heartrate after taking the medecine a definite indicator that you've taken too much, or can it suddenly hit you out of nowhere? (say, mid-run?) I've been checking my pulse the last couple of days after taking my medication (granted, this is a reduced and lesser amount than I what I had previously described, but still a little more than you guys would recommend), and my pulse is steady. I am also still interested in the manner of how much medecine I'm really getting into my body through and MDI without a spacer...
 
While I'm starting to realize that I should see a lung specialist, that probably won't be an option for me for months, and I don't want to throw away valuable training time in the meantime.  However, the spacer is definitely something I'll be looking into in the future as well...

Post Edited (walthenf) : 5/1/2009 11:27:02 PM (GMT-6)


SmurfyShadow
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Date Joined Dec 2008
Total Posts : 2386
   Posted 5/2/2009 4:18 AM (GMT -6)   
Ok you should only do one to two puffs before the race, then only when you have an attack. If you keep endangering yourself, your going to crash. Asthma CAN KILL. I ALMOST DIED in an attack. If you need a spacer til then you can even get a toilet paper roll and mold the inhaler at one end of it and tape it to provided a seal. Then breathe through the other hole. Hey a doctor told me this. And frankly, if you are having to use your proair that much you NEED a pulmonologist.

One night I got off the bus to go to the hospital while I was blacking out from lack of oxygen from my bad asthma attack. It took me 4 times to stand up to deboard the bus. I could tell I was going to black out again. I pushed myself to get into the ER that was 500 ft away from the bus stop. I managed to get in the doors, and someone in scrubs asked me if he could help me. I handed my inhaler to him then I passed out. I was unconscious so long they had time to bring a medical team, have equipment on me, and put me in a wheelchair. I woke up with my vitals getting finished and oxygen on my face and being whisked into a critical care room where the Respitory team was waiting. After they got me breathing I was told I would of died 30 minutes later and there was nothing they could do to save me cuz of how far gone I was, that would of been the next bus.

Stop putting your life in danger, unless you really do want to die. Maybe you should quit running or get a pulmonologist to do your care.
 
Smurfy Shadow
 
Desirèe 
 
DX: Wegener's Disease, Migraines, Diabetese Type II, PCOS, Lactose Intolerant, Benign Heart Murmer, Depression, Asthma, Asperger's Syndrome, Necrotizing Gramultous Inflamation in eye, A.D.D., Acid Reflux, Tumor Behind the Eye, Carpal Tunnel, Fibromyolgia, Clasterphobic, Arthritis
 
Medications:  Tri Nessa, Percocet, Metformin, Prilosec, Protonix, Zantac, Advair, Cingulair, Albuterol, Calcium + Vitamin D, Pro-Air, Pepcid, Rolaids, Zofran, Compuzeen, Refresh Plus Eye Drops
 
PRN: Epi-Pen, Albuterol Nebulizer, Benedryl
 
Undergoing Radiation
 
Taking Lorazepam (Ativan) on Radiation Days


dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7157
   Posted 5/2/2009 9:38 AM (GMT -6)   
walthenf,
I was looking for information for you, and found this article. It's pretty technical, but if you take the time to read it, it might give you some information that is helpful in understanding your situation. If you'll notice, it mentions the fact that overuse of albuterol can make it ineffective for times when you need it. This is called "tachyphalaxis". I had it happen to me, after a year of using the nebulizer with xopenex, it became less effective. The article also mentions the potential cardiac effects with overuse of albuterol. (And they are talking about normal dosage, not the unbelievably high dosage you're administering to yourself.)

Regular use of asthma drugs poses respiratory, cardiac dangers
17 Jun 2004

Physicians who prescribe the regular use of beta-agonist drugs for asthma could be endangering their patients, two new studies by researchers at Cornell and Stanford universities find. One study compiles previously published clinical trials to conclude that patients could both develop a tolerance for beta-agonists and be at increased risk for asthma attacks, compared with those who do not use the drug at all. The second study shows that beta-agonist use increases cardiac risks, such as heart attacks, by more than two-fold, compared with the use of a placebo.

Furthermore, the researchers say that their analyses lead them to suspect a conflict of interest among scientists who are supported by pharmaceutical companies that make beta-agonists, among the world's most widely used drugs. This conflict, they say, could be putting 16 million U.S. asthma sufferers in harm's way. Their statement comes as the American Medical Association is voicing its concerns that drug industry sponsorship of clinical tests is affecting the quality of research.

The first study (a meta-analysis, meaning a study of other previously published studies) of more than a dozen research papers on the respiratory effects of beta-agonists is published in the journal, Annals of Internal Medicine (May, 2004), by Shelley R. Salpeter, M.D., Thomas M. Ormiston, M.D., and Edwin E. Salpeter. The second meta-analysis pooled the results from 33 trials on the cardiac effects of beta-agonists, and is published in Chest ( June, 2004), the cardiopulmonary and critical-care journal.

Edwin Salpeter, the eminent astrophysicist who is professor of physics emeritus at Cornell, has turned his interest to medical issues in recent years. He assisted his daughter, Shelley, by performing statistical analyses for asthma drug studies. Shelley Salpeter is a clinical professor of medicine at Stanford University School of Medicine and a physician at Santa Clara Valley Medical Center in San Jose, Calif., where Ormiston also is a physician.

Adrenergic beta-agonists, such as albuterol and terbutaline, work on receptors located on smooth muscles and inflammatory cells in the lungs. These bronchodilator medicines can relax the muscles around the airways that constrict during an asthma attack. Short-term use of beta-agonists has been shown to be helpful in reducing symptoms associated with acute asthma attacks. But continuous use of beta-agonists is a riskier proposition, the authors suggest in their Internal Medicine article.

"Almost all the scientifically valid studies we examined associated continuous beta-agonist use by asthma patients with a decreased bronchodilator response to subsequent beta-agonist administration, and with increased airway inflammation compared to placebo use," says Shelley Salpeter. Continuous use of beta-agonist drugs cause asthma patients to develop a tolerance for the drugs, she adds, making beta-agonists less effective in true emergencies.

Edwin Salpeter questions why so many physicians ignore warning signs of beta-agonist overuse, and why drug companies continue to promote the products for continuous use. "We think the studies warning of adverse respiratory effects are getting lost among the dozens of poor-quality studies that missed the point," he says.

Most studies of continuous use of the drugs that showed favorable results were eliminated from the Salpeter-Ormiston-Salpeter meta-analysis because Cornell and Stanford researchers considered them to be scientifically flawed -- in part because they allowed the as-needed use of beta-agonists in the placebo groups of clinical trials.

Most of these "poor-quality studies" that were eliminated from the meta-analysis, the three researchers say, also turned out to involve conflicts of interest -- because the studies were funded by pharmaceutical companies, because researchers had financial ties to the industry, or both.

"If you want to push continuous use of beta-agonists, you'll find plenty of published studies to back your point of view," Shelley Salpeter says. "However, because of their flawed study designs, none of these trials were truly placebo-controlled and therefore should not be used to make valid conclusions about the safety of beta-agonists. We worry that physicians who recommend regular use of beta-agonists may actually be putting their patients at risk."

To make matters worse, beta-agonist use in patients with asthma and chronic obstructive lung disease also increases the risk for adverse cardiac events (such as heart attacks) by over two-fold compared to placebos, the Cornell-Stanford researchers warn. Beta-agonists work on receptors found in the heart, to increase the heart rate and decrease the level of the essential element potassium. These effects are the exact opposite of beta-blocker drugs, such as atenolol, that often are used in patients with heart disease to decrease their risk for heart attacks and congestive heart failure.

In the spirit of full disclosure, the meta-analysis authors say they have no ties whatsoever to the pharmaceutical industry. In the course of the meta-analyses, Ormiston and Shelley Salpeter received salary support from Santa Clara Valley Medical Center. Edwin Salpeter received no support from Cornell. He did the statistical analysis work, he says, "just for the fun of it, and because I want to see good science rise to the top."

FOR RELEASE: June 17, 2004
Contact: Roger Segelken
Office: 607-255-9736
E-Mail: hrs2@cornell.edu

walthenf
New Member


Date Joined Apr 2009
Total Posts : 10
   Posted 5/2/2009 12:07 PM (GMT -6)   
Dencha, thanks for the article, that's pretty eye-opening, and definitely worth consideration.

SmurfyShadow, I appreciate the input. I do feel that the end of your post is a little extreme - Of course I don't want to do die, but giving up running doesn't seem like a necessary option either.

A little more about my asthma, that may (or may not) affect how one would answer this question: I've never had problems with asthma, or shortness of breath under ordinary circumstances besides excercise-related activities, and never come close to what I would describe as an attack. In the past (before I started taking medicine), I found it harder to breathe, especially dominated by the symptom of an almost "burning" feeling in my throat (this was most noticeable in cold situations, which you get late in the season running in the Midwest). Also, from before knowing I had asthma until now, colds have hit me really badly - Dominated by coughing, especially after excercise. This is what actually made me wonder if there was something wrong with me, since I was still coughing from a cold 2 months after the season. So, I got it checked out by my doctor, was diagnosed with asthma because of certain attributes in how I was breathing, and got his treatment plan.

I still am interested in the question of, whether by doing this through just an MDI without a spacer, what level of the medicine I am ACTUALLY getting in my lungs. And, even if it doesn't get in my lungs, but my mouth, how can that affect a person? Some still? Not at all?

And, I am also interested in the question of whether the symptom of increased blood pressure is something that will always accompany taking too much of the medecine (or, any of the symptoms for that matter), or whether I could have been taking too much medecine all along, without noticing the blood pressure rise, and then have severe problems suddenly hit me. My pulse normally rests around 60-64 - Once, I saw it at 56, well before I started taking asthma medication, but I routinely saw it in the 60-64 area even before I started taking medecine. On average, after I start taking the medicine, but i'm standing and walking around, with some stretching, my pulse in the 70s, peaking maybe at 80, but never really higher.

Thanks to all of you for working with me! I really do appreciate it.

Aurora60
Veteran Member


Date Joined Jul 2006
Total Posts : 1249
   Posted 5/2/2009 12:22 PM (GMT -6)   

My experience with asthma and the ER are very similar to Smurfys.  I passed out just as I got into the ER.  I had to go to the ER twice for asthma and it is no fun.  You say you don't have time to go to a pulmonologist.  How much time do you think it takes?  Is risking your life worth more than the morning is would take to see a pulmonologist?  Dencha is right about you probably having inflamation in your lungs and that is why the pro air is not working for you and by everything you have said it sounds like it is barely working for you. A spacer can be bought at any pharamcy. My Walgreens always has them in stock. How long will it take to go to the pharmacy?  You truly don't seem to understand how seriously you are risking your life.  If running is that important to you get yourself help while you can. Otherwise the next race may be your last.  I can assure you the specialist will be truly alarmed by what your are doing. And if you reach the point where you develop heart problems your running days as you know them will be over. I am curious where you are getting all this albuterol from. If you are taking as many puffs as you say, the inhaler, which has 200 puffs is not even lasting you a month.  If a dr. is giving you a bunch of pro airs he needs to be reported to a medical board. Any pharmacy will not dispense more than 1 inhaler in a month.What you have to understand is that we post on other forums where we get a lot of help and comfort and understanding.  When we see someone who is harming themselves we want to make things better for them.  Please don't ignore this very serious problem.  I feel better knowing that others are telling you the same as I have. Do you remember that famous runner Jim Fix? I'm sure you do - you know then that he died of a heart attack.  I wish you the best and am hoping for the best for you.

Aurora


walthenf
New Member


Date Joined Apr 2009
Total Posts : 10
   Posted 5/2/2009 1:19 PM (GMT -6)   
Aurora, I appreciate you guys trying to help me, I really do - That's why I am listening to you. As I have said, I am cutting back on my medecine right now.

I have two weeks before I leave the country for a while - My experience with any specialist is that it takes much more time than that to get a person in. Hence, why I don't think I'd be able to get an appointment anytime soon. If you think I am ignoring my current situation... Well, I wouldn't even be here if that was the case.

The proair seemed to work fine for me at the level I was taking. Which, again, is why I'm wondering about how much medecine the MDI alone gets into you - No one has taken time to answer that question yet. Thus, I'm going to keep asking about it and wondering if what I'm doing isn't so terribly bad. Now, granted, I realize now that I most likely have been taking too much anyways - But understand that I wasn't blind in my decision to do what I have done. I simply followed what my doctor said, and perhaps took a little too literally what he said about "experimenting". I repeat, I have cut back right now and am no longer doing this for the time being, especially after considering what you guys have to say. And I am currently trying to contact my doctor about things. Based off of your guy's insistance, I probably will look into seeing a lung specialist, but understand how that could be very difficult to do in the next two weeks.

I've been getting a new inhaler about every month and a half. Like I said, I don't think that these "double" puffs were actually discharging two full doses. I also wonder why the pharmacies would have kept getting me the medicine when the prescription itself says take 4-6 puffs. Wouldn't they have noticed something was up and told me?

I realize that several runners have died because of heart attacks. Jim Fix did - but this has nothing to do with answering my question concern whether the symptoms WILL hit you right away and ARE a sign of taking too much. Jim Fix died because of completely different circumstances, asthma and albuterol had nothing to do with it, and many even believe he lived far longer than he would have because of his running (poor family health had caused his dad to die of heart problems at 42. He had also ballooned up in weight before he even took up running, which is probably where his arteries got so clogged in the first place). So, if you could name a runner that applies to this situation, that would go a long way.

Yes, I know I may sound a little stubborn, but I do have some specific questions that no-one has bothered to answer. And, these answers could very well affect how I go about things. If the MDI is only getting about the correct dosage into me afterall because of a combination of using it incorrectly, and using it without a spacer - Why would I be inclined to change something that isn't dangerous for me and has worked for me for this long? YES, I realize this probably isn't quite correct, but I can't help wondering, especially when no one has treated the question.

But, once again, I repeat, I have cut back for the time being and am being very careful. I appreciate your guy's input, which is why I'm still here! Please, keep bringing it to my attention. :)

SnowyLynne
Veteran Member


Date Joined Apr 2004
Total Posts : 1539
   Posted 5/2/2009 1:23 PM (GMT -6)   
Proair has that new propellant in it so is different than the old ones......
SnowyLynne


Aurora60
Veteran Member


Date Joined Jul 2006
Total Posts : 1249
   Posted 5/2/2009 2:31 PM (GMT -6)   
I am confused about how you are using your inhaler.  I want to be able to answer your question.  I don't think I understand what you mean by using the MDI. Is this to mean you are just using the actual inhaler as is, and putting the red casing part in your mouth?  I am going to explain again how a spacer is used.  You should also take the time to get one from the pharamcy where they will demonstrate its exact use.  A spacer looks like a cannister.  It has a small tube opening which is the part you put in your mouth.  At the other end is where you insert the inhaler. You have to make sure you have inserted the inhaler tightly into the cannister. You must be sure to shake the inhaler for at least 5-10 seconds before inserting.  You then put the other end in your mouth, press down on the inhaler to release the med into the chamber.  Then you breathe in the med.  You have to get the med into the chamber before you inhale.  This way when you do inhale the med goes right to your lungs. After you breathe in you must hold your breath for at least 10 seconds and then breathe out through your nose slowly. You must wait 5 min before taking the second puff. Spacers need to be rinsed out just like inhalers do.  That is another question for you. Have you been rinsing out your inhaler every day?  If not you will notice white powdery residue that builds up on the opening where the med is released. If this isn't kept clean your inhaler is clogging up and you are getting no benefit from using it.  I would also like to say that I got in to see both my pulmonologists very quickly, within the next week.  Not every dr. is so hard to get into. And if you are in a big city many nurses are good at finding an opening for you. You will never know unless you try.  I still can't figure out why you are so persistent in pushing this issue when the answer to all your questions would be cleared up by making a drs appointment. We are only asthma patients and can give you the results of our experiences. No one can take the place of a dr. I would not fool around if it were my health especially when lungs and heart are at issue.

walthenf
New Member


Date Joined Apr 2009
Total Posts : 10
   Posted 5/2/2009 3:33 PM (GMT -6)   
I know what a spacer is, and I am just using the actual inhaler right now. I take inhilations like that, and I've even noticed that some poofs out of the top of the inhalor when I do so (which, at first, made me more likely to want to use more). Nor have I been cleaning it out because I was never told that it was necessary. Thanks for that info! That could make a difference...

I am not fooling around, please don't accuse me as such. I go to college in a small town where there is no option of seeing a lung specialist here, only in the city which is hours away - Combining that with the possibility of not being able to get in as easily has made that a difficult option. Like I said, I am looking into it now, but please understand that I am not fooling around - Especially when I'm not even convinced that I'm getting much more in than normal amounts because of a combination of what I've previously mentioned (in addition to medicine escaping, and perhaps not a full dose getting into me, now that I understand that I haven't been cleaning it).

Regardless, I have currently lowered my dose - I cannot repeat that enough. So, again, I ask if anyone (and I realize you may not know these answers) knows the answers to me aformentioned questions.

SnowyLynne - Your post intrigues me - Do you (or anyone else) know how this could affect things?

Aurora60
Veteran Member


Date Joined Jul 2006
Total Posts : 1249
   Posted 5/2/2009 5:00 PM (GMT -6)   
The propellant in all albuterol inhalers is no longer CFC as it has been banned by the EPA. They substituted HFA as a propellant which most of us i'm sure would agree is not as effective but that is the way it is and it is pretty hard to fight the government once they have ruled something to be usafe to the ozone layer.If you want to know more about this go to www.cfcinhalers.org and you will get a lot of information. The CFC is flourocarbons and that was a propellant that you really knew was delivering your med as it came out of the inhaler in a fast burst. With HFA the med is sometimes difficult to tell if the dosage has all been released as it is a much softer burst of med. I'm sure you notice this. As far as cleaning your red encasing the reason you see it come out of the top is your inhaler is clogged at the opening where you receive your med. This is probably why you feel you are not getting enough. So it is very important at the end of the day to rinse you piece out with plenty of warm water until you see all the white residue go away. You can let it air dry overnight. But if you must use it after cleaning do a test spray to make sure all the water is cleared out. This should help you. I have to say that the pharmacist who gives you your inhaler should have either told you to clean it out daily or he should have told you to read ALL the instructions that come in your packaging. No matter what med you ever get if is of utmost importance to read all the information given in the pamphlet or on the pharmacy instructions. Never take a med without first reading everything you are given. I think this is going to help you. This is what Snowy was talking about.

SmurfyShadow
Veteran Member


Date Joined Dec 2008
Total Posts : 2386
   Posted 5/3/2009 1:11 AM (GMT -6)   
Walt, I may be blunt and harsh but its because I care. I am telling you how it is, and letting you make the decision. We've all stated you are endangering your life. You have time to go to your doctor, but not time to a pulmonologist (which is the same amount of time). Now from MY MEDICAL TRAINING: two inhalations 15 to 30 minutes before exercise.
120 mcg is in per puff.
From my medical book: Fatalities have been reported in association with excessive use of inhaled sympathomimetic drugs in patients with asthma. The exact cause of death is unknown, but cardiac arrest following an unexpected development of a severe acute asthmatic crisis and subsequent hypoxia is suspected.
Further reading in my book I noticed mice and rats were dying at your dosage in the test stages... It also states max dose should be 4-6 puffs a day. That is 2-3 "double puffs".
 
Smurfy Shadow
 
Desirèe 
 
DX: Wegener's Disease, Migraines, Diabetese Type II, PCOS, Lactose Intolerant, Benign Heart Murmer, Depression, Asthma, Asperger's Syndrome, Necrotizing Gramultous Inflamation in eye, A.D.D., Acid Reflux, Tumor Behind the Eye, Carpal Tunnel, Fibromyolgia, Clasterphobic, Arthritis
 
Medications:  Tri Nessa, Percocet, Metformin, Prilosec, Protonix, Zantac, Advair, Cingulair, Albuterol, Calcium + Vitamin D, Pro-Air, Pepcid, Rolaids, Zofran, Compuzeen, Refresh Plus Eye Drops
 
PRN: Epi-Pen, Albuterol Nebulizer, Benedryl
 
Undergoing Radiation
 
Taking Lorazepam (Ativan) on Radiation Days


Aurora60
Veteran Member


Date Joined Jul 2006
Total Posts : 1249
   Posted 5/3/2009 10:54 AM (GMT -6)   

Smurfy, I am glad to see you stating your position on this issue again.  Everything you and all of us (4 to be exact)have posted is correct information.  As you may have noticed over 180 have viewed this post. I think the reason others don't want to respond is they see someone who keeps coming up with excuses to continue what he is doing and challenging anyone who wants to help. I am giving up on trying to be of help here as I can see that nothing is going to change. You and I and I am sure others have been through serious illnesses and we know the importance above all else to get to the dr.  I see you are in radiation therapy.  I am at this point a 3 yr cancer survivor and I ran the gamut of all the treatments.  At one time I had 3 oncologists I was working with, down now to 2. Small town or not there is a dr. available here even if it means going to campus health. So I think all has been said that can be done and hope this will get resolved in the best way.

Aurora


walthenf
New Member


Date Joined Apr 2009
Total Posts : 10
   Posted 5/3/2009 1:25 PM (GMT -6)   
To clear up the record, I am unable to see my doctor right now as well - Agan, because of my position. Please don't assume that which you don't know.

My current daily dosage is now down in the levels that are safe, according to what you're telling me - Again, I've stated that about 5 times, but I'm getting the same old answers. Yes, I've realized (for the first time, just a few days ago) that what I'm doing was dangerous, so I stopped. Is that enough, or are you guys going to keep harping on me for it? Because, quite frankly, you are, and it's making me less willing to want to reach out to you guys. I am respecting what you guys are saying, and have already made changes that need to be made.

Now, because of my current situation: Hours away from a lung specialist and unable to get to my doctor - I'm just trying to get some answers. YES, I'm currently trying to get answers from those two sources, but it just might not happen in the next (now less than) two weeks - Have I not stated that already? Have I not stated that I've dropped my meds down to safer daily levels? Now, is there anything wrong with my trying to research my problem in another way I know how? And, may I add, to people's opinions which I DO respect? (Again, why would I still be here?) I don't see anything wrong with that, especially since I've recently been cutting things back to far-more acceptable levels.

So, I repeat my two questions:

What is the difference in how much medecine you get int your body between taking an MDI without a spacer, and one with a spacer? Is it possible that a person could take more with just an MDI because less medicine is getting to his lungs? (i.e. not getting a full dose?) (Again, I am NOT doing this right now)

And: Will the different side effects of proair always be an indication that you've had too much? i.e. Could you at all use that as a gauge of what you're taking? (if, for example, in my situation, I can't see a doctor but want to try to keep training at peak levels?) Or could bad side effects suddenly hit out of the blue? (Again, I am NOT doing this right now)

If I keep getting the same type of answers that I'm starting to get, I will stop posting here. Again, I repeat myself for the umpteenth time - I have cut back to safe levels (according to your medical book) and am doing whatever I can to get the problem figured out in my current situation. Now, can you be fair to me and discuss these issues with me? Because I can tell you that I have been listening to you. Now, can you listen to me on these two issues?

Post Edited (walthenf) : 5/3/2009 12:28:48 PM (GMT-6)

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