Is my ashtma inhaler making me cough? Would tablets be better?

September 19, 2008 10:44 AM

I've got asthma, which is allergic and exercise-induced. It is rarely bad except when my allergies are acting up and I'm exercising intensely. Lately I've developed a problem that I believe is related to my inhaler.

My usual routine (only when I do intense cardio) is to take a dose 30 minutes prior, then one dose an hour during the activity (we're talking very intense activity), which lasts one to three hours. I will take an extra dose, up to one per hour, if I experience chest tightness, which I'd say happens about once in three or four sessions. Outside of exercise, non-symptomatic. If I don not use the inhaler during my regular sessions, I definitely get chest tightness every time.

The problem is that I believe the inhaler irritates my throat - using it too much, I assume. I cough a lot, and even a little bloody sputum, which is definitely not good. So I need to stop that. I understand that albuterol tablets exist.

I know I should ask my doc, but are the tablets something I could use prior to the exercise that I'd normally pick the inhaler for, and then keep the inhaler for only the big moments - true rescue, so to speak? Or would I have to take the tablets on a regular basis? Or would they not work that way at all?

posted by soulbarn to health & fitness (16 comments total)

So it's an albuterol inhaler? My understanding of albuterol inhalers (keeping in mind that I also have asthma, though mine is year-round and fairly severe) is that they're rescue inhalers. Meaning, you shouldn't be using them preventatively. Talk to your doctor about a preventative. I use Advair and I love it. There are several preventative medications out there; surely one would work for you. If you're lucky you would only have to use it during allergy season. You might also want to get your allergies under control if you haven't already done so. I started immunotherapy for my allergies and my quality of life has never been better.

Seriously. Talk to your doctor. The effectiveness of your albuterol inhaler will decrease if you're using it preventatively and not as a rescue inhaler.
posted by cooker girl at 10:55 AM on September 19, 2008

As a child I took oral albuterol as needed, not daily. I'm pretty sure the inhaler and the tablets/liquid are exactly the same except that the inhaler works much faster.

But ditto on "ask your doctor"--there may be better ways to deal with this.
posted by needs more cowbell at 11:00 AM on September 19, 2008

Thanks for the reply.

I've tried Advair - it didn't do anything for me. As I said, I only get asthma problems during very intense exercise, and even then, they're not awful unless I am having concurrent allergy issues. I never use the inhaler or have symptoms if I'm not exercising. So it is being used, in a sense, as a "rescue" product - just a few minutes in advance of being rescued. (Pre-exercise usage is a standard and medically accepted use of the inhaler, btw.)

I'm concerned with the throat irritation and coughing that may be related to the inhaler, and finding an alternative, since I clearly need to use some form of medication during exercise. I do not want to go on a chronic asthma medication as my condition is not chronic.
posted by soulbarn at 11:05 AM on September 19, 2008

IANAD, but my dad is an allergist and my son has some asthma, so Dr. Grampa gives us very good advice. He says that if you use a rescue inhaler more than twice a week, that is classified as 'uncontrolled asthma' and you should increase your dose of preventative medication until you don't need the rescue inhaler more than twice a week. The form of albuterol really isn't the issue here; your doctor will probably put you on an inhaled steroid that you will take regularly, whether you're having trouble or not. Shorter: You can't fix this yourself, go to your doctor.
posted by ulotrichous at 11:09 AM on September 19, 2008

As a fellow asthmatic, I will second the advice that you should go see your doctor and try to find a preventative that suits you. I've never used advair, I have used inhaled steroids (becotide in the UK, no idea what it's called in the US) and then I went to a nasal inhaled steroid (that I forget the name of) to get allergies under control, which had the side effect of drastically calming my asthma and reducing the need for Albuterol at the slightest thing.

It sounds like your use of the albuterol is somewhat reasonable in the situation, but if you can get the background allergies and asthma under control, you would likely use the albuterol less when exercising, which in turn means your throat would be less irritated. I don't know anything about the albuterol tablets, but IMHO you are still going to be fixing the symptoms and the not the cause, but using a different medication to do so.

But go ask your doctor, he or she knows more about this than any of us do :)
posted by Joh at 11:19 AM on September 19, 2008

There are other inhalers. Cromolyn (intal) is often used as a preventative for exercise induced asthma. And some exercise induced asthma is actually related to food intolerances. Go back to the doc and make him do it right this time.
posted by ikkyu2 at 11:24 AM on September 19, 2008

You didn't say if you are currently using the albuterol inhaler as prescribed. I have exercise-induced asthma and have always been told to use my albuterol inhaler before exercising, but not to use it again until 3 hours have passed. Does your doctor know you are using it every hour? It sounds like the irritation you're experiencing could be due to overuse.

When I was having problems during and post-exercise that were not controlled by the pre-exercise use, I went on a steroid inhaler for a few months. I haven't had those problems again, since.
posted by hydropsyche at 11:25 AM on September 19, 2008

1. Based on my experience, you need to switch to steroidal inhaler.
2. Also based on experience, you need to crank up your cardio hard. 160+ bpm training can seriously reduce your exercise induced asthma.
posted by ewkpates at 11:40 AM on September 19, 2008

You might try looking into Veramyst (which is nasal, preventative, and helps control asthma on a daily basis) or Singulair (pill). I've tried both and people tend to be 50/50... Some like the Veramyst because it has a small dose of steroids, I prefer the Singulair because I get wigged out sticking something up my nose every day.

YMMV. But since I use a preventative, I no longer do what you do (which was use albuterol before and after a workout... which I did daily, before going on preventative meds).
posted by Unicorn on the cob at 11:41 AM on September 19, 2008

The strategy I'm recommending may eventually allow you to switch back to a Ventolin type medication which you wouldn't need as much.
posted by ewkpates at 11:42 AM on September 19, 2008

What I should have added to my first response:

He says that if you use a rescue inhaler more than twice a week, that is classified as 'uncontrolled asthma' and you should increase your dose of preventative medication until you don't need the rescue inhaler more than twice a week.

Totally seconding. This is what I've been told by my allergist and pulmonologists all along. Like I said before, there is a preventative out there that will work for you. You may only need to use it during allergy season, but you still need to try something else. Chronic doesn't necessarily mean every day, year round. Someone with seasonal allergies still has chronic allergy issues. That would be you, with both the allergies and the asthma.

Again: see your doctor. He/she will be able to help you.
posted by cooker girl at 11:44 AM on September 19, 2008

I actually have had docs say that albuterol as preventive before exercise is ok, but I can't imagine that your doc thinks that every hour during exercise is good.

Inhaled steroids (Flovent) have been very effective for me. And once the asthma is really under control, the doses may be able to come down (say, from 2 puffs 2x a day all the way to 1 puff in the morning. Seriously). Honestly, you are worried about chronic use of medication, but if you are using a rescue inhaler for exercise and allergies, it sounds like you are more tied to the medication that way. I don't even take a rescue inhaler with me places, and I have moderate, life-long asthma.
posted by Pax at 12:12 PM on September 19, 2008

He says that if you use a rescue inhaler more than twice a week, that is classified as 'uncontrolled asthma' and you should increase your dose of preventative medication until you don't need the rescue inhaler more than twice a week.

This is a misleading statement. This applies only to using an inhaler in a "rescue" application. Using albuterol as a preventative for exercised-induced asthma is a different case and widely accepted on a daily basis. Virtually all asthmatic athletes use albuterol or similar drugs regularly. This is confirmed by the OP's report that he has no problems at other times.

What you may find useful is to supplement your use of albuterol, which is a short-acting beta-2 agonist, with Salmeterol (Serevent), which is a long-acting beta-2 agonist. Serevent is an inhaler that is taken twice a day, morning and evening. It will prevent the rollercoaster effect of just using albuterol alone by smoothing out your lung function throughout the day. It is safe to use both drugs.

One warning. There have been some adverse effects reported for Serevent but that is due to the fact that it works so well that some patients stop taking it and have a rebound effect. You need to take it every day as a preventative, even if you aren't exercising.

What you are experiencing is very common for high-intensity endurance athletes and is very dangerous because you are overdosing with albuterol. Serevent should allow you to complete your two to three hour workout using a single albuterol dose. This is what many asthmatic high-performance athletes do -- serevent twice a day and albuterol shortly before exercise.
posted by JackFlash at 12:18 PM on September 19, 2008 [3 favorites has favorites]

Oh, and I assume when using the word "dose" you mean the usual albuterol dosage of two puffs at a time. I hope you aren't taking just single puffs spreading them out before and during your workout. You need to use the full dosage, two puffs, before exercise to reach a therapeutic level.
posted by JackFlash at 12:40 PM on September 19, 2008

Dittoing JacFlash. I've used a combo of Serevent and Pulmicort every day for 14 years and have very well controlled asthma but ALWAYS must use salbutamol (Canadian for albuterol) to prevent EIB. Not all asthmatics have EIB but those of us who do MUST use a fast-acting bronchodilator like albuterol or the afore-recommended cromolyn. The only alternative is to not exercise.
posted by ethnomethodologist at 4:10 PM on September 19, 2008

i haven't read all the replies, but perhaps get a non-albuterol inhaler. albuterol makes me feel high, so i switched to xopenex. same purpose, no high. so, just switching might help you out.
posted by misanthropicsarah at 6:38 PM on September 19, 2008