Why the sudden breathing problems?

December 13, 2005 1:29 PM

Why would I, an asthmatic man, all the sudden start having abnormal breathing issues? (Note: I am not using Ask MeFi as a substitute for a doctor's opinion)

I am 18 years old. I have asthma. My asthma is fairly consistent. Every night (usually anywhere from 5:00 to 11:00 PM), I oftentimes have issues breathing. The remedy is to simply take my Serevent powder discus inhaler and this is, for the most part, the only time I ever need to take it. If I decide it's time to go to bed and I have not yet taken my inhaler yet that night, I will do so to ensure a good sleep.

But, today and yesterday, I've had problems my inhaler isn't solving. I'm a fairly fit person, but this has caused me to not be able to slowly walk almost any distance (such as a city block or even shorter) without having issues breathing. If I sit still in one place, I will slowly be able to breathe again almost, but not completely, normal.

I have taken my inhaler many times hoping it will relieve this to no avail. It does not seem to help at all, which leads me to believe that this may not be an asthma problem at all. If I exhale deeply and quickly, I feel a sudden urge to cough, and occasionally I sputter up amounts of phlegm with the cough.

Does anyone have an idea of what could be the problem and what might be a temporary form of relief? I plan to see a doctor about it as soon as possible, but until then, I'd like to see what Ask MeFi has to say.

posted by Anoxs to health (25 comments total)

I'm asthmatic, and I take Advair, which has Serevent in it.

Serevent is NOT a fast acting inhaler - you need something like Albuterol or Proventil for that. Serevent is meant to be used once or twice a day, at regular intervals, as a maintenance medication. People have died from taking too much Serevent.

Don't 'plan' to see a doc, get up and call yours right now. Go to Urgent Care if necessary. Breathing problems are nothing to ignore, and especially if it's getting worse. Get the breathing under control first, then suss out why it's getting bad now. Temporary form of relief? Walk into Urgent Care and get a nebulizer treatment.
posted by spinifex23 at 1:49 PM on December 13, 2005

Go to a doctor today.
posted by BackwardsCity at 1:54 PM on December 13, 2005

Just to add: A woman in my graduate program died last year from complications from asthma. It happens. Your doctor should know about this.
posted by BackwardsCity at 1:56 PM on December 13, 2005

asthma is no laughing matter. or, better: don't fuck around when it comes to asthma. even if your asthma is well-controlled on medication or trigger avoidance, you should always, _always_ have an unexpired albuterol inhaler available to you.

furthermore, be sure you know how to use it properly. have your care provider go over its use. if at all possible, get a spacer, which looks like this. it's much more effective to use an inhaler with a spacer than just an inhaler alone.


no amount of controller medication (advair, singulair, cromolyn, etc.) can be substituted for albuterol.
posted by herrdoktor at 2:28 PM on December 13, 2005

My very very mild asthma sometimes becomes a problem with a quick drop in temperatures. Cold dry air is no damn good for my lungs.
posted by chiababe at 2:44 PM on December 13, 2005

Serevent will gradually make your breathing worse as it will make you hyperventilate more in the long run. I would switch to steroids as a preventative, and then read about alternative asthma treatments like buteyko. , which will allow you to kick drugs all together and be much healthier.
posted by blueyellow at 2:46 PM on December 13, 2005

buteyko's approach isn't going to let you kick drugs altogether. it can, however, help with hyperventilatory episodes that often manifest themselves in asthma exacerbations, especially when an anxiety component is present.

it is dangerous, misleading and irresponsible to suggest that any sort of breathing exercise or manipulation of breathing patterns can replace pharmacologic therapy in asthma.

we use various breathing techniques all the time in the ER and ICU for asthma exacerbations. they help by gaining control over the insidious hyperventilation that often accompanies asthma attacks. but no physician in their right mind would ever suggest that any patient could chuck their inhaler for any sort of breathing exercise.
posted by herrdoktor at 3:09 PM on December 13, 2005

Serevent will gradually make your breathing worse

As someone who takes it, I would be very curious to see links that support this statement.
posted by jessamyn at 3:45 PM on December 13, 2005

As someone who takes it, I would be very curious to see links that support this statement.

You just don't get it, man! The pharmaceutical companies have a vested interest in, like, keeping you sick. The sensible solution is herbs and shit. I mean, the Native Americans didn't have "modern medicine" and they were totally healthy. Except for smallpox and syphillis and shit.

You can learn more from convicted fraudster Kevin Trudeau's book "Natural Cures They Don't Want You to Know About."
posted by Mayor Curley at 4:17 PM on December 13, 2005

Depending on where you live, air quality could be a factor. In the winter we get horrible inversions here in Utah and sometimes it gets to the point where I don't even go outside unless I absolutely have to. It usually only takes two or three days of stagnant air before I'm hitting the inhaler a few extra times each day.
posted by mr_crash_davis at 4:40 PM on December 13, 2005

Serevent will gradually make your breathing worse

As someone who takes it, I would be very curious to see links that support this statement.

Likewise (now that best answer has been marked). I used Serevent for a while and now use Flixotide, as Serevent is a strongly controlled substance in NZ and requires some weird governmental permission. Yet I had no side-effects on Serevent that I haven't had on other preventatives. In fact, the only side-effect I've ever really noticed is a faster heartrate (like an adrenalin rush) after using Albuterol more than once in a short time.
posted by tracicle at 4:59 PM on December 13, 2005

jessamyn: i don't know of any studies that show that serevent leads to more hyperventilatory episodes, as blueyellow claims.

however, over recent years there's been much said about how serevent is bad/can kill you/should be taken off the market. the truth of the matter is that current guidelines state that serevent should be used in conjunction with a controller medication, such as a steroid, and not used by itself as a controller med.

hold on a sec. lemme find a link. don't use serevent by itself. the basic message is this: serevent, used by itself, in patients who weren't taking an inhaled corticosteroid (such as fluticasone, as is found in advair), had a statistically significant, higher death rate.

numerous studies have shown that there's no big deal if you _do_ take it with a controller med, such as fluticasone, as is found in advair. one metanalysis found @ the cochrane database says as much.
posted by herrdoktor at 5:12 PM on December 13, 2005

My doc always prescribed Serevent with Flovent, a steroid inhaler. I used that combo for years, with a spacer. When Advair came out, I switched over to that and have been a happy asthmatic ever since. (The other advantage is that it's one drug instead of two, thus one copay, etc.)
posted by spinifex23 at 5:27 PM on December 13, 2005

I have had asthma since age 3 (currently 35). My treatment over my life has consisted of a plethora of drugs, including serevent and steroids at one time or another. 5 years ago I attended a Buteyko course in MA, practiced for 5 months and have since not taken or needed to take any drugs. The consequences of the treatment have been significantly more than just abolishment of asthma symptoms, they have included a significantly improved immune system (it is very rare that I get a runny nose anymore) and a major boost in my exercise stamina.

The buteyko concept of asthma (which is described here) is that many chronic conditions, asthma included, are caused by chronic hyperventilation (not acute herrdoktor). Despite the lungs being overoxygenated, the body becomes oxygen depleted due to a depressed Bohr effect, and the CO2 depletion can generate many systemic symptoms. The buteyko concept of an asthma attack is that as the person enters a state of serious hyperventilation, the body of people so disposed responds by trying to do what it can to stop the over breathing by constricting the bronchi. While you can use buteyko breathing to stop an attack, the real gain is in doing the regular exercises to reduce the chronic hyperventilation.

About serevent and albuterol, from freedom from asthma:
But perhaps the most relevant, but little known, reason for avoiding unnecessary doses of bronchodilators is that although they provide short-term relief, in the long term they make asthma worse. This is because opening your airways they make you hyperventilate even more than before, worsening your breathing pattern and causing you more severe problems with asthma in the future.

About responsible doctors. I have MDs in my family and I have a PhD in a biological field. To think that doctor's can actually take the time/effort to make up their mind against the hegemony of the establishment and cheerleaders they send their way, is greatly overestimating the abilities of doctors.
posted by blueyellow at 5:33 PM on December 13, 2005

If anyone is following this, I just got back from the ER. Used a nebulizer, they took chest X-rays (which had nothing abnormal) and gave me some Albuterol and medication I need to take for a few days.

And now I can actually breathe. Thanks a lot guys.
posted by Anoxs at 6:06 PM on December 13, 2005

blueyellow: a quick pubmed search under "buteyko" yields nothing conclusive, and certainly nothing to replace current NAEPP guidelines. nevertheless, i'll be speaking with some pulmonologists in the AM and will dig around some, if only to better educate myself.

anoxs: good for you!
posted by herrdoktor at 6:37 PM on December 13, 2005

herrdoktor: It is ridiculous to consider that any doctor could do anything other than follow the current established guidelines. Doing anything else opens you up to malpractice lawsuits. Buteyko would be hard to find in pubmed, it originated in Russia over 40 years ago. Relevant documents would be about hyperventilation syndrome. From here:

1. Bass C, "The hyperventilation syndrome", Respiratory Diseases in Practice, VOL , Oct/Nov 1990, 13-16
2. Bowler S, Green A, Mitchell C, "Buteyko breathing and asthma: a controlled trial", Medical J. of Australia, VOL 169, December 1998, 575-578
3. Brasher RE, "Hyperventilation Syndrome", Lung, VOL 161, 1983, 257-273
4. Clarke PS, Gibson J, "Asthma, hyperventilation and emotion", Australian Family Physician, VOL 9, 1980, 715-719
5. Cluff RA, "Chronic Hyperventilation and its treatment by physiotherapy: discussion paper", J of the Royal Society of Medicine, VOL 77, September 1984, 855- 861
.
.
.
posted by blueyellow at 7:00 PM on December 13, 2005

I just tried a pubmed search myself. It seems like there are some interesting articles, e.g., this
and this.
posted by blueyellow at 7:05 PM on December 13, 2005

thanks blueyellow, that is really interesting.
posted by jessamyn at 7:11 PM on December 13, 2005

I had a patient as an intern who came in with just this presentation.

He'd used so much inhaler that he'd triggered off a dangerous cardiac arrhythmia that was limiting his heart's ability to pump blood. The way this manifested was the way cardiac insufficiency usually manifests: shortness of breath.

If you can't breathe, quit fucking around on the Internet and go to the E/R.
posted by ikkyu2 at 7:29 PM on December 13, 2005

my dad had asthma ... it was fairly well controlled but he also had allergies to cats and horses, which would aggravate his asthma and make him miserable

you may want to be tested for allergies
posted by pyramid termite at 9:15 PM on December 13, 2005

Anox - very good! Glad to hear that it's taken care of. Hopefully, with your new regimen, you're asthma will be uunder control again!

Blueyellow - that's all fine and good, but I'll save the 'meditative breathing' for stress relief. For a potentially deadly disease, give me those drugs! Again - you don't fuck around with asthma.
posted by spinifex23 at 10:46 PM on December 13, 2005

Only one data point: Ghod bless the inventors of Advair. It worked on me when nothing else did. Ashtma sucks and I used to depend on the epinephine that is sold over the counter. I'm lucky.
posted by OneOliveShort at 5:14 AM on December 14, 2005

spinifex23: In my experience the breathing exercises are not meditative. They require effort and perseveverence. As herrdoktor pointed out, drugs like servenet make it that you are much more likely to die from asthma. So the drugs make it more dangerous. IMHO, blindly taking these drugs is fucking around with asthma. In any case no one would suggest you just stop taking drugs, any process to wean off them is a gradual one.
posted by blueyellow at 5:32 AM on December 14, 2005

I am going to agree that you should get tested for allergies, they can pop up unexpectedly. I knew I couldn't eat shelfish, then all of a sudden I got tight after eating (about 6 years ago at 19) just about anything. Turns out it is the salt, not salt per se, but iodine. Iodine, is also the main trigger in shellfish, so once I started avoiding processed and store prepared food, I felt much better.
posted by stormygrey at 5:52 AM on December 14, 2005