Asthma Anonymous

May 7, 2007 5:47 AM

[AsthmaFilter] - Will daily intake of a therapy spray like Alvesco (Ciclesonid) cause your asthma to become worse once you stop? It seems to have happened to me. Is it possible to become asthma free without the medicines?

I've never been much of an asthmatic, just occasionally, related to a change of season or proximity to horses. However, a year back or so, my asthma grew worse, probably because my girlfriend was riding horses.

So I started a spray combo for the first time in my life - Salbutamol for attacks and Ciclesonid to be taken daily. For the last few months, I've not had asthma, and I decided to stop taking the Ciclesonid. A few days after I stopped, I started having asthma - a lot more than I ever had in my life!

And this leads me to the assumption that daily intake of an asthma inhibitor is causing my lungs to not be able to deal with the problem on their own.

I asked my doctor when I can stop taking Ciclesonid, and she said that Asthma is a lifelong sickness, and I may have to take it forever. Well, I had asthma from 8-16, and from 16-24 no attacks. So I know I can spend years without having asthma. So obviously I do not want to be stuck on a spray when there is no need for it.

I refuse to take a spray my life long. The question is - does prolonged use of this spray make me dependent on it, and also, how best do I stop using it?

posted by markesh to health & fitness (15 answers total)

I am not a doctor.

OK. Having said that -- I have read (and I wish I could find the source; I read it fairly recently) that it's common for asthmatics to "outgrow" it as young adults, and then have the symptoms return a little later in life. (Mine kicked in with a vengeance in my mid-30s. I had symptoms as a child but it went undiagnosed then, because I was a cougher not a wheezer.) If I wasn't in the middle of doing an all-nighter grading midterms I'd search harder for a source for that -- but maybe someone will find it.

Also, I am not familiar with Ciclesonid, but many asthma meds are the type you're not supposed to just "stop taking" -- you have to taper off. (For example, my understanding is that Advair is one of those.) It's not clear from your post whether you actually told your doctor that you have stopped taking it already -- if you haven't, you probably should, just to be safe.

(Also, there could be a coincidental reason why the asthma flared up when it did -- a heretofore unknown trigger,maybe. I discovered a while back that rubbing alcohol fumes trigger asthma for me. But I had no idea of that when I started using shellac -- in an alcohol solvent -- to repair the vintage finish on our floor...)

I understand the rebellion against the possibility of taking it forever. I feel the same, but the improvement in my ability to breathe -- and the reality check that was my first trip to the ER with asthma symptoms -- is enough to keep me honest. (*sigh*)
posted by litlnemo at 6:08 AM on May 7, 2007

I am not a doctor but I am a (recent) asthmatic, reading over the literature it sounds like asthma levels can rise and fall somewhat randomly, and then also in proportion to allergies.

Personally, I wouldn't give up any of my asthma/allergy meds (which cost me roughly 30% of my take home income each month), but if you're really opposed to taking the meds, you could try getting a really really thorough allergy test and then avoid everything you're allergic to like the plague (and even then you're still probably at risk).
posted by drezdn at 6:35 AM on May 7, 2007

I'm not familiar with the inhaler you've been using but most daily inhalers are steroids and you always taper when ending the use of steroids. My asthma comes and goes with weather and stress. I have tapered off of a steroid inhaler and been fine. But stopping suddenly is a bad idea and, as the previous posters say, a good way to end up in the hospital.

If you've ever taken prednisone for bad poison ivy or something, you taper off that, too. It's not because the medicine is bad for you. It's just because it's strong.
posted by hydropsyche at 6:49 AM on May 7, 2007

Good point -- it could be a springtime allergy.
posted by litlnemo at 6:52 AM on May 7, 2007

(replying to drezdn)
posted by litlnemo at 6:52 AM on May 7, 2007

I don't know if this is related but I sometimes get mild asthma and use basic over-the-counter Primatene. I've noticed that the frequency of symptoms increases with my use of Primatene, but if I force myself to avoid it, the symptoms tend to abate on their own; sort of an addictive cycle. I have no idea whether it's a physiological or pharmaceutical effect, but it might be related. In any case I now try to use the stuff sparingly.
posted by rolypolyman at 7:15 AM on May 7, 2007

I've had asthma since I was 9 or 10. I think I've witnessed what you are experiencing. I'm of the thought that it is, at least partially, psychosomatic. I think it's because the inhalers work very well, and you get used to breathing very easily. YMMV, I guess.

I've been using an Albuterol inhaler for the past few years with good success, but I don't like the side effects very much and so try to do without, but I'd be dead without it.

All of that said, I'd talk to your doctor about it. It may be that using a different inhaler will reduce or eliminate this effect.

I hope this helps. Asthma sucks.
posted by Pogo_Fuzzybutt at 7:25 AM on May 7, 2007

My experience with Albuterol (non-steroidal) is similar rolypolyman's. My asthma is extremely mild and intermittent, but I did find that using a "rescue" inhaler for my occasional wheezing led to more episodes.

Everyone's right about tapering off steroids. If you hope to avoid meds, follow drezdn's advice and see a good allergist. For me, avoiding cats and certain foods has made a huge difference.
posted by dickyvibe at 7:28 AM on May 7, 2007

similar *to*...duh.
posted by dickyvibe at 7:29 AM on May 7, 2007

I am a doctor.

The ciclesonide is a corticosteroid. The salbutamol is a beta-agonist that is modified to be long-lasting. The combination of the two drugs should fight the two main aspects of asthma: bronchoconstriction (broncial smooth muscle constriction) and inflammation. People often forget that asthma has a large inflammatory component to it. It's much more than just tightend airway muscle.

This is why steroids are part of the treatment for severe asthma exacerbations. It's also why inhaled corticosteroids are important for the maintenance therapy of persistant asthma.

With that as background, there's nothing about the steroids that should make you more sus

I would recommend asking your doctor what type of asthma you have: mild/moderate/severe and intermittant/persistant. Patients with mild intermittant asthma (typically triggered by allergies) will likely only need an inhaled beta-agonist inhaler (e.g., albuterol) that they use when they have symptoms or before they're exposed (e.g., taking it before you exercise for exercise-induced asthma).

Patients with mild-moderate persistant asthma will typically need to take a daily maintenance inhaled corticosteroids (e.g., fluticasone) and then use albuterol as needed. Patients with severe persistant asthma may need higher potency steroids inhalers (e.g., budesonide) and possibly long-acting beta agonists (e.g., salbutamol). Thus the rationale for the Advair(R) inhaler (fluticasone and salmeterol).

That being said, there's nothing about inhaled steroids that makes your lungs dependent on them. Unlike pulse corses of systemic steroids, they should not need to be tapered. However, stopping them is something that you should discuss with your physician. If he/she says that your asthma is severe enough that daily maintenance inhaled steroids is important, then you can choose to believe them and do it, not believe them and get a second opinion (say, from a pulmonologist), or not believe them and assume the risks.

When faced with decisions concerning my own health care, I remind myself of the aphorism: "Any physician who diagnoses and treats himself has a fool for a doctor."

Hope this helps.
posted by scblackman at 7:55 AM on May 7, 2007 [3 favorites]

IANAD. I am an asthmatic and recently I had severe persistent asthma. Through the use of breathing excercises I was able to go from being a severe asthmatic to a mild-moderate one. Most days I am able to get by just taking some allergy medication.

How? You ask.

Using the butekyo method. Essentially, the butekyo method teaches you to breath differently. Clincial trials have proven that asthmatics are systematic overbreathers. Typical asthmatic will breathe 4-8 times as much air as someone without asthma. This results in dangerously low amounts of carbon dioxide in your lungs and asthma. Retraining your breathing to increase the amount of carbon dioxide really really helps. There are several books you can get on butekyo and many people who teach classes. Check and see there is likely one in your area.
posted by zia at 8:05 AM on May 7, 2007

Any of our resident doctors care to comment on the efficacy of the Buteyko breathing technique? I'm not an asthma sufferer, but I've heard good things said about it by several friends who are.
posted by flabdablet at 8:35 AM on May 7, 2007

Scblackman sums it up nicely, but if you want some more information, here are some additional resources. They don't mention ciclesonide specifically as they are US-based and that is not available here for asthma, but the the points about other inhaled steroids should apply. Here is a review article about the use of steroids in asthma; it is reasonably short and shouldn't bee too hard for a non-medical person to read. For a more detailed look at the current guidelines promulgated by the National Heart, Lung, and Blood institute here in the US, the 1997 guidelines are here and the 2002 update is here. Those are both 150 page PDFs, so if you want something more concise here is a summary of the update. The bottom line is that you have a chronic problem and may well require lifelong therapy, but that is between you and your doctor. Many things can cause asthma exacerbations and it is impossible to tell over the internet why your symptoms have gotten worse; your best bet is to learn all you can about the disease and talk with your doctor about where in the spectrum of severity you fall and what the treatment options are. If you have persistent asthma then keep in mind that inhaled steroids have really improved the outcome for these patients and so the ciclesonide may be helping more than you realize.
posted by TedW at 8:36 AM on May 7, 2007 [2 favorites]

Preview, flabdablet, preview!
posted by flabdablet at 8:38 AM on May 7, 2007

Please read scblackman's reply carefully. Your medicines are treating your asthma in different ways, and both may be necessary to control it. There are very clear guidelines on the diagnosis and management of asthma.

Asthma can kill you.

Ask your doctor for more information. If you feel like your questions about the nature and treatment of asthma are better answered in an online forum, find another doctor.

And if you're going to try something like Buteyko, for god's sake, keep your albuterol inhaler close by and do not forget that your inhaler won't help you if you can't move air anyway.

The stuff I see now on PubMed re: Buteyko is not very encouraging. Basically: small trials + conflicting results + the failure of increased CO2 as a reason for change = NO. No way would it replace any of the recommendations for the treatment of asthma.
posted by herrdoktor at 9:55 AM on May 7, 2007