Bronchial irritation from a new (to me) asthma inhaler?
March 31, 2023 2:07 PM Subscribe
Just wondering whether others out there have had the experience of switching to a new inhaled asthma medication that seemed to aggravate symptoms rather than relieving them.
I've had asthma all my life, mostly controlled well with antihistamines and the occasional puff of albuterol. In the past few years, though, I seem to have developed some bronchial hyperreactivity (woodsmoke, for example, is a much worse problem than it used to be), so I've been on a combination steroid/LABA inhaler for a few months each year as needed. I was on branded Advair Diskus for a while, then switched to Symbicort several years ago, which worked fairly well for me. Having retired recently and lost my excellent employer-provided Rx insurance, I consulted with my doctor about going back to a cheaper alternative, namely generic Advair Diskus. Based on three inhalations so far, it seems to exacerbate my symptoms rather badly, so I'm discontinuing and have put in for a refill of Symbicort. Given the hit to my pocketbook, it would be nice to hear that others have found that a different inhaler in the same class can be counterproductive (presumably because of different carriers/inert ingredients?).
I've had asthma all my life, mostly controlled well with antihistamines and the occasional puff of albuterol. In the past few years, though, I seem to have developed some bronchial hyperreactivity (woodsmoke, for example, is a much worse problem than it used to be), so I've been on a combination steroid/LABA inhaler for a few months each year as needed. I was on branded Advair Diskus for a while, then switched to Symbicort several years ago, which worked fairly well for me. Having retired recently and lost my excellent employer-provided Rx insurance, I consulted with my doctor about going back to a cheaper alternative, namely generic Advair Diskus. Based on three inhalations so far, it seems to exacerbate my symptoms rather badly, so I'm discontinuing and have put in for a refill of Symbicort. Given the hit to my pocketbook, it would be nice to hear that others have found that a different inhaler in the same class can be counterproductive (presumably because of different carriers/inert ingredients?).
Best answer: Pulmonologist here, not your pulmonologist. Yes, people will occasionally have adverse reactions to specific ingredients in various formulations of inhaler despite having the same classes of active ingredients. It's super annoying for all of the cost and accessibility reasons you mentioned, but it does happen.
The other theory that came to mind reading your story is that although formoterol (in Symbicort) and salmeterol (in Advair) are both long acting beta agonists, only the formoterol in Symbicort is fast acting. If you're accustomed to the quick relief of Symbicort, you may feel like Advair is, relatively, not working. It doesn't change the fact that your current generic Advair isn't working for you, but could be another explanation for the difference you've noticed.
posted by telegraph at 5:43 PM on March 31, 2023 [1 favorite]
The other theory that came to mind reading your story is that although formoterol (in Symbicort) and salmeterol (in Advair) are both long acting beta agonists, only the formoterol in Symbicort is fast acting. If you're accustomed to the quick relief of Symbicort, you may feel like Advair is, relatively, not working. It doesn't change the fact that your current generic Advair isn't working for you, but could be another explanation for the difference you've noticed.
posted by telegraph at 5:43 PM on March 31, 2023 [1 favorite]
Best answer: It was brand name and not generic advair, but I did indeed have a weird reaction to some non-active ingredient in the advair (I had actually had the drugs in it separately before without issue, so we knew it had to be the delivery mechanism somehow). So yeah, this sort of thing can happen. Since cost is a concern, are there other options that might work for you?
posted by nat at 5:58 PM on March 31, 2023
posted by nat at 5:58 PM on March 31, 2023
Response by poster: There might be, but I did check all of the standard steroid/LABA combinations. I can afford the Symbicort if I have to if it’s in the category of necessary expenditure.
posted by Creosote at 12:37 AM on April 1, 2023
posted by Creosote at 12:37 AM on April 1, 2023
I also found that my lungs really did not like the dry powder formulation of the advair diskus. There should be a generic version of Symbicort, I believe.
posted by litera scripta manet at 7:37 PM on April 1, 2023
posted by litera scripta manet at 7:37 PM on April 1, 2023
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posted by Dashy at 2:21 PM on March 31, 2023