Little Miss WRX

Is there such a thing? Can you after a while build up a temporary resistancde to the drug?

It seems that every three or five years I need to take a "break" from Ventolin and switch to Bricanyl for a while.

I was refereeing today, over the last week I had increased my preventer doses as I was poor in peak flow measurements last week. I am also on 50mg steroid tablets (reducing this week).
I managed to use up a whole canister of Ventolin (expiry date etc all okay) in a period of three hours!!!! I was still wheezing badly despite this.
One of the players had a Bricanyl inhaler, which I asked if I could use. A few puffs of that seemed to steady things up for me in order to continue my later matches.

I have found I need to rely more and more on my Ventolin and the effect it has is less and less to the point where I honestly think it isn't working at all.

Mossman

Hi there

Yes , you will build up resistance over a period of regular and / or sustained use.
Defo worth going to the doc and telling him/her.

Mossman

ajm

I'm not sure about tolerance to ventolin, but was the bricanyl inhaler a powder capsule type?

Reason I ask is that I have a Rotahaler type ventolin inhaler as well as the normal cannister type. Its more fiddly to use as you have to put in the capsules etc but it does seem more effective. The powder from the capsule is inhaled straight into the lungs. One capsule is equivalent to 2 puffs on a conventional inhaler, but it does seem to deliver more drug to the lungs as I notice more of the "shakey" feeling afterwards, and one capsule is definately more effective than 2 puffs on the conventional inhaler.

You should probably look into why you are having to use ventolin more and more though - probably a sign your preventer isn't doing its job for whatever reason.

MATTeL

As Mossman said, the body does develop a resistance to pharmacutical drugs.

When you notice the effects of the drug becoming deminished you should talk to your doctor.

Little Miss WRX

I will certainly be booking up an appointment to the doctors, at the moment my current doseage is:

Qvar 100 (Becotide 100 - they don't have it more powerful over here ) 5 puffs twice a day, upped to 5 puffs three times a day.
Seretide (powder inhaler) 250 - two puffs twice a day.
Serevent 25 - two puffs three times a day.
Ventolin - a canister ever couple of days at the moment.

I am also on steroid tablets - again.

I might try the Ventolin in powder inhaler form to see if that is any different, but I find with the accuhaler devices I end up eating most of the stuff after choking as I inhale.

The Bricanyl was a Turbohaler - not sure if you can get it in actual inhaler form - have never known it to be when i had it on prescription.

john banks

Tolerance to the direct bronchodilator effects of beta 2 agonists does not appear to occur in asthma (beta 2 agonists are salbutalmol/ventolin or terbutaline/bricanyl).

A breath actuated delivery device such as a turbohaler can improve delivery to the lungs, plus each puff is twice as potent.

Terbutaline/bricanyl is available in the UK as a normal metered dose inhaler as well as a turbohaler.

It sounds like you are over-using beta 2 agonists, but you are also on a fairly hefty dose of inhaled steroids with repeated rescue oral steroid courses. Also there appear to be some duplications with the drugs you are taking above - eg seretide has a steroid and long acting B2A in it, serevent is a long acting B2A, then you are on the Qvar which is a steroid.

Presumably you and your doctor have discussed (possibly gone round them all) other options including montelukast (or similar leukotriene receptor antagonists), theophylline?

Your asthma control as you describe is also an indication for a need for specialist referral if not already.

[Edited by john banks - 7/27/2003 4:07:12 PM]

Markus

Fapping hell Chelle! I thought I used loads of the stuff!

My doc would never put me on ventolin, the git so I am and have been on bricanyl for ooh, ages now. Building up a resistance is quite possible, I know I did to the bri, have not had to use it too much in Canada, but now I'm back here, I've had to use it quite a bit, and when I go back I know it'll take a week before I stabalise and don't need to use it.

BTW - not sure about over there but I was once wrongly perscibed the turbohaler for Bri, complained like a bugger I did, makes your throat so dry.

Chin up lassy and hope the ol wheezing calms down some for ya. I'm told booze will help lol

[Edited by Markus - 7/27/2003 4:33:29 PM]

douglasb

Hi Little Miss WRX

I've been on Becodisks/Ventodisks for around 10 years. My original dosage was a puff of the 400 microgram Becodisk (steroid) once a day. I would then use a 14 disk pack of 200 microgram Ventodisks in about 3 months.

I moved from London to Cheshire and registered with another doctor. The current doctor's thoughts are that preventing any asthma attacks is better than using Ventolin to help when they happen. So, I am still on the same medication but am now on 2 Becodisk puffs per day. Result is that a pack of Ventodisks lasts for ages. (Last prescription over 18 months ago. More than half the Ventolin still to be used.)

Probably worth talking to the Doc about upping the prevention dose.

Doug

Little Miss WRX

John,

I would certainly agree with the overuse of the Beta2 drugs - I can feel the side effects, but none of the benefits. However, if I don't use them I become "clogged up" and find it hard to bring up the mucus that is obviously being produced.

Would you say that the possible cause of the seemingly lack of effect of the Ventolin is due to an another underlying condition such as a minor chest infection? It doesn't feel like I have one.

My average peak flow has been around 220. After taking Ventolin, I can see a rise to 250, after half an hour, it will hit just over 300 maximum then drop back down again. I seem to be taking Ventolin just to keep my peak flow level.

When I was younger, I used to be on a whole concoction of inhalers which varied from immediate relief, preventers and protectors. I have taken Theophylline before after the doc weaned me off the nebuliser. I was on it for over a year IIRC.

I am going to be contacting my doctor tomorrow to see if we can come up with something that will help bring my asthma back under control.
When I first went to see him, he evaluated my UK doctor's method and prescriptions and agreed that it was a good course to continue. He has basically let me look after my own treatment and I have informed him of how I will make adjustments should I get a slight decrease to which he also agreed. I think now that it has gone beyond my control and that I have just put off going to the doctor for too long. Even after all this time I still try to deny that my asthma exists.

MArkus, I am trying to stay away from booze - she says cracking open a bottle of wine.

Doug, yeah, prevention is the best method, but I have left it a bit long I think.

Markus

Sorry, think my eyesight is going, you said you're staying away from booze? Is that possible

Little Miss WRX

That could be the cause of my Ventolin overuse. Anyhow....I did say trying....

No, seriously, I had to, my kidneys were really not very well and needed looking after. I don't miss it anyway.....much.
<gnaws at fingers>

[Edited by Little Miss WRX - 7/27/2003 5:39:27 PM]

douglasb

Hi LMW

While I didn't have any serious asthma problems (only one day off work due to a chest infection in 10 years) and didn't find that asthma restricted my lifestyle, I did find that the upping of steroid prevention made a big difference.

Good luck!

Doug

Little Miss WRX

Aye, there was a time when I just relied on Becloforte 250 - four puffs twice a day and hardly used my Ventolin at all, occasionally introducing Serevent when I had trouble at night.

The rescue course of steroids always does the trick and brings my peak flow above the 350 mark, it just seems at the moment that the new area and current level of medication is just not cutting it at the moment.
I definitely think a wee word with the doc about a new asthma plan is needed.

john banks

Think so. Sounds like the underlying asthma is worse rather than developing tolerance of B2As. Consideration of theophylline or a leukotriene receptor antagonist as I mentioned along with specialist input would be my next step.

[Edited by john banks - 7/27/2003 6:46:40 PM]

Markus

Trying? yup, you're very trying Soz about the ol kidneys Get to the quack and hopefully he'll sort you out. Probably find that 'roo poop has some magical qualities for helping asthmatics! lol

Little Miss WRX

More than likely right MArkus <hops after local Roo's in order to find magical poo >

John,

I phoned my doctor to ask his advice, he can't see me today as he is fully booked up as usual, but definitely wants to see me ASAP, in the next day or two. In the meantime he has suggested keeping up the steroid course and not dropping it down as I was doing.
I talked to him about something like Theophylline, telling him that I have been on it before and he said that was indeed a plausible option, but he wants to assess me first and check for any additional issues like a chest infection which he suspects there is.
He also wants me to join the asthma clinic that he runs (thought I'd got away with it before - he knows what I am like already ).
He understands that I want to keep on training and refereeing, but has suggested I take a break till my peak flow recovers sufficiently. I told him that I only had three more weeks of hte football season to go and would rather not miss out, so he says that is entirely up to me and will be working wiht me to rescue my peak flow.

Little Miss WRX

I went to see him on Wednesday (I think it was then) and he diagnosed me with a viral chest infection and has upped my steroid inhalers considerably, whilst also bringing me off the tablets (I prefer not to be on them anyway).
He has also swapped me onto Bricanyl to use as a short term replacement for Ventolin.
He decided against the Theophylline for now and wants me to do a trend peak flow graph over a week or two, suggesting an increase in the protector inhaler at night and at weekends when I am refereeing.

I refereed Friday, Saturday and will be refereeing tomorrow aswell. I have to say that the Bricanyl has been effective. Still wheezing a lot whilst running, but feeling more able to breathe if you understand what I mean? You could tell that my airways were opening because I am shifting the mucus that my lungs insist on producing and they are staying open for longer with better results on the peak flow meter.
All in all, feeling better and the peak flow is starting to head the right way.


[Edited by Little Miss WRX - 8/2/2003 3:40:08 PM]