Q. As someone who has been on daily asthma controller drugs for over 25 years, and who before that suffered periodic asthma attacks since childhood, I speak from experience when I say that anyone who makes frequent use of a rescue inhaler, such as ProAir, does not have adequately controlled asthma. I am on a daily dose of an inexpensive (generic) corticosteroid medication via a nebulizer, known as budesonide.
Prior to receiving this more effective treatment and mode of delivery, I experienced frightening episodes of “rebound asthma” from the use of Advair. No matter what brand of corticosteroid inhaler I used, toward the end of the month I experienced sharp lung pains and shortness of breath, presumably because the dose, even though they are supposedly metered, would not remain consistent. I was also frustrated with “sticker shock,” given that brand-name corticosteroid inhalers are so expensive. When I switched to a nebulizer for corticosteroid delivery, I was able to exercise for the first time in many years without routinely feeling short of breath.
For times when the Budesonide ampules are not enough, I have on hand yet another alternative: generic, extended-release albuterol tablets. If the albuterol inhalers and/or tablets are not enough, I have an even better (but costly) alternative via a nebulizer-dispensed version of albuterol, a drug called Xopenex (levalbuterol).
Because I take my asthma control medications religiously and see a doctor for bronchial infections before my asthma veers out of control, I have managed to stay out of emergency rooms for decades despite what is considered a “moderate-severe” case. I only need my rescue inhaler periodically. While I agree that the CFC-free propellants are not as good as the originals, the take-home message is that better treatment and control of one’s symptoms are necessary.
I would urge visitors to this website who have problems with asthma control to seek treatment by a specialist in pulmonology or allergy/immunology. With few exceptions, there is no reason in this day and age that one should land in an emergency room if you get adequate treatment.
A. Thank you so much for sharing your asthma experience. We agree that it is crucial to maintain good lung function in order to try to stay out of the ER, but if someone ends up in a breathing crisis, it is essential to seek immediate emergency treatment.
“Rebound” or “withdrawal asthma” is a frightening experience. If someone stops taking Advair suddenly, they could experience a serious wheezing attack. No one should ever change their treatment without careful consultation with a physician.
The “sticker shock” you refer to is not imaginary. Advair, or a similar asthma inhaler, Symbicort, can cost $250 or more for a month’s supply. The budesonide (a generic corticosteroid) you are using is no doubt more affordable. But all inhaled steroids can produce side effects including hoarseness, yeast infections in the mouth or throat, pharyngitis, sinusitis, digestive tract upset, suppression of the adrenal glands, visual problems (cataracts, glaucoma), weakened bones or osteoporosis.
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