Advair 250 Inhaler

[izzie]

Has anyone had a rough time using the Advair 250 Inhaler and if so, what did your doctor switch you to? I quit using it about a week ago and all my really bad symptoms have disappeared........and just starting to feel really great.

[izzie]

My apologies..........I just realized that my post may be asking everyone for info that may be considered too personal.

[susanny]

Izzie, it wasn't too personal for me to answer. I wasn't able to use Advair because it made me more SOB than without it. With my dr's permission I went off it for a month, improved and then went back on it. Once again I became more SOB. I stopped it and now am using a nubulizer with Budesonide and Brovana as my two meds. I also use Tudorza inhaler twice a day and morphine sulphate 60 mg three times a day. I am very serious now with my COPD and on Hospice, although I am doing pretty good now. My dr said I could be in Hospice for up to 4 years depending on how well I take care of myself.

[izzie]

Thanks for responding susanny, I found it amazing that it made you short of breath as well. It has put me into full blown attacks that were very difficult to get out of......and luckily I didn't have to call for an ambulance. About a week ago, I called my pharmacist and he told me to stop the Advair 250 puffer immediately and contact my doctor. I couldn't get an appointment with my Doc until this upcoming Monday, but I did stop all doses of the Advair...........and I can believe how well I'm breathing. I've been on that medication for 15 years..........but I really don't think I need it anymore because I'm also on Uniphyl Timed Release Pills which is also a bronchiodilator. What does that mean when you say you are in Hospice? Do you mind telling me what your symptoms were with Advair? I had terrible muscular-skeletal pain in my legs and feet, didn't sleep well at night, felt lethargic all day and couldn't eat anything with sugar or high carbohydrate content. I had to consume large amounts of water and food/beverages with high potassium content. I think it actually put me into adrenal fatigue and depression. After only one week, I feel physically well again and happy. I'm going to research the meds you have talked about in your post. Thanks again for your input. Be well...stay well.

[judi]

I was on Flovent (the steroid in Advair)for years and it finally started making me SOB too. Now I am on Symbicort and it does the same thing, if I try to take a full dose after a couple of days I start having problems. I am doing pretty well taking only 2 puffs of 80/4.5 in the AM and something else in the evening but I don't know if its going to be a long term solution. I can't sleep either if I take it in the evening and have had horrid muscle pain from all of them at higher doses.

If anyone finds out what is happening with the SOB I would like to know too.

judi

[David]

It's been years since I was on Advair. I think it was back in 2005 and 2006. If I am not mistaken I went to Spiriva after that.

[susanny]

Izzie, I had forgotten that another one of the symptoms I'd had were the muscle cramps in my feet and hands. Very painful. If I recall correctly, it was the steroids in the Advair that caused the symptoms. I also now take a daily dose of 10 mgs of prednisone (a steroid) and get the same cramping. I tend to run low on potassium because of daily doses of diuretics. I just was in the hospital for IV potassium over the course of 2 days and feel much better. I now take 40 mg potassium orally per day and it keeps my levels up there. I don't know how much of the symptoms are caused now by the steroids...just know that the diuretics have something to do with it.

[izzie]

Thanks to you all for responding.....I've always thought the steroids in Advair caused some of my side effects. While do some of my research on COPD and the various medications used to treat it, I did find a little article on the internet that said adults between the ages of 50 and 60 have problems using it.......especially females, more so than males. Judi,I thought using a lower dose would help, so I switched from Advair 250 to Advair 125 and it still caused SOB problems.

Susanny, the potassium is so important for the maintenance of our good physical health and I find I crave foods/beverages that are high in it. Fresh, homemade ginger tea and bananas seem to relieve the craving for a while, but then it's not far into my day that I just seem to need more and more.......sometimes I drink up to 5 cups a day. The cramping from Advair is painful and I've been on prednisone a couple times, but not for long periods. When I read the side effects on the Advair insert included with the packaged inhaler.....I have all of the bad side effects plus more and I've recently developed floaters in my eyes which scary is because my vision has been perfect until last year.

Anyway, when I see my Doc on Monday..........I will let you all know the outcome, but for now I think I'm gonna stay away from anything that has steroids in it.

Susanny, I'm finding that a strong cup of ginger tea is a great bronchiodilator by itself, add a little cranberry juice to it and it's great for the liver and kidneys as well, as it cleanses them naturally.

[izzie]

Good Morning Everyone...

Well, I wasn't able to see my regular doctor yesterday....but I did see the nurse-practitioner who can advise and prescribe medications in same way as a doctor in Canada. Yikes, in spite of all the side effects I've had with Advair, I was advised to go back on it, of which I refused. The nurse-practitioner then gave me a sample pack of Symbicort Turbohaler which is a budesonide/formoterol combination, which is also considered a corticosteroid/bronchodilator and again containing lactose........just like the Advair.

Here is the thing, I haven't been taking the Advair for the last 10 days and I feel really good and most of my really uncomfortable symptoms are disappearing. I have decided to become my own guinea pig and not take the Symbicort either........I tried Symbicort many years ago and had problems with it back then as well. Both contain lactose, of which I have an allergic reaction to........I haven't been able to drink cow's milk for years because of my allergy.

For right now, I am on Uniphyl(theophylline drug), Spiriva, Ventolin Puffer and Nebules for my Nebulizer. The Spiriva also contains lactose, but I don't seem to be too terribly bugged by it.

At this point, I don't know if I am making the right choices for myself.........but I gotta try something different and outside of the usual box that the medical community wants to put me in.

[Deborah]

Izze, I tried to persuade the respirologist to let me off the Advair, as I am at an early stage of COPD and want to hold some things back in reserve. It didn't help when I was taking it alone and only when I started Spiriva did I see any improvement (now I'm on Seabreezi instead of Spiriva).

Anyway, he said that Advair worked on different parts of my COPD and was essential, despite the side effects. I would be deeply concerned about going against medical advice despite a short term improvement; after all this is a long term progressive disease.

Can you talk with the nurse practitioner about the risks of going off the advair? At least that way you would know what to watch for.

So sorry you having so many troubles. I hope that others with more experience will chime in. It's only been two years and a bit since my diagnosis and I am still at the early stage with no major exacerbations since starting treatment, for which I am grateful.

Good luck!

Deborah

[David]

If it ain't working then I stop taking it but that is just me. I am not suggesting you stop. If I am not mistaken all those drugs do is help you breath better. They don't cure anything.

[izzie]

Thanks Deborah and David......I appreciate all your input. I feel so let down by the medical community that it's forced me to explore all other options as well. I was seeing a pulmonary specialist here in Calgary, who led me down a very dark road and it caused me to go into anaphylactic shock, because he didn't warn me of possible interactions of certain medications. Drug interactions can be common, moderate or mildly interactive and I think the medical profession needs to respect the patients right to choose if they want to take the risk or not. For me....going into anaphylactic shock was the most frightening thing I've ever experienced and I've never returned to see that pulmonary specialist ever again and I never will. The drugs that are helping me the most right now are Uniphyl(theophylline) and Spiriva, and I am also on Oxygen 24/7.

I'm doing well without the Advair and I feel good.......better than I've been in a long time. Of course, having spring like weather today is also a big bonus. I will keep you all posted though........if I have any negative or more positive changes. Thanks for being there for me.

[David]

izzie, have you ever used a nebulizer?

[sandy07]

If you don't mind me asking....what drugs were you taking that made you go into anaphylactic shock? Was it an antibiotic?

[izzie]

Hi David.........yes I have used and still use a nebulizer to administer the salbutamol sulphate solution that I have been prescribed. Since I quit taking the Advair, I've had to use it a little more over the past few days, but still feeling much better than before. Been off the Advair for 2 weeks now and I feel so pleased that I've identified the medication that has been causing me so much grief. I have decided to document everything that is happening to me, the doctors and/or anyone connected with the medical community and what they say, suggest or prescribe.

Right now, I am battling swollen salivary glands at the very back of my tongue and in my throat. It feels almost like hives, because I just want to reach down and scratch the inside of my throat.......but of course we all know that is impossible to do. In Alberta, Canada we have what is known as Health Link, where we can phone in and talk to a registered nurse. She suggested, drinking room temperature to cool water as well as sucking on ice chips.....it does seem to be helping and I think the inflammation in my salivary glands is subsiding. Then she suggested I see a doctor, and I hit the ceiling........why the hell would I see a doctor, when they were the idiots that got me into this mess. I ended the conversation with the registered nurse by saying that if she could find me a doctor that is capable of thinking outside of their little medical soapbox, then I would go..until then forget it. However, I did thank her for her suggestion of sucking on ice chips.......and it seems to be working.

[sandy07]

izzie...have you ever had allergy tests done? That might give you some ideas of what to avoid.

[izzie]

Hi Sandy........No, I wasn't on an antibiotic. I was on Advair, which of course I should have never been taking because I have an allergic reaction towards Lactose which is a milk protein that messes around with some people's hormones. The paper insert that comes with the Advair, clearly outlines that the medication should not be used by those who have an allergic reaction to lactose and/or dairy products. My question is WHY would I be prescribed this drug and next.....why would a doctor prescribe the same dose to a 135 pound woman as they would a 200 pound man?? Sorry, but I really need to scratch my head and my throat right now, .

I went into anaphylactic shock after my doctor insisted I get the pneumonia shot.........which also has lactose in it. From my research..........there is a moderate risk with taking a pneumonia shot while on Advair and a high risk if you are also lactose intolerant. I was also on Uniphyl(theophylline drug) which is well known for it's drug dumping properties when the human body is under extreme stress or shock. I was lucky that I didn't go into a seizure, but it seemed like forever before my breathing returned to normal.

[sandy07]

Maybe ibuprofen will help with the inflammation. I got a prescription anti inflammatory that gave me shooting stars and black spots in my left eye. The jury is out whether it gave me the loss of hearing I now have in the left ear. When that happened the doctor told me to just use ibuprofen for inflammation. (bronchial tubes)

[izzie]

Hi Sandy......what was the name of the prescription anti-inflammatory? If you ever need to check out a new drug that you have been prescribed, drugs.com is a good website to do your research on. That's where I do a lot of my reading and research.

But let's face it....anything that we ingest or inhale can cause us some grief. Can certain drugs make you experience hearing loss?..........maybe or they could be a contributing factor.

While using the Advair for the last 15 years......I've had a persistant rash in and around my left ear that never goes away. The ears, eyes, nose and throat are all connected by threw our nervous system. If my rash doesn't go away after being off the Advair for at least 30 days, I'm planning to go see an ear, eye, nose and throat specialist. Long term use of Advair can cause or contribute to glaucoma. I've enjoyed perfect vision all my life, but developed "floaters" in my eyes last year.......which I think are the black spots that you speak of. Anyway, I was told by my eye specialist to get to a hospital immediately if I develop black spots or some loss of vision....apparently they can do something about it.

[judi]

Izzy, I have some lost relatives that were in Alberta, maybe you are one of them as we have some of the same problems. I have had a rash in my left ear for years too that gets worse and itches the more ICS I take, one reference I found said it can be a sign of a drug allergy but I don't know if most doctors would agree. I do have signs of early glaucoma from the meds but the pressures go down if I titrate a bit, that's a work in progress.

I understand your problems, been there, done that, and I know its HARD when they ignore your distress. I have had very painful neuropathy from meds and my pulmo likes to deal with side effects primarily by putting his fingers in his ears and going 'la la la'. :-D I am getting more help now but its still a challenge because they just want to diagnose everything as a disease before they will consider the meds. I was going to have to have a endoscopy (nope! nope! nope!) and seem to have taken care of the gastric irritation from ICS by drinking good quality full-fat organic milk. My doctor still thinks there is something wrong even though it has happened before and gone away on less med. He is wrong but they just can't seem to 'get it' sometimes.

I want to caution you a little bit not to throw the baby out with the bathwater, you need to keep your airways open and not have exacerbations. I hope it doesn't but you may find your breathing deteriorates after awhile on no Advair or you could start getting exacerbations. That always happens to me when I stop ICS, I go great guns for awhile and then gradually my airways close up. It does happen faster for me though so maybe you are on enough other things to compensate. Your swollen glands sound kind of like an immune problem from stopping ICS after so long though, it is a question of whether your body will adapt or you will start getting more and more problems. I don't mean to lecture you and hope you are not offended. I have some pulmonary hypertension that is likely at least partially from untreated airway obstruction, I get that on not enough med or on too much. You just have to try to find your good spots. They may be moving away from throwing so much ICS at people, they have come out with a LABA/LAMA combo but those of us who have been on them for so long have to be careful.

I am on a MDI Symbicort that is 80/45 and used for asthma and not COPD, I can't tolerate a full dose but am doing ok. I don't know if there is any lactose in it, I'm a little lactose intolerant too, I can't drink a lot of milk. I was taking 2 puffs of Symbicort in the morning and one puff of Qvar 40mcg in the evening and breathing so well my doctor asked if I was going to start running. Unfortunately after about 2 weeks I reacted AGAIN to the Qvar so had to stop. I am going to ask pulmo next visit if I can try something similar with a different ICS but don't know if he will go for it. I wonder if you could take just a low dose ICS instead of the ICS/LABA combo since you have other bronchodilators.

Its just hard. do the best you can but be prudent.

judi

[izzie]

Hi Judi.....thank you for your reminder to not throw the baby out with the bath water. Sometimes I get a little too zealous about what I'm doing to help myself and/or others. It's possible that we are related, except I don't know where you live. Some of my family settled in North Dakota and I have a few aunts and cousins living in California.

Unbelievable that you have itching in your left ear as well, mine has turned into eczema that never goes away in spite of all the creams I've used. I firmly believe that I have developed an allergy to corticosteroids, and let's face it..........when we inhale the corticosteroids like Advair and Symbicort, it filters into our throat, ears, eyes and nose. They are all connected by our nervous system. Anyway, I have decided to ask my Doc for an allergy test and specifically for corticosteroids.........my mother was allergic to them as well. Advair and Symbicort both contain lactose because the steroid needs a protein to bind to, in order for it to work as a corticosteroid. Corticosteroids suppress the immune system response, and the medical profession claims there isn't enough lactose in them to really have an effect on anyone who is lactose intolerant.

Judi...I developed a cow's milk allergy at the age of 14, and broke out in hives all over my body. My face, tongue and throat became swollen and I had ringing in my ears until the swelling subsided. I was drinking store bought cereal cream shortly before all of that happened, so I can't be sure if it was the milk or the additives they use in milk and cream. I started drinking goat's milk after that, with no problems. Even to this day if I have even a quarter cup of milk, I bloat and get horrible stomach pain and gas. People need certain enzymes in their bodies in order to break down the milk proteins or lactose in milk. I am sure that is why Uniphyl(theophylline drug) works well for me as a bronchiodilator. Theophylline is a synthetic drug that belongs to the xanthine group of drugs....which is an enzyme. Theobromine is a naturally occurring enzyme in a lot of foods and beverages....chocolate is especially high in theobromine.

Anyway, I am continuing to be vigilant with what I believe is the underlying problem.

[stoker55]

Izzie I truly feel for you as I am going the round about just trying to get a proper rescue inhaler that doesn't send me to the moon. Hang in there and if it doesn't help you breath better make them listen. I had to physically yell at my Doctor before he took me seriously. Hopefully it won't come to that for you as it can make you SOB. Take care & I hope you get the right meds soon.

[izzie]

Hi stoker55.....Yes, sometimes we may have to raise our voice a little to get the medical communities attention and yes I do get short of breath from yelling. But it will never make me shut up........as long as I'm drawing some breath, as shallow as it may be at times, .

Anyway, there are many digestive enzymes that our body naturally manufactures from the foods we ingest. A lot come from the amino acids contained in certain foods. I could not digest fats for the longest time, but we need a certain amount of fats in our diet to maintain good health. If I ate anything too fatty, especially animal fat......I become violently ill and sick to my stomach. Typically I would squeeze lemon juice into a glass of water to help digest any fats that I felt would or could make me sick. Then I discovered N-Acetyl-L-Cysteine which is an amino acid.......and guess what, I can now digest fats. NAC or N-Acetyl-L-Cysteine is one of the things used to treat chronic bronchitis or COPD.

Hope you can find the proper rescue inhaler soon stoker55......doesn't Ventolin HFA Puffer or Nebules work for you?

[izzie]

Anyway, I just wanted to report that I'm still breathing quite well and feeling good only taking Uniphyl, Spiriva. After going off the Advair 250 on Mar 26/14, I had to use my Ventolin Puffer and Ventolin Nebules a lot at first..........but I have significantly reduced my intake of Ventolin as well. Drinking lots of water, and still itchy in my throat, but that seems to be subsiding today. Have changed up my diet a bit and hoping for good results.

I don't recommend anyone trying what I am trying without the advice of a doctor, but I have hit a point of desperation with my symptoms. Each of us are different and have our own unique body chemistry. I am the only one that can understand my physical self from top to bottom and I've failed at making my doctor understand. Maybe I need a course in good communication skills, but I think when I do finally see my Doc next.........I'm gonna put it all in writing on letterhead. everyone.

[judi]

Good for you that you are breathing better, do you have an oxymeter? You want to be sure you are getting enough O2. My pcp actually just tried to take me off steroids too but I can't do it. My pulmo did not agree with the idea but he is one of the 'give everyone the same dose of the same drug and then forget about it' crowd.

Eczema is what is in my ear as well, I also have it on one palm. It gets better with less med. I read your thread in general discussion where you mentioned irritation from the inhalers. Can you please explain what happens? I have struggled with that for nearly 2 years but mine seems to be mostly from the steroids. Qvar and Alvesco (in the US) work a little differently, they are converted to steroids in the lung instead of being one in themselves. I don't think Qvar was as irritating but I had what the doctor called and idiosyncratic reaction to it. It comes in a small 40mcg dose.

I am starting to have problems with an immune response TO the meds instead of them stopping it. I don't know if the irritation is part of that. I started eating salmon and that seems to have helped the irritation, I guess we old Norwegians need our 'fiske'. :-) There are some people who can't convert short chain fatty acids form plants into long chain Omega 3s.

Please let me know how it goes for you and don't shoot yourself in the foot! :-)

My Alberta family's name was Hicks.

judi

[izzie]

Good Morning everyone......I'm still doing o.k. without my Advair 250 inhaled corticosteroid, but I am sure I wouldn't be o.k. if it weren't for my bronchiodilator theophylline drug Uniphyl and Spiriva.

Judi.....I don't have an oxymeter at home, but I can tell right away when my saturation levels are going down by the way that I feel. I probably would have never risked going off the Advair 250 if I had other health problems like high/low blood pressure, diabetes, etc. The risk would be too high because Advair 250 affects blood sugars and potassium levels in the blood. The thing that concerns me the most by going off the Advair 250 is that the corticosteroids affect our adrenal cortex...thyroid gland, pituitary gland, adrenals glands, etc. Just google adrenal cortex and Wikipedia is pretty good for giving you a complete list of all the glands in our Adrenal Cortex. I know it's going to take quite a few months before my adrenal glands start functioning properly, due to my use of ICS for soo long, but I can take some herbs to help it recover.

An idiosyncratic reaction is simply a reaction that is NOT desirable....it would be nice if the doctor were a little more descriptive, like does the doctor mean that it caused a shortness of breath episode or an exacerbation that lasted only a short time. ICS like Qvar stops the immune response in the lungs, but I don't think it stops the immune response in the throat or pharanyx and I find that the delivery system of Advair 250 irritates my throat/pharanyx tissue. I sometimes get polyps and inflamed salivary glands at the back of my tongue, throat and pharanyx causing me to have a very hoarse voice. When this happens, and the Advair hits the back of my throat, it can cause me to go into a complete exacerbation that leaves me temporarily short of breath. In other words......my throat closes/swells and I can't get much oxygen for a while. A strong cup of ginger tea will almost always cause my throat to open again. Ginger is a natural anti-inflammatory and antihistamine.

Eating salmon is a good start Judi. It would appear that we are both of European descent and that might have something to do with our lack of ability to convert short chain fatty acids from plants into long chain Omega 3s. I take a Vitamin B complex to help metabolize carbohydrates, proteins and fats for energy, tissue and red blood cell formation. Also the amino acid called carnitine is very helpful and can be found in asparagus, swiss chard......as well as all other leafy greens. NAC is also great for helping digest fats. If you can tolerate sardines in spring water......yah just can't any better nutrition than that in a little tin box, .

Anyway, yes there are a lot of Hicks in Alberta but I am not related to any that I know of. I am a Dutch, English and Polish mix.........Heinz 57 blend. Now, I am Canadian.....the melting pot for all ethnicities.

[judi]

Well good luck to you. I have a pulmo appointment coming up and if I can squeeze info out of him concerning SOB in response to meds I will let you know. :-) Inquiring minds want to know. I think some of it in my case may be CO2 retention because it frequently gets better if I turn my O2 down but I don't really know.

An idiosyncratic med reaction is a medical description. Most side effects are dose related, some of that is due to body weight, female sex, etc. but there are also different polymorphisms (genetic expressions) of liver enzymes that metabolize meds and some people are 'slow metabolizers'. They don't metabolize a standard dose fast enough to get rid of it before the next one so they end up with too much med. I think I am one to some extent and it has become worse as I age. Spiriva gives me fits if I take it every day because it is designed to be long lasting.

In a drug allergy the person has an immune reaction to the molecules in the actual med, I believe an anaphylactic reaction fits here.

They aren't too sure what causes an idiosyncratic reaction but think it may be that the individual metabolizes the med and a metabolite (what's left) bonds with a protein molecule and triggers an immune response. I developed a relatively high fever and it went down when the med wore off but as soon as I took more the fever shot up again. I kept lowering the dose and trying to take it and the last time got so sick it scared me.

I am taking 1/2 the dose of Symbicort that is not recommended for COPD because its too weak (80/4.5) and if I try to take a full dose I start to get a sinus infection, upper respiratory infection, congestion, SOB, etc. At this point I don't know really know what to call that... bad little inflammatory molecules!

Judi

[izzie]

Hi Judi........nice to hear from you again. Bad little inflammatory molecules...that's funny, but it's probably a good way to describe it. Enzymes are extremely important when it comes to metabolizing our meds, food and beverages and my metabolic rate varies daily and of course with age as well. There are a lot of amino acids, but only a few help to produce the enzymes needed by the human body for digestion. The NAC helps to produce the enzymes needed for the digestion of fats, in addition to the B Vitamins.

I am curious.........when is the last time your Doc checked your Cortisol levels? I just wonder how much our meds affect the functioning of our thyroid gland..........I mean there is hypothyroidism and then there is the opposite hyperthyroidism. I have had issues with hyperthyroidism before, which can cause fever and SOB. Mine was never bad enough to justify any kind of medical intervention........but it is interesting that they treat it with beta blockers as well.

So,it looks like you immune response to corticosteroids is fever and mine is anaphylactic, and both are cause for concern. Just wondering if you get any relief from SOB by drinking certain types of tea, especially black tea?

[izzie]

everyone,

I just thought I would pop in and give everyone an update......whether they are negative or positive. So far my breathing has improved by eliminating the ICS, but sticking with the Spirva and Uniphyl(theophylline) and Ventolin Puffer and/or nebules as needed.

I contacted GlaxoSmithKline Inc. in Mississauga, Ontario today to ask a few questions regarding Advair 250, after all I had been using it for many years......and they said all their studies with the interaction between Uniphyl(theophylline) and Advair were not complete and would I mind if they contacted my doctor for follow up.....and I agreed. So I guess I will be seeing my Doc sooner rather than later.

Now for the negative....my hyperthyroidism has returned full blown and is slightly un-nerving, maybe the Advair helped to control it. In any case, I will need to see my Doc about some testing on my thyroid and get cortisol levels checked. Typically, I have been able to control it with diet. Another negative thing is I've just recently discovered that the little polyps in behind my tongue and throat are known as esophageal varices and can be caused by long-term inhaled corticosteroid use. So, I need to get those checked out by a specialist as soon as possible because they can bleed and become cancerous.

Another negative thing about going off ICS is the extreme lethargy I've been experiencing. Did a little shopping yesterday, but became very tired after an hour. Anyway.......this is my journey with COPD.

Hope you all have a lovely evening.

[sandy07]

izzie...it's good to have you post your symptoms. Others may have some of the same and not know why. I've never heard of polyps in the throat or on the tongue being caused by inhaled steroids. That's a good thing to know.