Spiriva respimat

New article on LAMA's https://www.pulmonologyadvisor.com/reports/long-term-ics-in-copd-has-significant-risk/

@lilianna and @rstel7272 - Spiriva Respimat is tiotropium bromide a LAMA (bronchodilator) with no inhaled corticosteroid (ICS).
The article actually talked about Symbicort and similar inhalers, which combine a bronchodilator with an ICS. The point of the article is that a single-drug inhaler is preferred to the combination ones, but many docs use the combos.
It sure give me something to discuss with my new pulmonologist as I currently use Symbicort.
Sue

I think that article Rick mentioned was about copd and not about people who have asthma. Or?

Also I am pretty sure that it is dangerous to use a laba without a steroid. At least I was told that when I lived in Europe. Maybe the thinking is different in the US? I use breo which is a laba and a steroid.

Hello Sue. When I had problems with tight chest, palpitations and high pulse symbicort, annuity Ellipta and spiriva respimat were eliminated one by one after trying and nothing helped. So I tried on my own half a vile of albuterol for a few days ( by advice of an immunologist) and noticed there was some improvement. So eventually it was switched to levalbuterol and it did help a lot. So now I will have a discussion may be I will switch to something without steroids instead of nebulizing Budesonide. I know how doctors at NJH try to avoid inhaled steroids during the Mac treatment. Sometimes I think how much we have to be our own advocate and constantly ask.

From what I read, budesonide is less likely to cause as many side effects as fluticasone. In either case, we need to be careful. Finding the minimum effective dose very important.

There are many articles that outline the longterm dangers/risks of inhaled corticosteroids alone or in combination. No medications are risk free. Finding the minimum effective dose might help to mitigate the various side effects. An important question to ask, do the benefits outweigh the risks of the medication in question? What works for one might not work for the other. It's not black or white -- there's a lot of gray area. Humans prefer black and white but reality is grayscale!

The other issue is the use of anticholinergics which I believe Spiriva is. I try to avoid them because I worry they they will dry up secretions and make it harder to remove mucus...I have occasionally used benedryl when I have too much coughing up stuff and it briefly quiets things down (4 hours max). Benedryl is an antichoinergic also. A number of inhalers include one anticholinergic or another so you have to check if you want to avoid them.

I use Anoro, no steroid but does it dry secretions?

Anoro has an anticholinergic as part of it: Umeclidinium bromide..."Umeclidinium is a long-acting muscarinic antagonist, which is often referred to as an anticholinergic". I am pretty sure all anticholinergics are drying but whether this is good or bad is the issue. I think there may be varying viewpoints on the use of anticholinergis and bronchiectasis. It probably isn't cut or dried...it's just that we worry about getting out all the mucus and if it is dried up is it gone?

At least in my case, 3 years of Symbicort turned into aspergillus as described in this paper ..
https://www.mdpi.com/2309-608X/6/4/346