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Mentor

Is Anyone Else Confused About All Those Inhalers?

Posted by Sue, Volunteer Mentor @sueinmn, Jul 18, 2022

Is Anyone Else Confused by all the inhalers prescribed for our lungs?

After a lengthy visit with my pulmonologist yesterday, I came away with a new set of medications and a whole lot of confusion!

This morning, I sat down and made list of all the drugs I use/have used, all the drugs we talked about yesterday, and several that have been suggested or mentioned here on Connect. Then I got busy and figured out what they are and why we use them.

Here is a summary…incomplete for sure, listing the classes of drugs with a short explanation of each class, and individual drug names (not the Brand Name or Combo name).

“Rescue” drugs – may be inhalers, or in some cases nebulizer solutions
Short Acting Beta Agonist (SABA) Opens airways quickly, relaxes airways, but doesn’t last long
• Albuterol (Common Brand Names: ProAir, Ventolin, Proventil)
• Levalbuterol (Xopenex)
• Salbutamol

Short Acting Muscarinic Agonist (SAMA) Like SABA, opens airways, or prevents bronchospasm. Less often used than SABA
• Irpatropium Bromide (Atrovent)
• Tiotropium Bromide (Spiriva)

Long Term or Daily Use Medications
Inhaled Steroids Direct dosage to lungs compared to oral steroids which are systemic. Reduces inflammation which helps keep airways open.

Inhaled Corticosteroid (ICS)
• Budosenide (Pulmicort, Entocort, Rhinocort)
• Mometasone (only in combinations)

Inhaled Glucosteroid (IGS)
• Fluticasone Propionate (Flovent, Allerflo)

Long Acting Beta Agonist (LABA) Acts to keep airways open – usually used in combination with an inhaled steroid
• Formoterol Fumarate (Foradil)
• Salmeterol Xinafoate (Serevent)
• Vilanterol (only in combinations)

Long Acting Muscarinic Agents (LAMA) Relaxes muscles around airways for 12-24 hours to reduce asthma attacks
• Tiotropium bromide (Spiriva)
• Umeclidinium bromide (Incruse)

Here is a summary of the most commonly prescribed Name Brand medications and what drugs are in each one.
Advair - Fluticasone propionate (IGS), Salmeterol (LABA)
AirDuo - Fluticasone propionate (IGS), Salmeterol (LABA)
Anoro- Umeclidineum (LAMA), Vilanterol (LABA)
Breo - Fluticasone Furoate(ICS), Vilanterol (LABA)
Combivent - Irpatropium Bromide (SAMA), Albuterol (SABA)
Dulera - Mometasone (ICS), Formoterol (LABA)
DuoNeb - Irpatropium Bromide (SAMA), Albuterol (SABA)
Nebulizer Solution
Symbicort - Budosenide (ICS), Formoterol (LABA)
Trelegy - Fluticasone (IGS), Umeclidinium (LAMA), Vilanterol
(LABA) Explanation

This is not a list of inhalers you should use, just a list of those that are often used for Asthma, Bronchiectasis & COPD - some of us have only one of these diseases, some of us have several.
I have attached a PDF file if you would like to print this list.
Sue

Shared files

Inhalers (Inhalers.pdf)

Interested in more discussions like this? Go to the MAC & Bronchiectasis Support Group.

onana | @onana | Jul 22, 2022

@sueinmn

Thank you! Especially for mentioning how long it took to get back to your normal weight. One of my questions has been how long will this take.

REPLY
nana43 | @nana43 | Jul 23, 2022
In reply to @onana "@nana43 @sueinim Thanks so much for your responses. I have to say this forum has been..." + (show)
@onana

@nana43 @sueinim

Thanks so much for your responses. I have to say this forum has been an absolute godsend to me over the last 5-6 years of experiencing the nasty progression of bronchiectasis and MAC. Two and a half of those years were spent enduring the Big 3 meds in a failed effort to rid my body of MAC. It is a strange and wonderful comfort to be connected at a distance to a large compassionate group enduring many of the same challenges and sharing information that's helpful to others, certainly helpful to me. My current reality is the loss of 20% of my weight. My pulmonologist's response was, "well, that's the disease." My ID doc said nothing. I want to regain some weight. Does anyone in this group have suggestions based on successful weight gain after this kind of loss?

Jump to this post

I have lost weight as well. I’ve always been small, weighing about 113-115 when healthy. I dropped to 99 lbs and still no appetite but hubby has been trying to beef me up. One thing that seems to work for me is Smoothies. I really enjoy them even if not hungry.
He makes me 1 or2 per day.
He puts 4-5 fruits, heavy cream, and Who knows what else. But it has boosted my weight to 103-105 and holding steady!

REPLY
1 reply
Mentor
Sue, Volunteer Mentor | @sueinmn | Jul 23, 2022
In reply to @nana43 "I have lost weight as well. I’ve always been small, weighing about 113-115 when healthy. I..." + (show)
@nana43

I have lost weight as well. I’ve always been small, weighing about 113-115 when healthy. I dropped to 99 lbs and still no appetite but hubby has been trying to beef me up. One thing that seems to work for me is Smoothies. I really enjoy them even if not hungry.
He makes me 1 or2 per day.
He puts 4-5 fruits, heavy cream, and Who knows what else. But it has boosted my weight to 103-105 and holding steady!

Jump to this post

Yes indeed, I forgot to mention smoothies! You can really make them tasty & with plenty of calories. I used full-fat greek yogurt instead of cream, even added protein powder & veggies like carrots and avocado. When my throat hurt, it was soothing too.
Now that my weight is stable, I don't "load" them with calories, my grands will drink them too if we pretend they are adult food that they can only have as a special treat.
Think I'll make a pitcher today - we have a refrigerator full of quite ripe fruit & berries!
Sue

REPLY
nana43 | @nana43 | Jul 23, 2022

I just received this from NTM Info & Research about an upcoming webinar that may be helpful for weight loss issues.
https://events.r20.constantcontact.com/register/eventReg?oeidk=a07ejahj50v858a7b3e&oseq=&c=&ch=
REPLY
becleartoday | @becleartoday | Jul 24, 2022

Excellent information!
Best,
Linda Esposito

REPLY
sandy148 | @sandy148 | Jul 25, 2022

Hi Sue -

Thanks for the great information. I have bronchiectasis and asthma and was using levalbuterol and 7%. Recently, the doctor added Flovent. This seems to be doing an ok job. He also wants me to do a pulmonary function test. Can't figure out why because I have told him I go to the gym twice a week and walk every day for 20 to 30 minutes. Have you had this test done?

Also, you mentioned you had changed your meds to 2 things - can you share what you are taking with the levalbuterol?

REPLY
1 reply
Mentor
Sue, Volunteer Mentor | @sueinmn | Jul 25, 2022
In reply to @sandy148 "Hi Sue - Thanks for the great information. I have bronchiectasis and asthma and was using..." + (show)
@sandy148

Hi Sue -

Thanks for the great information. I have bronchiectasis and asthma and was using levalbuterol and 7%. Recently, the doctor added Flovent. This seems to be doing an ok job. He also wants me to do a pulmonary function test. Can't figure out why because I have told him I go to the gym twice a week and walk every day for 20 to 30 minutes. Have you had this test done?

Also, you mentioned you had changed your meds to 2 things - can you share what you are taking with the levalbuterol?

Jump to this post

Hello Sandy - We removed the Flovent & Levalbuterol from my routine and replaced it with a generic version of Symbicort, which is Budosenide (ICS) plus Formoterol (LABA). I still carry the Levalbuterol rescue inhaler for "episodes" but have not had to use it - even while camping & while being out in the wind. So far, so good - except for a slight increase in my tremors, which I will tolerate in exchange for being able to breathe. And the "weight" on my chest that has been bothering me is getting to be less by the day.

As for the pulmonary function test, it is a standard for those of us with any lung disease - as we age, changes can be so subtle we don't realize they are happening. Having this (non-invasive) test once or twice a year can help keep us on track.

Sue

REPLY
scoop | @scoop | May 1, 2023

Hope this is helpful. Photo snapped at allergist appointment!

REPLY
shar1120 | @shar1120 | May 17, 2023
In reply to @onana "@nana43. I'm so glad you brought up his question about a corticosteroid inhaler enhancing the environment..." + (show)
@onana

@nana43. I'm so glad you brought up his question about a corticosteroid inhaler enhancing the environment in the lungs that encourages NTM infection. I recently came across a study that reported this finding. I had been using Arnuity Ellipta (an inhaler similar to Trelegy) for the last 5 years. It was originally prescribed for me by a pulmonologist I later found to be incompetent (knew absolutely nothing about bronchiectasis and MAC). Now I work with very competent doctors (pulmonologist and Infectious disease docs), and I brought the article to my ID doc and expressed my concern about the inhaler -- do I need it and is it the wrong thing for my condition? He knew about the finding and said this question often comes up and it's a tough call. If the inhaler helps you breathe, we don't want to take it away, but it's true that it could be making treatment for MAC more difficult. I question whether I needed the inhaler in the first place. I wasn't wheezing and don't have serious asthma. The whole thing is confusing and frustrating. The only lesson I draw from the experience is to always question a prescription: Do I really need this, and, if so, why? The pre-requisite however is that the prescribing doctor be competent and knowledgable about your condition.

Jump to this post

@nana43. Would you happen to have that article that you can share ? Thank you

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