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.

68 Years old, severe asthma since birth. The inhalers will save your life. Been on Flovent since it came out in 1994. I take the highest dose they manufacture 2x per day. If sick, take more. Been on allergy shots since 2 years old. Allergy shots work and make a normal life possible. I too have allergic reactions to many of the drugs that are available for breathing issues. Flovent has always worked for me up until they quit making it October 2023. Struggling to find another inhaler. The re-branded version does not seem to work. I have ordered from Canada but I think that my package has been lost in the mail. Ordered May 6, 2024 and still not here. I have 10 days of Flovent left. Any ideas from those of you that use to take Flovent. Have your tried other inhalers that work as well?

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Profile picture for scoop @scoop

@hip123 How do you know you are allergic to your inhaler? What are the symptoms?

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I react with itching over a large portion of my body.
It is very frustrating because I am allergic to many medications and have allergies to dust, trees, grass etc.
I also have severe arthritis and osteoporosis. I took one year of prolia and then followed with one year of reclast and had many side effect from the prolia. I am still dealing with a skin condition that has been diagnosed as a fungus. Almost everyone of the medications that are suppose to be helpful for me have the side effect of making one more vulnerable to getting infections. Also I have been very careful to stay up to date with all of the vaccinations, but I really think that they also cause me to be more vulnerable to infections. I got Shingles two weeks after the last COVID vaccination. I have tried many inhaler medications and I start itching all over after the second or third dose. Good luck to all of you who have COPD and are looking for an inhaler. Listed in the side effects of all of them that I have tried is the increased vulnerability of infections. I find the whole situation overwhelming.

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Profile picture for dmcara @dmcara

Thank you for this information!
I have been searching for a method to wean off QVAR 80 mg two puffs in am and pm .

I have mild asthma completely controlled by QVAR when first pulmonologist put me on QVAR 40 mg 2 puffs once per day. After a few weeks he told me I was “cured” and could stop the inhaler without weaning off. I stopped gradually anyway and the symptoms came back worse than before.. so he added Pm dose. Every time I tried to wean off it got worse. I am now with a different pulmonologist who controlled the wheezing with my current 80 mg two puffs twice per day now for several years. I have been unsuccessful in weaning off and she says not to worry— just take it , it’s helping. But I can’t help thinking that the only reason I have to take such an increased dose from the original is not knowing how to wean/taper the dose in a way that works for me. I believe the steroids are causing my skin to erupt in blood spots now and the skin on forearms is paper thin. Pulmonologist said this is a side effect. I am trying now to drop one pm puff of 2 to see if I can wean off while taking lung supportive homeopathic remedy, but I am worried that I may trigger an onset of symptoms that will require prednisone which just escalates this steroid dependency further.

Does anyone else have experiences of trying to wean off maintenance inhaler…or use of QVAR?

Thank you!

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Ps I am 66 years old

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Thank you for this information!
I have been searching for a method to wean off QVAR 80 mg two puffs in am and pm .

I have mild asthma completely controlled by QVAR when first pulmonologist put me on QVAR 40 mg 2 puffs once per day. After a few weeks he told me I was “cured” and could stop the inhaler without weaning off. I stopped gradually anyway and the symptoms came back worse than before.. so he added Pm dose. Every time I tried to wean off it got worse. I am now with a different pulmonologist who controlled the wheezing with my current 80 mg two puffs twice per day now for several years. I have been unsuccessful in weaning off and she says not to worry— just take it , it’s helping. But I can’t help thinking that the only reason I have to take such an increased dose from the original is not knowing how to wean/taper the dose in a way that works for me. I believe the steroids are causing my skin to erupt in blood spots now and the skin on forearms is paper thin. Pulmonologist said this is a side effect. I am trying now to drop one pm puff of 2 to see if I can wean off while taking lung supportive homeopathic remedy, but I am worried that I may trigger an onset of symptoms that will require prednisone which just escalates this steroid dependency further.

Does anyone else have experiences of trying to wean off maintenance inhaler…or use of QVAR?

Thank you!

REPLY
Profile picture for hlp123 @hlp123

I am having trouble finding an inhaler that I am not allergic to.
I have a prescription for Serevent. I am wondering if I can use it only once a day instead of twice a day in the beginning to see how I react to it.
Thank you

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@hip123 How do you know you are allergic to your inhaler? What are the symptoms?

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I am having trouble finding an inhaler that I am not allergic to.
I have a prescription for Serevent. I am wondering if I can use it only once a day instead of twice a day in the beginning to see how I react to it.
Thank you

REPLY
Profile picture for scoop @scoop

@janskallerud I hear you! Exactly my issue - nighttime airway noises, sometimes I sound like a squeaky door. If I hear those rattles after I lie down at night I know I am in for a restless sleep.

I wish an inhaler would replace the extra session but I have yet to find one that doesn't turn the phlegm into cement. The first night or two on a recommended inhaler always feels pretty good but the gunk dries and builds up.

After a lot of experimenting, the good news is that I found that an extra clearance session right before bed is helpful. The bad news is that it's an extra session and I can't use a bronchodilator before, so the clearance can be time consuming. Working to decrease the time! Postural drainage has been helpful. Your mileage may vary but I found mucinex (guaifenesin) and NAC made night-time rattling worse. You'll likely need to experiment to see what works for you.

So my (present) routine: levalbuterol and 7% saline morning upon waking.; levalbuterol and 7% saline prior to dinner; autogenic drainage and active cycle of breathing and postural drainage before bed. Very little gunk comes out but apparently enough to help keep me rattle/cough free. Movement exercise during the day I find makes clearance sessions easier.

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Thank you for sharing your method of dealing with this night time problem. I will try adding your suggestions to my routine. I think you are right though.....we need to experiment and determine what works best for each one of us. Thanks again! Jan

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Profile picture for janskallerud @janskallerud

When I was diagnosed a year ago with Bronchiectasis, I was prescribed a Trelegy inhaler to use until I could get an appointment with a pulmonologist. After 5 days, my voice had been diminished to a whisper, and I was taken off of it. ($550. inhaler not covered by Medicare or my supplemental policy now wasted.)
I am getting by OK with nebulizing both Duoneb and Acetylcysteine twice a day while using my Hill-Rom Compression vibrating Vest. My problem comes when I lie down at night. I am sleep deprived, because when the wheezing and whistling start, I can't sleep. My next appointment with my pulmonologist isn't until June. Do you have an opinion of whether an inhaler would help to stop this noise if used during the night? Sue's list of all the kinds of inhalers makes me understand that it may not be as simple as just asking for an inhaler. (Thank you for the list, Sue!!)

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@janskallerud I hear you! Exactly my issue - nighttime airway noises, sometimes I sound like a squeaky door. If I hear those rattles after I lie down at night I know I am in for a restless sleep.

I wish an inhaler would replace the extra session but I have yet to find one that doesn't turn the phlegm into cement. The first night or two on a recommended inhaler always feels pretty good but the gunk dries and builds up.

After a lot of experimenting, the good news is that I found that an extra clearance session right before bed is helpful. The bad news is that it's an extra session and I can't use a bronchodilator before, so the clearance can be time consuming. Working to decrease the time! Postural drainage has been helpful. Your mileage may vary but I found mucinex (guaifenesin) and NAC made night-time rattling worse. You'll likely need to experiment to see what works for you.

So my (present) routine: levalbuterol and 7% saline morning upon waking.; levalbuterol and 7% saline prior to dinner; autogenic drainage and active cycle of breathing and postural drainage before bed. Very little gunk comes out but apparently enough to help keep me rattle/cough free. Movement exercise during the day I find makes clearance sessions easier.

REPLY

When I was diagnosed a year ago with Bronchiectasis, I was prescribed a Trelegy inhaler to use until I could get an appointment with a pulmonologist. After 5 days, my voice had been diminished to a whisper, and I was taken off of it. ($550. inhaler not covered by Medicare or my supplemental policy now wasted.)
I am getting by OK with nebulizing both Duoneb and Acetylcysteine twice a day while using my Hill-Rom Compression vibrating Vest. My problem comes when I lie down at night. I am sleep deprived, because when the wheezing and whistling start, I can't sleep. My next appointment with my pulmonologist isn't until June. Do you have an opinion of whether an inhaler would help to stop this noise if used during the night? Sue's list of all the kinds of inhalers makes me understand that it may not be as simple as just asking for an inhaler. (Thank you for the list, Sue!!)

REPLY
Profile picture for lindam272 @lindam272

@sueinmn This is on my list to do this week - sort through the types of inhalers to see if I can get some improvement in keeping my airways open longer. Saw a commercial on television for Airsupra that I am going to investigate. I'm sure Medicare won't want to pay for it, but worth a try if it appears that it would work better. Airsupra is a rescue inhaler that has albuterol and budesonide. Thanks, Sue! @lindam272

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Or...if you have an albuterol or levalbuterol inhaler and a budosenide (Pulmicort is one brand) inhaler, you can make your own combination - simply use the albuterol, wait one minute, then use the budosenide. This is what my daughter did for several years before she was switched to Symbicort (for the long-acting beta-agonist fomoterol.)

By the way, my pulmonologist prefers Symbicort to the albuterol/budosenide combo - formoterol keeps the airways open longer. It used to only be used for COPD, but is now the second-step choice for difficult asthma or reactive airways. I had a little drama getting it with Medicare Part D but after intervention by my pulmonologist they approved it. I have never had airway control this good since I was in my 40's. No nebs except 2-3 times a week saline, no exacerbations requiring ER or antibiotics, no bronchitis (even with getting 2 colds).

Sue

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