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Adult onset bronchial asthma

Hi. I am new here. I was diagnosed with adult onset bronchial asthma last January, so this is all new to me. Unfortunately, I cannot get flu vaccinations due to an autoimmune disease.  I got sick last January and as a result I now have this asthma.  

I exercise and have a healthy diet, but I am in a situation at work where I sometimes I have hours of exposure to people wearing perfume, which makes me cough, feel very ill and exhausted.  This happened to me yesterday; and I am still suffering. 

I can't use an albuterol rescue inhaler, because it has no effect on my asthma. I am really concerned about this. How can I continue to work in this environment over which I have no control?  Does anyone know of any rescue inhalers for bronchial asthma other than albuterol? 

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  • Allison

    Hi Gloria! I'm glad you saw my message and joined!

    What options has your doctor given you?

    Also, can you ask your place to go fragrance-free? Are you in an office (which maybe can be controlled) or in a more public spot (like retail?)

    See this page on the

    This is our page on

    Are there other triggers within your control, or you can ask people for help in controlling?

  • Gloria

    I tam taking Adviar 250 x 2, prescription Flonaseand Singulair. I saw a pulmonologist. He put me on Breo, but that gave me unbearable leg cramps. When I told him that, he told me that it is no different from Advair. Not true!i think sometimes docs don't look at your other conditions when they prescribe (in my case, hypocalcimia).

    I can't request a fragrance free environment because I work face to face with customers.

    granted, I am new at this, but without the the ability to get any relief from Albuterol, I would appreciate any other suggestions that I could present to my internist.

  • Allison

    Well, we can't give medical advice here – we are a mix of staff, volunteers, and other community members with asthma, although we can share what has worked for ourselves or family members…

    Forgot to mention last night we also recently ran this blog post about. It was the first time I had heard of asthmatic bronchitis – is that what you have?

    The other short-acting drug that I know of is Xoponex (generic name levalbuterol) – my son took it when he was younger instead of albuterol (although he can take both) and his cousin took it (same age) because he could not tolerate albuterol. 

    Finding the right medicine for you can be challenging, especially if you have other medical issues. 

    Do you feel like your doctor listens you you, or do you feel like maybe you want to try a new one and get a second opinion?

  • K8sMom2002

    Gloria, hi and and I feel your pain about having to take whoever shows up when you're working with the public. Cigarette smoke is one of my worst triggers — an almost instant asthma attack for me — and when I worked as a caseworker I had clients come into my office reeking of cigarette smoke. I knew they were extremely nervous and had likely just smoked a cigarette outside the government building, but that didn't help my asthma!

    , even with albuterol, work differently for different people. Has your doctor talked about the dry powder inhalers, for instance? It's an inhaler that doesn't require a spacer. 

    Also, an inhaler LOOKS easy to use, but it takes some getting used to, and if you're not using a spacer, you may not be getting the meds down into your lungs. I remember posting this that talked about adults actually needing more help than kids!

  • Gloria

    I appreciate the info about Xoponex and also about using a spacer. I went over use of Albuterol both with my doctor and the pharmacist. No mention of a spacer, only the little plastic thing that the canister is seated in. However, when I ended up in the emergency room one time, they gave me nebulized Albuterol, and that did give me a good deal of relief.

    The pulmonologist told me that Albuterol is not effective for me because it goes to the lungs, and my asthma so is bronchial. He said that the long term powder inhalers would work better; and Advair 250 has given me some relief, along with Singulair pills daily and RX Flonase. However, these are all long term and I sure would like to be able to achieve some short term relief when needed.

    My internist is very helpful. Although I seem to always have the rare and unusual conditions which include Antuphospholipid Antibody Syndrome (autoimmune) and Transverse Myelitis (neurological). She has to do her research when I see her, but she is very good about it.

    naturally, I do not intend to circumvent my doctor's professional advice. We must be a team; but since I always seem to be the one with somewhat to very rare medical conditions, I must be proactive in understanding my own care.

  • Jen

    Hi Gloria – welcome to our forums.  I am glad that you are working with a pulmonologist.  Since he said albuterol isn't effective for you, what does he suggest as a quick relief option?  There has to be something.

  • Gloria

    My pulmonologist has suggested nothing for rescue relief. He actually gave me a sample of Breo, which caused me great discomfort even after I stopped taking it. Personally, I have much more confidence in my internist than I do in the pulmonologist. I have a few other rare conditions that I doubt the pulmonologist really reviewed. I did learn something from the Breo experience, though: NEVER get samples. With samples, a my pharmacist didn't have the opportunity to review my other conditions and medications for contraindications.

  • K8sMom2002

    Gloria, since the nebulizer usually has the same active ingredient as the rescue inhaler, and since it sounds like you haven't tried an inhaler with a spacer, I'm wondering if the meds are just not getting into your lungs.

    I'm about what you said here:

    The pulmonologist told me that Albuterol is not effective for me because it goes to the lungs, and my asthma so is bronchial.

    Asthma involves the bronchial airways, and albuterol inhalers help open those airways. 

    As far as samples: I think that's a good point — so many times people forget that our pharmacists are very valuable members of our healthcare team. Whenever I get a sample, I always put a call into my pharmacist and ask, "Hey, my doc has suggested I try this. Will it work with my other meds?"

    Could your internist recommend another pulmonologist for you to get a second opinion from? I hear you on the rare condition issue — my DD has a rare bleeding disorder, literally one-in-a-million disease. It's hard when it seems like the medical guys are clueless and you're the one with the most knowledge in the room!

    So the trick (which you've already tumbled to) is to find a doctor who is willing to work with your team and learn about your pre-existing conditions. One way I've done that is to ask doctors that you LIKE who they would see. Docs tend to recommend other doctors that they are similar to. 

    If your internist was the one who recommended the pulmo, could you go back and say, "Uh, this doc and I just don't seem to hit it off. Do you have another one that I could try?" Doctors — at least the good ones — understand that "chemistry" between doc and patient is an important consideration. 

  • Gloria

    Thank you for asking! Okay today. I went out for a bike ride early this morning and it was great! But someone came in where I work wearing perfume and now my throat is a bit tight. 

    I have a doctor appiintment on Wednesday. Hopefully I can find sone help.

  • K8sMom2002

    Fingers crossed for a helpful appointment! I'm glad you could go on the bike ride … I'm a firm believer that strengthening my lungs will help … if only I could get motivated to actually exercise!

    What kinds of things are you allowed to do at work to protect yourself from perfumes or scents? What kind of strategies have you used in the past?

  • Gloria

    Unfortunately, there is nothing I can do about it. This is all very new to me.I try to put a hanskerchief over my nose. It probably looks rwlly rude. It seems like the scent sticks to the nares in my nose, so even after the offender leaves, I suffer.

    i have one year four months until retirement. Hope I can make it!

  • K8sMom2002

    Would your boss object to a surgical mask over your face? Or would they say it might scare the customers? 

    I thought about you when I saw this article on LexisNexis:

  • Gloria

    I'm afraid surgical masks wouldn't go over well with what I do. Tomorrow morning is my appointment with my doctor (internist). I have a whole page of notes to go over. I'll bet that makes for a high complexity visit code!

  • Gloria

     I just read the article. Thank you for sending that. My problem is that I sell Native American arts in a small family owned store. There is no way to control customers wearing perfume when they come in. Many days I am working alone, so I have no one that I can ask to take over with a customer who is wearing perfume. Unfortunately, it seems that some days I become so sensitized that even the detergent (with fragrance) on their clothes gets me going. Someone suggested to me putting up a sign that says "fragrance free store", but that is impractical. My boss, understandably, would not take kindly to anything that would deter customers.

  • Jen

    Gloria – that is tough.  Let us know how things go with the dr.

  • Gloria

    I went to see my internist this morning. She wants me to try Symbicort instead of Advair. She even got on the CDC website to make sure there were no contraindications.

    She prescribed nebulized albuterol to me for a rescue inhaler!

    She told me that unlike my pulmonologist, she would never recommend Advair 500 for someone like me. (I'm so glad I declined taking it).

    She is sending me to an immunologist and a new Pulmonologist.  I really like my Internist. She is very good and I am feeling encouraged.

     

  • Jen

    Gloria – sounds like you have a great internist.  I hope the new pulmo she recommends is a good fit.

  • K8sMom2002

    Gloria, I'm not sure how effective a portable air cleaner is in spaces bigger than it's designed for, but I'm thinking that it might work in a radius to clean the air around you. 

    Here's a link to a list of — they've been tested and found that they really do work to help asthma and allergy sufferers. Some of them are advertised as being able to handle a room as big as 600 square feet. That would be a room size, say 30 feet x 20 feet. Amazon has one of these, the , on sale for just $160 — a small price to pay for clean air! 

  • Gloria

    Thank you for the info. Where I work is a pretty large space, and I have to be eveywhere in it, so that's probably not practical; although I do have one at home. I will bring it in and try it out. 

    On the bright side, my nebulizer is being delivered tomorrow!

  • K8sMom2002

    At 150 bucks a pop, you might buy two and have a 1200 square foot area filtered. Your company might decide to help you out with the cost to help you manage a better work environment. 

    It's worth asking and trying, I think.

    And yay on the neb! 

  • Kathy P

    I'm glad you had a good appointment. That's interesting that the pulmo said the albuterol would not be helpful – yet you said that nebulized albuterol was. I'm glad you now have that as a rescue option. I highly recommend seeing if you can get a small, portable nebulizer so you can take it with you. I have a small one that will run on AC/DC and has a rechargeable battery pack. And I know there are even smaller and more portable ones than what I have. It will all depend on your insurance though and what they will cover.

  • Gloria

    I'm not sure what they are delivering tomorrow, but when I saw my internist yesterday, I did let her know that I need rescue therapy while at work. We'll see…

  • Gloria

    Got my neb last night! It is bigger than a smart phone and smaller than a bread basket, so not the smallest, but still portable. Just in time. Two ladies came into the store just before closing last night. They were laden with perfume. Naturally, I started coughing heavily and feeling like a fish out of water. They did end up spending quite a bit of money in spite of my distress…a very good thing. But I left work feel disoriented, agitated and short of breath. I used the neb this morning; and so far so good. It seems to be helping. How wonderful!

     

  • K8sMom2002

    Oh, I'm so glad about the neb! Can you take it to work with you and does your doctor have a plan in place for just these occasions? 

    I still think that it would be worth a shot to put the air purifier right around the area where you are mainly working. Have you talked to your doctor about what to do to help reduce the severity of those attacks? I hate that you have to endure it … It's not good for you. 

  • K8sMom2002

    I found this article on Bloomberg about … I'm wondering if your employers couldn't at least figure out a way to better ventilate the public area so that the perfumed air doesn't stay in so long. Yes, I know that the perfume would cling to their skin and waft off them when you were serving them, but does it linger once they're gone?

    Can you describe IN DETAIL the chain of events that happened to you so that maybe we can brainstorm some solutions? I just hate the idea that you are at the mercy of whoever walks in that door. 

    edited to add the link to the article – CRR 09/07/2016

  • K8sMom2002

    And another — this is an old one, back in 2010, but it has some good possibilities that you could ask for, I think. 

  • Gloria

    Hi. Thank you for asking, Jen. I took the advice listed above regarding air purifiers. I asked my boss to provide one while I provide the other. He would not do it. So I was able to round up two Honeywell tower purifiers. Not the best, but better than nothing. Let me tell you…the air smells so good in here that people comment on it when they come in! Let's hope it provides good results.

  • Kathy P

    That's great that you were able to get your hands on 2 air purifies! Too funny that others are commenting on how good it smells.

    Have you worked many days since you put them in? Can you tell a difference?

  • Gloria

    I just brought the second one in three days ago. I have worked each of those three days. I'm not really sure if they are helping. I will have to wait for a perfume assault to find out. Wish me luck! 

  • Kathy P

    Good luck! K8sMom posted some interesting links about . Even if it makes a marginal difference, hopefully that will keep some of the issues at bay.

  • Gloria

    Good article. The two towers that I was able to round up are electroststic, which are listed as less effective than the HEPA devices. My question: has anyone purchased HEPA devices that you find helpful? Please let me know brand and your experience. I would be ibterested in looking into these.

  • K8sMom2002

    Gloria, good for you about taking the initiative about getting the air filters — and : that customers are commenting favorably. When I first read your update, I thought he wouldn't agree to even allow you to put the towers in … I'm glad you did. Fingers crossed that they help!

    I can't speak to air cleaners/purifiers, but I know that my HEPA filtered vac does a much better job than my old vac. 

    I hope so many folks compliment your towers and the nice smell that your boss decides to invest in some new ones!

  • Gloria

    Today I saw the Allergist. I had a blood test to try to determine allergic triggers. She also referred me to a rheumatologist. She says that they can determine if there are flu and pneumonia vaccines with killed instead of live viruses that I could get since my autoimmune disease prohibits my use of regular immunizations. I am hopeful! I am also scheduled for a Pulmonary Function Test next month.

  • Kathy P

    Sounds like a pretty good appointment! That's great that they want arheumatologist to check into possible available vaccines – that wouldreally be great if you can get some protection!Did she say how long it would be for the blood results to come back?

  • Gloria

    She did not say, but I have an appointment scheduled in about a month and a half.

  • K8sMom2002

    Gloria! That's terrific! How are the filters at work doing? Are they helping? I'm hoping they will help you with the exposure to folks who wear strong scents. 

  • Gloria

    I really can't tell how the filters are working yet. It is still the slow season here and Imhaven't had a lot of exposure since I brought them in…but the time is coming when hopefully they will be helpful. So between the Nebulizer, the air purifiers and the potential for being able to get vaccines, things are looking up!