Acid Reflux Signs And Symptoms

Q: I'm a middle aged male who developed asthma about 9 years ago after a bout of severe bronchitis. My pulmonist has me on Azmacort 6 puffs 2x a day. I also have Proventil as needed. I use prednisone only when I get my occasional bronchitis....usually 3 days after a cold sets in. The current treatment plan is working well. However I hear that Intal is a very safe drug with 0 side effects and works well for exercise induced asthma. I was on it early on into the start of my asthma. It seemed to have no effect. My question is : has anyone had good results with Intal? Should I discuss with my dr the possibility of lowering the inhaled steroid and using the intal with it. I'm concerned of the side effects of the steroids. A story I will share with you. When I get bronchitis I take prednisone...60 mgs 2 days... then taper 10 mg a day. After using this med I noticed at night a glare from cars. I went to my opthamologist and they found what looked like a hard crystalline spot on the lense of my eye. Very small, yet irratating. From the steroid? Maybe? It's not what they would say is your normal cataract either. I know the inhaled corti-steroids are relatively safe but I would like to cut down the use of them. Any suggestions out there? The Intal? Mixed with Azmacort?

A:Intal is a tool used to prevent the full blown asthma response in exercise induced and other forms of asthma. It works for some and not for others.The same can be said for "leuks" like Accolade or Singulair. When I trained, we were taught that EIA was caused by a cold air trigger response which occurred during exercise ( mouth open- breathing deeply with fast gas flow ). This still has merit. At our center, we have noticed acid reflux occurring in some patients during exercise as well. One patient was a 8 year old girl. We had them use anti-reflux measures and they observed a great relief from EIA signs and symptoms. There is little in the literature to support this, but I have to remind myself that empiricism plays a huge role in medicine. Do you have heartburn, chest tightness, bubbling sensation or acid test ever? Night time awakenings with choking/coughing? Some physicans only resort to prednisone if doubling the dosage of inhaled steroids fails after 1-3 days. It generally take 24 hours for peak flow monitoring to reflect an increase in inhaled or oral steroids. Are you monitoring peak flows and kepping an asthma diary to correlate signs with peak flows and medication dosages? If you are not using one, a spacer device should be used for administering your inhalers. Spacers (such as Aerochamber, Ventahaler etc )have 2 functions: 1. To reduce oropharyngeal deposition of large particles When you puff your inhaler, a mixture of large and small particles are administered. Only the small particles get into the small airways, the large particles end up in the mouth and throat. The spacer device filters out a lot of the large particles and with routine use should get a white coating which tells you it is filtering. The big particles tend to cause the side effects. There is no filtering with a common nebulizer. 2. Improve Timing and inhalation technique. That spray from your puffer is coming out at 70 MPH. Can you consistently inhale at the correct time? Do you shoot yourself in the lip or teeth occasionally? Spacers eliminate this timing/technique problem You may need to develop a new management strategy with your doctor. Read and inform yourself about all aspects of asthma. Know and when possible avoid your triggers. You can never know everything there is to know about asthma, I am in the field and can barely keep up. Asthma is not my chosen area of interest ( COPD is) but I still have to keep current.

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