How to control post-pregnancy asthma?

Question

Hello doctor,

I am a 37-year-old, and my asthma has been out of control since I developed it suddenly two years ago, right after having my twins. I never had breathing problems before pregnancy, but now I use my Albuterol inhaler six to eight times a day and still wake up wheezing every night. My peak flow readings are usually around 320, when they should be close to 450 for my height. I tried a combination inhaler with Fluticasone and Salmeterol, but I still have exacerbations that land me in the emergency department about once a month.

Last time my oxygen saturation dropped to 88 percent, and they gave me a Prednisone burst, which helped temporarily, but I gained 12 pounds. My allergist tested me and found I am allergic to dust mites, mold, and cat dander, but we have two cats that the kids are attached to, and I also have bad acid reflux, which the doctor thinks might be triggering asthma symptoms. I cannot exercise at all anymore without getting severe bronchospasm. My periods make everything worse; asthma always flares up the week before menstruation starts. Is there a hormonal connection with asthma?

I have been breastfeeding for the past 18 months, and I am wondering if that affected my immune system. I really need better control because I cannot take care of twins when I can not breathe.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com

I read your query and understand your concern.

Let me walk you through what is going on and how we can get you breathing comfortably again.

Your rescue inhaler many times a day and waking up wheezing every night means the background inflammation in your airways is not fully controlled. We need to strengthen your daily controller (maintenance) treatment so your lungs stay open and calm all the time, not just when you use the rescue inhaler.

You may need a higher dose controller inhaler, something you take morning and night, and that can also be used for quick relief when needed. I would recommend you use MDI Formoterol + Budesonide (400/6).
It can be used both as a controller when required, but ensure your inhaler technique is correct by getting it checked by a doctor, and you may also watch inhaler technique videos. If you have used the Budesonide and Formoterol combination earlier as well, its dose can also be increased.
You may also take a Montelukast tablet once a day. If that still does not control the symptoms, there are newer injectable medicines called biologics that target the exact allergy or inflammation driving your asthma.
They are given every few weeks and can reduce attacks dramatically. There are other options, such as immunotherapy, as well, which can be helpful and will desensitize your body to the allergens.

Allergies are also playing a big part here. If you cannot give up on cats, keep them out of the bedroom, vacuuming, and dusting with a HEPA (high-efficiency particulate air system. filters, and using air purifiers can lower dander and dust levels a lot. For mold, fix any damp spots. Every bit of allergen control gives your inhalers a better chance to work.

Hormones definitely play a role. Many women find their asthma worsens in the week before their period. Sometimes increasing your controller dose just during that week, or using a tablet like Montelukast, helps. Exercise will come back, but for now, start a slow warm-up, gently use your reliever inhaler a few minutes before activity, and avoid cold air or strong odors while exercising. Building back fitness actually helps the lungs become less twitchy over time.

I hope this helps.

Thank you.