How can a 70-year-old manage daily inhaler use for COPD?

Question

Hi doctor,

I am 70 and have asthma and COPD. Lately, everything is getting worse. I am already using Symbicort every day, but very often I have to use my Ventolin inhaler five or six times daily.

How does a 70-year-old manage daily rescue inhaler use that happens five or six times every day?
I get breathless even while just walking to the mailbox now. Does using my rescue inhaler this much mean my lungs are getting worse?
Should I change my inhalers?

I am scared that one day the inhaler just will not work when I really need it. I am trapped inside my house, and it is all affecting my life.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understand your concern.

It is not great that you are using rescue inhalers so often, so it requires a deeper look. Many times, after identifying the cause and treating it, the use of rescue inhalers can be brought down.

We have to see if there are any complications like pneumothorax (a collapsed lung), which requires a chest X-ray first, or any associated heart ailments, which can happen in COPD (chronic obstructive pulmonary disease) patients and require an ECG (electrocardiogram, a test that records the heart's electrical activity) and a 2D or two-dimensional echo (an ultrasound scan of the heart).

Such patients with right heart dysfunction often have associated swelling near the ankles of the lower limbs. Keep an eye on your SpO2 (blood oxygen level) levels at home as well.

We also have to rule out associated conditions such as ABPA (allergic bronchopulmonary aspergillosis, an allergic reaction to a fungus), which is an allergic reaction to a fungus and is a common cause of exacerbation of asthma and COPD.

Apart from ruling out all possible complications, if you have any comorbidities (other medical conditions) like gastroesophageal reflux disease (acid reflux), hypertension (high blood pressure), diabetes, or sleep apnea (a condition in which breathing repeatedly stops during sleep), it is very essential to control them. Otherwise, your asthma-COPD overlap will keep on aggravating and will not remain controlled.

It is also very essential to have the correct inhaler technique because, until your inhaler technique is perfect, your asthma-COPD overlap will not be controlled.

Also, maintain a strict diet schedule. Do not eat too much at once; rather, break your meals into four to five modest-sized meals a day.

Your sleeping schedule is also important, so sleep and wake up on time. When your symptoms are controlled, start pulmonary rehabilitation (a supervised exercise and breathing program for people with lung disease) for daily exercises and breathing techniques, which can make a significant difference to your quality of life.

Also, stay away from all allergens. Wear a mask in public, stay away from smoke, perfumes, and dust, and ensure there is no mold in your home, especially.

Your medication may also need a review and may require modification or stepping up, so please visit a pulmonologist (lung specialist) and undergo spirometry (a breathing test that measures lung function) and basic blood tests like CBC (complete blood count), AEC (absolute eosinophil count, a measure of allergy-related white blood cells), and IgE (an antibody associated with allergic conditions).

If your problem is not controlled by inhalers, sometimes newer drugs called biologics can work wonders over time and provide you with significant relief.

So, you do not have to give up or get depressed. You have an array of treatment options that your doctor can suggest depending on your history, examination, and investigation results.

I hope this helps.

Please revert in case of further queries.

Thank you.