Why is my asthma still poorly controlled at 50?

Question

Hello doctor,

I am 50 years old and have had asthma since childhood. Over the past few years, I was also informed that I may have an asthma–COPD overlap due to my long-standing breathing difficulties and previous smoking history.

Even with the daily maintenance inhalers I am supposed to take, I still need to use my rescue inhaler four to five times a day just to get through work and simple walking. I thought rescue inhalers were only for occasional use, but this has troubled me because my disease may not be well-controlled.

Could you please explain why someone with severe asthma might still require rescue medication so frequently despite ongoing treatment?
Does this usually indicate that the maintenance inhalers are not strong enough, or could it be related to incorrect inhaler technique?

I am also worried about whether frequent use of rescue inhalers could lead to long-term heart or lung complications.

Please help.

Thank you for your guidance.

Answer 1

Hi,

Welcome to icliniq.com

I read your query and understand your concern.

What your doctor has described is known as Asthma–COPD Overlap Syndrome (ACOS), a condition in which features of both asthma and COPD are present, often along with some degree of structural airway damage.

That said, needing to use your rescue inhaler four to five times daily is definitely a matter of concern and suggests that your condition may not be optimally controlled. I would strongly recommend the following steps:

Very prevalent is the incorrect use of the inhaler, which can significantly reduce treatment efficacy. Ask your healthcare professional to show you the proper method for using the exact inhaler you are taking, or watch an instructional video from a trusted source.

Allergic bronchopulmonary aspergillosis (ABPA) can occur in some asthma patients and may require additional treatment beyond standard inhalers. Asthma symptoms might be exacerbated by conditions like GERD (Gastroesophageal Reflux Disease), diabetes, hypertension, post-nasal drip, allergies, or sinus problems. Overall, respiratory control is frequently improved with proper treatment of these problems.

Review your current medication plan:Sometimes adjusting the dosage, changing medications, or adding inhaled medication may provide better symptom control. For example, if you are currently using a two-drug inhaler, your doctor may consider adding a third medication if appropriate.
Stay up to date with vaccinations:Vaccinations, especially for influenza and pneumonia, are important in reducing respiratory complications.

Regarding your concern about side effects, it is true that all medications can have potential side effects, and the risk may increase with higher doses or prolonged use. However, uncontrolled asthma or COPD can be far more harmful than appropriately adjusted treatment. Therefore, optimizing your medication regimen should be the top priority.

I hope this answers your questions.

Please feel free to follow up whenever needed.

Thank you.