How to treat asthma without increasing doses in late 60s?

Question

Hello doctor,

I am 68 and have had asthma for most of my life. Lately, it has been worsening, especially due to my allergies to pollen and paint fumes. I am currently using a long-acting bronchodilator and a steroid inhaler, but I still experience wheezing or shortness of breath when pollen levels are high. Even small paint jobs around the house trigger my symptoms.

Recently, my doctor noted that my oxygen levels were lower than normal and suggested adding oral steroids or stronger inhalers. However, I am concerned about the potential effects on my bone health and other side effects. Is there a way to manage my asthma more effectively without significantly increasing medications? Are there any specific steps I can take to better avoid my triggers? Please advise.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Managing asthma, especially when it is compounded by allergies and other sensitivities like paint fumes, can be challenging. Here are some strategies that may help you avoid increasing medication dosage while still maintaining good asthma control:

1. Environmental control and trigger avoidance: On high pollen days, try to stay indoors with windows closed, especially during peak times (early morning and late afternoon). Use air purifiers with HEPA (high-efficiency particulate air) filters in your home to reduce indoor pollen levels, and consider a dehumidifier if you live in a humid area, as mold and dust mites (also common allergens) thrive in damp conditions. Additionally, when painting or doing renovations, wear a mask, ensure the area is well-ventilated, or consider hiring someone else to do it to avoid direct exposure.

2. Optimize your inhaler technique: Even a small change in technique can affect how much medication reaches your lungs. You can learn the appropriate inhaler technique on the Internet. Ask your healthcare provider to monitor your technique to ensure it is correct. Always use a spacer with an inhaler since it will improve the delivery of inhaled medication.

3. Regular use of preventative inhalers: Ensure that you are consistent with both your long-acting bronchodilator and steroid inhalers, as they work best when used as prescribed, even on days when symptoms are mild. Such an inhaler is to be used for a long time, even when you do not have symptoms, and no dose shall be skipped unless advised by your treating doctor.

4. Exercise and breathing exercises: Controlled, gentle exercises like walking or swimming (especially in a well-ventilated, pollen-free environment) can strengthen your lungs and improve breathing capacity.

5. Regular monitoring and pulmonary rehabilitation: Keep a record of your symptoms and peak flow readings (if you have a peak flow meter). This can help you recognize early signs of worsening asthma. Pulmonary rehabilitation programs, often offered at hospitals, can teach you breathing strategies and physical exercises to improve lung function.

6. Diet and bone health: Usually, oral corticosteroids are prescribed for a very short duration period in asthma patients and hence are generally free from long-term side effects on bone health. As far as the inhaled corticosteroids are concerned, they do have systemic effects, but their systemic effects are minimal and can be ignored most of the time.

7. Frequent check-ins with your healthcare team: Regular appointments can help catch any decline in lung function early, allowing your doctor to adjust your treatment in smaller, manageable increments.

By focusing on avoiding triggers, optimizing current therapies, and exploring additional non-steroidal options, you might be able to reduce the likelihood of needing higher doses of oral steroids. Always discuss any changes with your healthcare provider before starting them, as they can help tailor these suggestions specifically to your asthma profile.

I hope this helps you.

Take care.