Question:
I’m glad that this thread has been brought up, because I too am confused about it. During my last visit to the doctor, I had hoped that we could try reducing my prednisone dosage. (I take 30 mg every other day & haven’t gotten below 17 1/2 mg every other day in the last 6 years. I also use 20 puffs/day of Vanceril as well as Beconase, Intal for exercise and Ventolin.) He explained to me that he was in the process of doing new research that indicated that severe flare ups might cause permanent damage to the lungs. He seemed to imply that these results were unexpected and that they were going to do more research to clarify the issue. Since whenever we lower my dosage I tend to get sick and then have flare ups which required additional bursts of prednisone, he recommended that we wait to reduce my dosage for the time being. When I was talking to him on the phone yesterday, I asked him to explain more about this and he started talking about something called End Stage Asthma which seems to have to do with the lungs’ being inflamed for years — even if controlled with prednisone, etc. I tried to search for information about this in MedLine, but was unsuccessful. When I have a chance, I’ll go to the nearby med school and peruse the journals. I also plan to ask my doctor for more information when I next see him. I’ll let you know what I learn. In the meantime, if anyone has any information about this, I’d really appreciate it. Thanks. Lisa in Chicago " ‘Hope’ is the thing with feathers ~ That perches in the soul ~ And sings the tune without the words ~ And never stops ~ at all." Emily Dickenson, #254, 1861.
Response:
<<Yes you can damage your lungs further by not properly treating them. Sadly to say Asthma can be progressive…you can "grow" out of it…or it can progress into a COPD. Asthma is classed as COPRD Chronic Obstructive Pulmonary Reversible Disease…the next stages can enclude emphysema..which is what I now have. Too many years of asthma out of control and severely reactive to to many things. My doctor and I had a long discussion recently about this very subject. I am a bit confused by what my doctor told me a few weeks ago and what you just said. According to my doctor (pulmonary specialist), asthma is not a progressive disease, and will not lead to emphysema or COPD. He says my lung’s ability to exchange oxygen and carbon dioxide will not decrease with length of time I have had asthma, whether it is controlled or not. In fact, since he had not done an extensive test of my lung function in the last five years, he put me through a long battery of tests. So far, in a ten year time period, my lung capacity, ability to exchange gases, and internal surface area have not changed at all. I’d appreciate anyone being able to reconcile these two, seemingly-contradictive positions. Thanks in advance, Joe Toomey
Response:
I also am confused. I have Kaiser for medical coverage, so I am sure I will remain confused. . My asthma after 10 years of being controllable, got about 100 times worse when pregnant with my daughter, I was told by the doctors at that time that it would probably go back to the way it was after the baby was born. It didn’t. It has become progressively worse since her birth in ‘91. My asthma has gotten to the point where it is almost uncontrollable. I have a few serious attacks, I get put on prednisone, along with the ventolin and azmacort inhalers. After about 7-10 days after the pred wears off, I start to go throught the same cycle again. But I am at the point where not breathing would be better than the side effects of prednisone. I do think asthma may be a disease that no one is quite sure about, but for some of us it is progressive. kadi – Hide quoted text — Show quoted text – I’m glad that this thread has been brought up, because I too am confused about it. During my last visit to the doctor, I had hoped that we could try reducing my prednisone dosage. (I take 30 mg every other day & haven’t gotten below 17 1/2 mg every other day in the last 6 years. I also use 20 puffs/day of Vanceril as well as Beconase, Intal for exercise and Ventolin.) He explained to me that he was in the process of doing new research that indicated that severe flare ups might cause permanent damage to the lungs. He seemed to imply that these results were unexpected and that they were going to do more research to clarify the issue. Since whenever we lower my dosage I tend to get sick and then have flare ups which required additional bursts of prednisone, he recommended that we wait to reduce my dosage for the time being. When I was talking to him on the phone yesterday, I asked him to explain more about this and he started talking about something called End Stage Asthma which seems to have to do with the lungs’ being inflamed for years — even if controlled with prednisone, etc. I tried to search for information about this in MedLine, but was unsuccessful. When I have a chance, I’ll go to the nearby med school and peruse the journals. I also plan to ask my doctor for more information when I next see him. I’ll let you know what I learn. In the meantime, if anyone has any information about this, I’d really appreciate it. Thanks. Lisa in Chicago " ‘Hope’ is the thing with feathers ~ That perches in the soul ~ And sings the tune without the words ~ And never stops ~ at all." Emily Dickenson, #254, 1861.
Response:
Dear Joe, The issue is a potentially confusing one. In broad general terms, asthma is disease of airflow obstruction with signficant potential for improvment and COPD is a disease of airflow obstruction that is persistent. As your lung specialist suggested to you, most asthma sufferers have no reason to fear progressive loss of lung function and development of emphysema or COPD. However, it is fair to say that some asthma sufferers with severe disease that is poorly controlled may developed an element of obstruction that is permanent. For example, if someone with severe asthma is left undertreated for many years, the response to maximal therapy may be less than 100% lung function. Some elderly people who have never smoked but who have had a long background of treatment with only bronchodilators show a permanent loss of lung function so that their best airflow is just 40 or 50% of normal even with maximal therapy. Often these people have had few complaints and seem to be insensitive to the severity of their disease. This is one of the arguements for testing lung function in addition to asking questions about symptoms to assess disease control. If doctors don’t measure what they are treating, they may undertreat. Remember though, most asthma sufferers are unlikely to lose lung function progressively – only a small number are at risk. – Hide quoted text — Show quoted text – <<Yes you can damage your lungs further by not properly treating them. Sadly to say Asthma can be progressive…you can "grow" out of it…or it can progress into a COPD. Asthma is classed as COPRD Chronic Obstructive Pulmonary Reversible Disease…the next stages can enclude emphysema..which is what I now have. Too many years of asthma out of control and severely reactive to to many things. My doctor and I had a long discussion recently about this very subject. I am a bit confused by what my doctor told me a few weeks ago and what you just said. According to my doctor (pulmonary specialist), asthma is not a progressive disease, and will not lead to emphysema or COPD. He says my lung’s ability to exchange oxygen and carbon dioxide will not decrease with length of time I have had asthma, whether it is controlled or not. In fact, since he had not done an extensive test of my lung function in the last five years, he put me through a long battery of tests. So far, in a ten year time period, my lung capacity, ability to exchange gases, and internal surface area have not changed at all. I’d appreciate anyone being able to reconcile these two, seemingly-contradictive positions. Thanks in advance, Joe Toomey
Response:
[in response to growing out of asthma, or it getting worse] My doctor and I had a long discussion recently about this very subject. I am a bit confused by what my doctor told me a few weeks ago and what you just said. According to my doctor (pulmonary specialist), asthma is not a progressive disease, and will not lead to emphysema or COPD. He says my lung’s ability to exchange oxygen and carbon dioxide will not decrease with length of time I have had asthma, whether it is controlled or not.
My Dr. didn’t comment on the lung’s ability to exchange oxegon, but rather the muscles around the small airways getting "worn out", and not being able to open back up properly, when you have severe chronic asthma. The smaller surface area makes for a decreased volume of O2=CO2 exchange, even though the rate of exchange per cubic centimeter of air remains the same. My *guess* is it’s like any other form of exercise: walking a few extra miles a day might get you in better shape, but being forced to run twenty miles a day might wear out your muscles and lead to leg problems…which is why some people, especially with mild asthma, "grow out of it", and others get worse. I’m not a physician, but the theory made enough sense for me to keep taking my meds more religiously (and after a minor attack a few months later, I was glad I had). Scott T.
Response:
Hi Joe; Like every ailment asthma progresses differently for each of us. Some outgrow it, others progress into more severe forms. As a child I was asthmatic…exercise related, allergy related, stress related and Bronchial..each bout of pneumonia and bronchiatis damaged my lungs more and more. For a very long time during my early adult years I was not able to afford Dr.’s or prescription medications, using instead OTC drugs to try and control it. Unfortunately they tend not to be as effective in my case. One very severe attack in my late 30’s landed me in the hospital under the care of a Dr. who ignored whatever I had to say instead asking what kind of dinosaur he had on his tie (I told him what to do with the stegasaurous), he overdosed me on Theopyllin, to the point that I can no longer take any medications containing it. Over the years my asthma has continued to progress to the pint where I am now diagnosed with emphesyma….not what I wanted to hear. As well long courses with steroids has brought forth a latent tendency to diabetes and I now have to take insulin 2x per day. asthma can progress and get worse under certain conditions, heavy smoking around you, environments that are toxic..like NJ…constant bouts of pnuemonia, flu and bronchiatis can weaken your lungs further. But as I said it is different for each of us, the key is control though. Right now you may not have had any further lose of lung function, or you could have been having a good day. What tomorrow may bring, no one knows, sadly not even the Dr.’s they are not omnipotent..merely trained to look at the odds. The odds are currently with you, but like any ailment they can change, a genetic predisposition to certain ailments can also change your picture even though you are healthy right now. The best advice that I can give, or anyone can is listen to your Dr. if he seems competent, check with the Asthma Society, and keep your asthma under the tightest control you can manage. rainbird – Hide quoted text — Show quoted text – My doctor and I had a long discussion recently about this very subject. I am a bit confused by what my doctor told me a few weeks ago and what you just said. According to my doctor (pulmonary specialist), asthma is not a progressive disease, and will not lead to emphysema or COPD. He says my lung’s ability to exchange oxygen and carbon dioxide will not decrease with length of time I have had asthma, whether it is controlled or not. In fact, since he had not done an extensive test of my lung function in the last five years, he put me through a long battery of tests. So far, in a ten year time period, my lung capacity, ability to exchange gases, and internal surface area have not changed at all.
Response:
Please use your medications as they are prescribed…by not taking the Ventolin you are in effect (using and analogy here) writing code for a program and leaving out the .exe file. Each medication addresses a diferent area in a different way. If you are "tight" but not wheezing your peak flows are lower than they should be then you do not have enough oxygen in your blood to supply your muscles properly. Ero sum..tired and listless. I have to use an O2 condenser…the difference between me off O2 and me on is phenominal. Yes you can damage your lungs further by not properly treating them. Sadly to say Asthma can be progressive…you can "grow" out of it…or it can progress into a COPD. Asthma is classed as COPRD Chronic Obstructive Pulmonary Reversible Disease…the next stages can enclude emphysema..which is what I now have. Too many years of asthma out of control and severely reactive to to many things. Use your meds as directed…and start slow on exercise, walk a block, then add more walking time and speed slowly over a series of weeks. It will help. rainbird – Hide quoted text — Show quoted text -Hi there, I have recently been diagnosed as a chronic asthmatic, I don’t get the acute episodes, but seem to be "tight" in the chest most of the time(my peak flow is down on what it should be). I origionaly sort help because about a year ago I began to feel tired and listless, I had night coughs, and my fitness level seem to plummet. I quite often don’t take my prescribed ventolin since I don’t feel "whezzy". (but the peak flow tells me I’m not running on all cylinders) Is this ok?, the books that I have read mention ventolin as a reliever, I don’t like the idea of being on 4hrly ventolin for the rest of my life when I have never suffered from an acute attack. I have also been prescribed pulmocort from a turbo inhaler 2puffs twice a day. Although my peak flow has improved, and the night coughs have vanished I still feel tired. I THINK that it has to do with my fitness level being so poor now. My questions are Is my "ventolin on demand" scheme ok, or should I go back to the 4hrly presciption Can having untreated chronic asthma damage your lungs(even with a good peak flow I seem to have less "wind" than I remember having) What are the long term effects of chronic asthma, will it/can it become acute? What else should I be looking for? boc — Brian O’Connor, Unix Systems Consultant Latrobe University,Bendigo
Response:
Hi there, I have recently been diagnosed as a chronic asthmatic, I don’t get the acute episodes, but seem to be "tight" in the chest most of the time(my peak flow is down on what it should be). I origionaly sort help because about a year ago I began to feel tired and listless, I had night coughs, and my fitness level seem to plummet. I quite often don’t take my prescribed ventolin since I don’t feel "whezzy". (but the peak flow tells me I’m not running on all cylinders) Is this ok?, the books that I have read mention ventolin as a reliever, I don’t like the idea of being on 4hrly ventolin for the rest of my life when I have never suffered from an acute attack. I have also been prescribed pulmocort from a turbo inhaler 2puffs twice a day. Although my peak flow has improved, and the night coughs have vanished I still feel tired. I THINK that it has to do with my fitness level being so poor now. My questions are Is my "ventolin on demand" scheme ok, or should I go back to the 4hrly presciption Can having untreated chronic asthma damage your lungs(even with a good peak flow I seem to have less "wind" than I remember having) What are the long term effects of chronic asthma, will it/can it become acute? What else should I be looking for? boc — Brian O’Connor, Unix Systems Consultant Latrobe University,Bendigo
Response:
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