Any other asthmatics here? Possible drug issue...

[jade_dragon71]

Hi, I don't post here very often, but I do lurk alot. I'm "technically" a Pre-D, but my numbers aren't too great in general. I take things for both my asthma/allergies and for blood sugar control. I'm having some issues that make me wonder if I'm having drug interactions or if I'm just sensitive to a med.

This is what I've taken for a while now:

Byetta (5)
Singulair (for asthma and allergies)
Xopenex rescue inhaler, as needed
Allegra

I was also on Metformin 500 mg, once daily, but had to be taken off of it due to gastric distress. This is what I'm on now:

Byetta (5)
Singulair
Veramyst (steroid nasal mist for allergies/rhinitis)
Symbicort (steroid combo inhaler for asthma)
Actos (15 mg)

I have had a couple of episodes in the middle of night where I just couldn't breathe at all when I lay down. No infection, no loose cough, no drainage, nada. I also feel like my heart is going to explode out of my chest. Told the doctor, he had no explanation for it.

Fast forward to a couple of weeks since I got on Actos and the two inhaled steroids, I'm having miserable control with my blood sugar levels. I have had trouble with being over 200 2 hours post meal, and then turning around and getting hypo in the afternoon and sometimes evenings. I woke up in the middle of the night hypo last night, and I've been feeling as if my heart was going to pound out of my chest ever since. (My pulse is normal, not fast, I just feel like my heart is beating really HARD, it's not pleasant.) I'm really jittery, hyper, and nervous as well.

Called the pharmacy, who in turn had me call my Dr. He told me to cut the Actos in half, and call back in a week if it's not improved. So he feels like it's the Actos, obviously. After a while to think on it, I wonder if it's the inhaled steroids?? He wouldn't give me a Medrol shot this fall, because it makes my blood sugar skyrocket, but I wonder if the inhaled steroid could have sort of the same effect.

Any thoughts???

Thanks in advance

p.s.....before anyone asks, I haven't been eating the way I should, but the heart pounding and trouble breathing when I lay down are still unusual in me..my asthma is usually brought on by illness and/or allergy, and I've done super with both of those this fall.

[slipperyelm]

In those middle of the nigh episodes when you cannot breathe lying down, does it seem to be totally relieved by sitting up? Does it happen when you are awake, or only when you are asleep?

I'm don't know if your inhaled steroids are enough to cause your increased BG. The point of being inhaled, after all, is to use only a tiny amount of steroids that will mostly be active only where they are deposited. But it sounds like you really need the inhaled steroids. Have you ever taken a nonsteroidal systemic asthma controller such as theophyline? Do some of the older inhaled bronchodilators work well for you? Just seems that there may be some inhaled alternatives besides steroids. Looks like what you take is all "newer" stuff. Older meds sometimes relieve the asthma well but do sometimes cause stronger problems with increased blood pressure and pulse and anxiety or creepy-crawly sensations---so they might not be right for you anyway.

But if your sense of your heartbeat being too strong is due to worse asthma when you lie down, your heart really might be pumping harder at those times. It could be showing your asthma is not controlled. In fact chronic asthma can cause "back pressure" on the heart that can cause the heart to enlarge. This is something your doctor should be able to discern.

Do you have your own hand held spirometer or expiratory peak flow meter? If you do, you can compare your middle of the night lung volumes and expiratory force with your best such numbers. When the numbers are low as compared to your best numbers, you are having asthma. People generally lose 15% of the lung volume before they even know that are having asthma. That is why if your asthma is chronic it is helpful to actually do those tests regularly at home. (But you need to get a new meter every now and then. They do get worn out.) Anyway, check your peak expiratory force when you've had theses lying down episodes of hard heart beat and difficulty breathing. It should be able to tell you whether it is asthma at the moment.

You probably already know that overweight can interfere with breathing while lying down. There are ways to address that, too, including ways other than weight loss.

[jade_dragon71]

RE:the middle of the night episodes, sitting up helps quite a bit, but then not totally. I usually have to take a hit off the Xopenex inhaler, but I do that as a last resort. I'm an insomiac without all the extra help!

Yes, I do take pretty much all new with the asthma meds. I was on theophyline a looooooooooooong time ago, in my childhood, but not since. To be honest, the thing that helps my asthma the MOST is the stinkin steroids that bother my blood sugar so much now. :(

Yes, I am overweight, but I don't have trouble breathing when I lie down all nights. Just more frequently now than before.

I would honestly like to give something like Advair a shot, instead of the steroid inhaler, though it helps me.

[pdxdennisj]

I'm asthmatic and diabetic. I'm leery of steroids. I know that they are now "standard" treatment but I was put on them about 25 years ago and within 2 years I developed cataracts in both eyes. Not supposed to happen but did. The pulled me off the steroids and later did cataract surgery (plastic implants). I won't touch them.The only time I got the "heart pounding" thing was when I need to use my "rescue inhaler" more than suggested. I use Foradil now, twice a day - it keeps me under control.

[jade_dragon71]

I'm asthmatic and diabetic. I'm leery of steroids. I know that they are now "standard" treatment but I was put on them about 25 years ago and within 2 years I developed cataracts in both eyes. Not supposed to happen but did. The pulled me off the steroids and later did cataract surgery (plastic implants). I won't touch them.The only time I got the "heart pounding" thing was when I need to use my "rescue inhaler" more than suggested. I use Foradil now, twice a day - it keeps me under control.

That's what is odd to me about this....I haven't needed my rescue inhaler for about a week, yet last night was my latest "heart pounding" thing. I was hypo, though, and it woke me, which was another first.

[Alice]

I don't think it's your asthma meds...I get the heart pounding (like it's going to jump out of my chest) rarely, but sometimes during a nighttime extreme low...a low when I probably was low for sometime. I've always been able to get up and treat these...then it subsides quickly. It wears you out.

Doesn't happen very often, but like everything else...it happens to all of us sometime.

I'm on Advair with good results. Haven't used my fast-acting in months, if then.

[lilituc]

I always get heart pounding with inhaled steroids, but I'm not familiar with what you've listed.

[jade_dragon71]

Thanks for all the input everyone. I know that every time I go on a round of prednisone or get a Medrol shot, I'm a nervous wreck that doesn't sleep much for a couple of weeks. It makes sense, then, that even the inhaled ones would bother me to a degree, too.

I'm gonna call my doctor back today to see if I can cut back on the Veramyst and get the steroid inhaler changed to Advair.

[Kubilee]

I have Asthma and I took Actos when I was first diagnosed in May. I also have a Mitral Valve Prolapse and that Actos REALLY really messed me up. The Dr said it wasn't that, but that was the only new thing I had introduced to my system so it had to be it. Once he took me off it in late July, all of that stopped.

If I were you, and I am no expert, I'd have them look into taking you off that Actos, not to mention to me, it's dangerous ANYWAY!!

My asthma isn't too bad, I just need an inhaler from time to time, but needed it alot more when I was on that stuff.

My Son takes Singulair, uses an inhaler and he is fine on that. He used to take Advair and it was like some wonder drug or something, it worked on him so well. But there were some bad side effects that his Dr was worried about with his age, he was 10 at the time. so they took him off and put him on Singulair, and that seems to be doing very well for him.

I would seriously look at the Actos if I were you. But then I can't be too objective about that drug since it REALLY caused me some serious health problems. :eek: ;)

[JediSurfer]

I am asthmatic and use Salbutamol when needed and Becotide steroid twice daily. My asthma get bad if my numbers are high and sometimes when low. Other than that it doesn't really bother me unless its very cold or I am at higher alltitude.