Use of Albuterol in Asthma – using it too often?

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Hi there, my name is Dr. Chet Tharpe and I’m a board-certified allergy and asthma specialist in South Carolina. For this video blog, I want to discuss albuterol use in asthma. I think this is probably one of the most misunderstood medications in all of medicine but definitely the most misunderstood medication in the world of asthma.

On an almost daily basis, I encounter patients in various settings including urgent care settings or more commonly now, through telemedicine who are looking for refills of albuterol for their asthma. They often state that they use albuterol daily or multiple times per day because they need it for their symptoms such as chest tightness, shortness of breath, wheeze or cough. They state it’s been prescribed 2 puffs every 4-6 hours as needed by previous doctors so they just use it as often as they need per the prescription instructions. Many tell me they have used albuterol several times weekly or daily for several years for these breathing symptoms and that’s normal for them.

And then, I catch them by surprise. And I may be catching you by surprise now as well, by telling you that albuterol should not be used more than 2 times in 1 week excluding prior to exertion. Again, I repeat, you should not be using albuterol more than 2 times in 1 week unless you use it before exercise or exertion only. If you are using it purely for exercise induced asthma or bronchospasm and need to use 2 puffs prior to exertion for symptom prevention, that doesn’t count. However, if you use it during exertion after initially using it beforehand for prevention, or using albuterol at any other time during the week more often than 2 times, your asthma is not controlled.

And this is not something that I have made up based upon my own personal experiences or opinions as a physician. This is agreed upon by worldwide asthma guidelines.

Now, to clarify, you can use albuterol every 4-6 hours as needed for asthma symptoms. It is there for you to use if needed. However, what many medical providers fail to tell you, is that if you are using it on a regular basis more than 2 times in 1 week excluding prior to exertion, your asthma is not controlled and you need to discuss this with them as soon as possible.

I am going to explain in detail why it is so important to decrease your use of albuterol and get your asthma under control, but let’s start by going into what albuterol does because I think that can also be helpful for you.

Albuterol works on receptors in your lung to relax the muscle and help pop your airways open almost immediately to “rescue” you, which is why it’s called a rescue medication. So when you are having asthma symptoms and your airways are constricted and tight, albuterol works fast to help open them up almost immediately helping you breathe better. However, the effects of albuterol will only last a few hours and then they are gone. So it’s a very temporary measure which is why you can use it as needed every 4-6 hours because its effects will completely wear off in about 4 hours. It’s very important to recognize that it is only helping to relax the lung temporarily and is not treating the cause of your asthma which is inflammation.

Think of your uncontrolled asthma as a bleeding wound and albuterol as a bandaid stopping the bleeding temporarily. The band aid will cover up the issue for a few hours but the wound is still bleeding so the bandaid will need to be replaced in a short time. The band-aid isn’t addressing the underlying problem which is the cause of the bleeding, it’s just masking it temporarily.

So now let’s talk about why it’s important to get that uncontrolled inflammation or bleeding so to speak under control and decrease your use of albuterol.

First, it signifies that you are at a higher risk of having an asthma attack that will likely require more harmful medications to control it such as oral steroids. More importantly, it also means you are at a higher risk of a bad outcome from asthma such as a hospitalization and even death.

Secondly, repetitive use of albuterol may cause it to not work as effectively over time. So, in other words, your body may become “resistant” to albuterol over time. In the medical world, resistance to a medication is known as tachyphylaxis and this is a possibility. And as a rescue medication, you want it to work or rescue you when you absolutely need it to. If it doesn’t, again may be at a higher risk of a bad outcome from asthma.

Also, since the underlying issue of uncontrolled inflammation is not being addressed, chronic inflammation of the lungs can cause lung remodeling. And this lung remodeling as a result of chronic uncontrolled inflammation is just a really nice way of saying the lungs have become scarred. And scars are permanent and will permanently decrease the function of your lungs.

As you may know, asthma is what we call a reversible lung condition. COPD or chronic obstructive pulmonary disease, which is what we often see in smokers, is an irreversible lung condition. Believe it or not, they are basically the same condition, just asthma is reversible and COPD is irreversible. Well, we know that over time due to remodeling as a result of uncontrolled inflammation, asthma can lose it’s reversibility and make a transition to COPD. We call this transition to COPD, the asthma COPD overlap syndrome or ACOS. As a result, these patients often have more difficulty controlling their lung symptoms and have poorer outcomes.

Another thing to point out is that if you’re using albuterol regularly your lungs are not optimized and exchanging air as they should be. Thus, you’re probably not performing or exerting yourself very well without having breathing symptoms and you may feel limited in what you can do with respect to exercise. As a result you may not exercise much, may become inactive and obese which can have a direct impact on your asthma and cardiovascular health in general.

In my clinic, when I prescribe albuterol, I do not give refills unless I’m treating someone whom I’m confident only uses albuterol prior to exercise. Otherwise, not giving refills helps me keep tabs on how much albuterol you are using and thus, how well controlled your asthma is. This is purely to look out for your best interest to not only address a current issue due to uncontrolled asthma but also to help prevent any remodeling or other bad outcomes in the future.

Thus, as you can see, uncontrolled asthma, signified by how often you use albuterol can harm you greatly in many ways. It is absolutely imperative that if you use albuterol frequently such as more than 2 times in 1 week excluding prior to exertion, your asthma needs to be better controlled. Thankfully, there are many medical options or “controller” medications that your physician can discuss with you to get your asthma under better control which will decrease your need for albuterol.

So, as always, I hope this has helped you give you a better understanding of albuterol’s use in asthma and I also hope it will stimulate a productive discussion with your physician about your asthma if you find yourself using albuterol more often than you should be. If you liked this video, please leave me a comment and subscribe to my e-mail list where I can keep you updated on new videos and educational opportunities through ChetTharpeMD.com. Thanks for your support! Great days are ahead!

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