(no subject)

[rivka]

A couple of times in the past, I've had a simple upper respiratory infection spiral into a massive case of reactive airway disease: shortness of breath, wheezing, dizziness, brain fog, and prolonged fits of coughing in a spasmodic, wheezy, and completely nonproductive manner. The first time I was amazingly ill and wound up in the ER, and then on multiple daily nebulizer treatments at home. I lay on the couch like a zombie for a couple of weeks. I occasionally needed an inhaler for months before my breathing finally returned to normal.

The second time, the acute illness wasn't as bad. But I still wound up on home nebulizer treatments, and carried - and needed - an inhaler for months afterward.

I've been having episodes of wheezing and shortness of breath recently. Not consistently, but sometimes. Michael caught me having a can't-breathe-coughing-helplessly episode and browbeat me into going to the doctor. Fortunately, they've opened up a new urgent care clinic right near my office, for members of the university community only.

I went there this morning. My inconsistent symptoms obligingly appeared for the nurse practitioner. (More accurately, I started having them on my way in to work, and that reminded me that I'd promised Michael I would be seen, so I went.) She gave me a breathing treatment in the office. The heavens parted and choirs of angels sang hosannas as I found myself able to take deep, satisfying breaths.

The breathing treatment had albuterol and something else in it. She looked up the something-else to see whether it was safe for breastfeeding. Class B; fine with me. She wrote me a prescription for an albuterol inhaler, which I dropped off at the university pharmacy.

This afternoon I went to pick up my prescription. There was a bright yellow sticker on the inhaler box: "Not recommended for use while breastfeeding." I asked to speak to a pharmacist, who hunted through the package insert and found that the "not recommended" label was due to animal studies, that human studies are lacking, and that the manufacturers suggest that one "consider whether to stop breastfeeding or stop use of the medication."

Refused the prescription. Called the nurse practitioner, who has yet to call me back. Came back to my office and did some googling for albuterol breastfeeding.

According to the National Library of Medicine's LactMed database: "Although no published data exist on the use of albuterol by mouth or inhaler during lactation, data from the related drug, terbutaline, indicate that very little is expected to be excreted into breastmilk.[1] The authors of several reviews and an expert panel agree that use of inhaled bronchodilators is acceptable during breastfeeding because of the low bioavailability and maternal serum levels after use."

So I don't know what the hell is going on with the Proventil package insert, or whether I should believe the folks who actually made the medicine or the database. I understand that for liability reasons they are on much safer ground if they tell pregnant and nursing women to never take anything, and online sources seem to be pretty much in agreement about the safety of albuterol. But. But.

The wheezing and coughing aren't really that bad. Crap. I don't know.

Comments

[txanne.livejournal.com]

As I was reading your symptoms, I thought "oh jeez, now Rivka has asthma too." Please go to your regular doctor and have yourself checked out! Untreated asthma leads to horrible things like pneumonia. Treated asthma lets you walk around and do normal things without coughing and chest pain!

[rivka.livejournal.com]

According to my primary care doctor, I don't have asthma. I've had three episodes of this in the last 10 years, and each time it's been a temporary problem related to an upper respiratory infection.

While it's happening, though, it does mimic asthma pretty closely.

[txanne.livejournal.com]

Thank goodness! In that case, I wonder if Xopenex would be a better inhaler. I don't know what's in it except that it isn't albuterol.

[jerusha.livejournal.com]

Xopenex is levalbuterol. It has only left-handed molecules of albuterol, but not right-handed ones (plain albuterol has both).

Short course in stereochemistry: Some molecules are assymetrical, so they exist in right-handed and left-handed versions. Sometimes there's a difference in how those molecules fit into cellular receptors, so either the left- or right-handed version has a greater therapeutic effect [and/or fewer/milder side effects] than the other. Since you can patent the single-enantiomer form of a drug, doing so has become somewhat of a cottage industry. Things to look for in drug names: dextro- or levo- [refers to how the assymetrical molecule rotates polarized light] or es- or ar- [refers to standard naming of chiral centers in molecules as S- or R-]. Example: escitalopram (Lexapro) is the S-enantiomer of citalopram (Celexa). "Racemic" means that both forms (dextro- and levo- or S- and R-) are present in a mixture.

No, I'm not in teacher-mode, not in the slightest. <quietly kicks podium into corner>

[txanne.livejournal.com]

Apologizing for teacher-mode in *this* crowd? ::blinks:: Which is to say, thank you and how cool!

[marydell.livejournal.com]

Reactive Airway Syndrome is basically Asthma that happens because of a specific thing (like a resp infection) instead of because of general cussedness. Symptoms are basically the same...

[elusis.livejournal.com]

Cough-variant asthma is what I'm diagnosed with, and sounds very close to what you experience.

Do you cough when you laugh or cry, or exercise, or inhale very cold air?

[rivka.livejournal.com]

Yes, but only in the context of these few particular illness episodes that I've had. Otherwise not. It doesn't happen every time I get an upper respiratory illness, even - just these three times over 10 years. The precipitating cold doesn't even need to be that bad. I've had plenty worse.

But indeed, when I have it, I am pretty much exactly like a person with cough variant asthma.