Road Bike, Cycling Forums banner

1 - 16 of 16 Posts

·
Registered
Joined
·
6 Posts
Discussion Starter · #1 ·
I was diagnosed with allergy induced asthma this past autumn and since then, I've been been prescribed:

Aubuterol-- which raised my heart rate prohibitively high on many training rides.

Flovent (which my doc took me off after a short period of time because it is a rather potent steroid),

Singulair in conjunction with Intal-- which seemed to work so well that I often times would forgo the Intal puff before exercise.

And most recently, Advair (used instead of the Intal) in conjunction with the Singulair.

I live in Upstate New York, where it is too nasty outside to log time on my bike, so I am confined to the torture of the trainer-- on which I ride about 5 days per week for 45 minutes to an hour per day. One would think that such a regimen would keep me pretty fit, right? Well, I seemed to be by most ways of evaluating fitness until a week and a half ago when I weighed myself (in a mall as I don't own a scale) to find that I have gained over ten lbs since going on Advair! (yes, I tried a number of scales and yes I've checked the weight on different days since to rule out factors such as water weight).

I've been under the assumption that this gain is due to the steroids found in the Advair, which my doc said were relatively mild. Again-- I seem healthy in most respects. Not fat at all. I'm just.... bigger.

And I don't like it one bit.

When I ran cross country in college, I weighed around 150 lbs. I'm now 38 and should not expect to weigh in at anything like that. But 180 is completely unacceptable.

So this new med--- Xolair--- is administered twice and month by injection and is non-steroidal. Anyone tried it? I've got an appointment with the doc later this week. I'll ask him about it.
 

·
Registered
Joined
·
1 Posts
asthma meds

Are you seeing a pulmonolgist? Sometimes other docs aren't fully up to speed on respiratory meds.

Advair is part Flovent part Singular. Flovent and advair come in three strengths. It is reduntant to use singular and advair. I haven't heard about associated weight gain with corticosteroids but I'm going to ask around at work. I'm a respiratory therapist. Intal is used less, it's an older line med. Xolair come out about 2 years ago. As I understand, it is used only for persistent otherwise untreatable asthma. Bring good insurance, I hear it is $1000 a dose (monthly injection). There is a new inhaler for Xopenex on the market. Xopenex is a bronchodialator (like albuterol) that keeps heart rates down. It's used in pediatrics alot. We don't particularly like it in our facility because we think it is not as effective as albuterol.

Studies presented at our resp convention in December all show great outcomes with advair to reduce airway inflammation in conjunction with a rescue bronchodialator such as albuterol/atrovent.

I use flovent in my peak asthma season twice a day and combivent (albuterol/atrovent) as needed.

Hope that helped, it not much fun trying to breathe thru a straw. BTW I use flovent/combivent because I get a discount, not with advair though. .

Steve
 

·
duh...
Joined
·
9,658 Posts
scottst said:
Are you seeing a pulmonolgist? Sometimes other docs aren't fully up to speed on respiratory meds.

Advair is part Flovent part Singular. Flovent and advair come in three strengths. It is reduntant to use singular and advair. I haven't heard about associated weight gain with corticosteroids but I'm going to ask around at work. I'm a respiratory therapist. Intal is used less, it's an older line med. Xolair come out about 2 years ago. As I understand, it is used only for persistent otherwise untreatable asthma. Bring good insurance, I hear it is $1000 a dose (monthly injection). There is a new inhaler for Xopenex on the market. Xopenex is a bronchodialator (like albuterol) that keeps heart rates down. It's used in pediatrics alot. We don't particularly like it in our facility because we think it is not as effective as albuterol.

Studies presented at our resp convention in December all show great outcomes with advair to reduce airway inflammation in conjunction with a rescue bronchodialator such as albuterol/atrovent.

I use flovent in my peak asthma season twice a day and combivent (albuterol/atrovent) as needed.

Hope that helped, it not much fun trying to breathe thru a straw. BTW I use flovent/combivent because I get a discount, not with advair though. .

Steve


And apparently even those that pretend to be pulmonologists (or resp therapists that go to resp conventions) aren't fully up to speed on respiratory meds. Advair is comprised of fluticasone propionate (corticosteroid, aka Flovent) and salmeterol xinafoate (long-acting beta-adrenergic agonist or bronchodilator, aka Serevent)... Advair does NOT contain Singulair (montelukast), which is available as an oral med. I don't believe any study shows additional benefit when Singulair is added to Advair (but not vice versa), so you are right in that for most cases it would be unnecessary to use both.

Xopenex is simply the R-isomer of albuterol (Ventolin and generics). Non-Xopenex albuterol is racemic mix albuterol, i.e., R- and S-albuterol; whether Xopenex is a benefit over plain ol' albuterol remains controversial (despite the marketing). Also, Atrovent (ipratropium bromide) and Combivent (albuterol + ipratropium) are not typcally used as a rescue inhalers, at least for asthmatics.
 

·
You're Not the Boss of Me
Joined
·
7,746 Posts
I'm shocked that an inhaled steroid would be metabolized systemically and contribute to weight gain. My general reaction is that that's a bunch of hooey. I'd love to hear from the experts (I use Advair b.i.d. and albuterol p.r.n.)
 

·
Registered
Joined
·
21 Posts
it's hooey

jtolleson said:
I'm shocked that an inhaled steroid would be metabolized systemically and contribute to weight gain. My general reaction is that that's a bunch of hooey. I'd love to hear from the experts (I use Advair b.i.d. and albuterol p.r.n.)
At least from a statistical perspective. In theory, there can always be rare outlier patients who do not metabolize the drug the same way as everyone else.

Here's one study of several that show no statistically significant association between body weight and inhaled corticosteroids:

Int J Obes Relat Metab Disord. 2000 Sep;24(9):1217-25.

Body weight characteristics of subjects on asthma medication.

Hedberg A, Rossner S.

Centre for Epidemiology, National Board of Health and Welfare, Stockholm, Sweden. [email protected]

OBJECTIVE: Weight gain is a frequently documented side effect after long-term anti-inflammatory treatment with systemic corticosteroid drugs in patients with asthma. In recent years new types of inhaled corticosteroids have been introduced, which act locally and are more rapidly bio-transformed. Even such corticosteroids may have a detectable, clinically relevant systemic side effect on weight. The aim of this study is to investigate if there is any relationship between body weight and asthma medication. DESIGN: The relationship between asthma medication and body weight was analysed in two combined randomized samples of the adult Swedish population 16-60 y of age (n = 17,912). Multivariate logistic regression analyses were carried out to obtain estimates for (1) body mass index (BMI) indicating 'obesity' (BMI > 29.9 kg/m2) in men and women controlling for self-reported asthma medication, and (2) self-reported asthma medication controlling for BMI. In both cases we furthermore controlled for interview period, age, Swedish region, smoking habits, physical activities and level of education. RESULTS: We found no significantly higher odds for obesity in men (OR = 1.21 (0.55-2.64) or women (OR = 1.97 (0.89-4.38) on asthma medication compared to men and women with pharmacologically untreated asthma even after adjustment for smoking habits, physical activities, level of education and other related co-variables. However, we found significant positive associations between obesity and interview period, age and former smoking and inverse significant relationships with the degree of physical activity. We also found significantly higher adjusted odds for asthma, indicated by self-reported asthma medication, in women (OR = 2.74 (1.91-3.91)) but not in men (OR = 1.57 (0.96-2.56)) with BMI indicating 'obesity'. CONCLUSION: There is no strong evidence to suggest that modern pharmacological asthma treatment may contribute much to the development of obesity in either men or women on asthma medication. Adjustment for smoking habits, physical activities, level of education and other related co-variables have minor effects on these relationships. Obesity may still be an independent risk factor for asthma since we observed significantly higher odds for self-reported asthma medication in women and an almost significant relationship in men even after control for BMI and other related co-variables.
 

·
Registered
Joined
·
6 Posts
Discussion Starter · #6 ·
No evidence of weight gain associated with steroidal inhalants, huh?

Yeah, well that's not too comforting. That means I'm just getting bigger because I'm getting older-- muscles thickening--- metabolism slowing down. But that's life, isn't it?

Of course we'll never really know until the weather breaks and I have the luxury of ridding two hours per day. Then-- we'll see!

On the plus side: a major goal of mine is to time trial a lot better this coming season. Added weight will bother me more on climbs than it will on my club's TT course which is very flat. I'll just have to remind myself that more weight means greater forward momentum!
 

·
Registered
Joined
·
1,272 Posts
fat tire fred is correct regarding these meds. a couple of thoughts: allergy induced asthma. your exercising frequently at home. the best practice is to attack the condition at it's origin. have you cleaned your home's air filters, checked for mold,etc., especially if you exercise in the basement? cheap and effective prevention. also, if the singulair was working, why stop? and, if you can train 5 days/week, you would not be a candidate for xolair, its for severe cases. if your looking for a different treatment option, you may want to ask your doctor (always the best place for advice) about foradil.
 

·
Registered
Joined
·
6 Posts
Discussion Starter · #8 ·
As far as treating the cause... It seems that I've developed an allergy to cat hair and dust mites, which is unfortunate considering one of my cats is far and away the best cat I've ever had; the "cat of a lifetime," I say at the risk of sounding overly dramatic. I have no such affection for dust mites however, and I've taken all sorts of measures to deal with that. I'll look into air filter situation...

I'm still on Singulair (in conjunction with 250 Advair twice a day), and if it weren't for the high demands that my passion for cycling places on me I might never know that there was an issue to begin with (save for a few scary instances this past fall). My mild condition makes me wonder how many people out there are slightly asthmatic without ever being aware of the fact. It kills me to imagine that I've had this condition at some level all along, and to think of what kind of track times I might have put in back in the day...
 

·
duh...
Joined
·
9,658 Posts
Jashue said:
My mild condition makes me wonder how many people out there are slightly asthmatic without ever being aware of the fact.

Tons. Underdiagnosis and denial of symptoms are very common with this disease. For various reasons there is a reluctance to diagnose asthma, esp in children. Patients with asthma often just plain get used to living with their symptoms. And as you would suspect, undertreatment is a huge problem as well.
 

·
duh...
Joined
·
9,658 Posts
Don't be shocked and it's not all hooey. The different inhaled corticosteroids are absorbed, distributed, and metabolized slightly differently, at different rates and extents. Absorption is generally low and metabolism quick (with few having active metabolites), but if you greatly escalate the dose or use the inhalers improperly the risk for systemic adverse effects goes up. That said, at normal therapeutic doses the risk for such adverse effects is small. However as stated previously, the susceptibility may be different for different individuals.
 

·
Registered
Joined
·
1,272 Posts
remember, though, allergies are acquired. your not born with them. and many people acquire allergies as adults. cat,bike,cat,bike................I'd choose bike. (sorry, I'm a dog person). as a practical solution, maybe try to isolate a ''bike only room" for your indoor training. perhaps a small room with a window for fresh air.
 

·
Registered
Joined
·
53 Posts
Jashue said:
So this new med--- Xolair--- is administered twice and month by injection and is non-steroidal. Anyone tried it? I've got an appointment with the doc later this week. I'll ask him about it.
My mother takes Xolair. She really likes it. She was involved with the introduction of the drug and said that it just didn't work for some of the people in the test group. It's also pretty expensive stuff being that it's actually a full on antibody, not just a protein. Being an antibody means it lasts longer, but they're very expensive and hard to produce. In addition to it being expensive, it can sometimes be a hassle to get an appointment frequently for shots. Other than that, for her, she rarely gets her usual asthma symtoms when she's on it. She can work hard outside or in the dusty garage without wheezing when she'd normally need to use the albuterol several times.
 

·
duh...
Joined
·
9,658 Posts
Fignon's Barber said:
remember, though, allergies are acquired. your not born with them. and many people acquire allergies as adults. cat,bike,cat,bike................I'd choose bike. (sorry, I'm a dog person). as a practical solution, maybe try to isolate a ''bike only room" for your indoor training. perhaps a small room with a window for fresh air.

That's a bit inaccurate. The immune system is not fully developed at birth, hence newborns cannot mount an immune response, i.e., allergy. There is genetic predisposition to who will develop allergies. They are not acquired in a sense that you do something and then become allergic or not do something and thereby prevent allergies. So to some degree you are indeed born with allergies, they just may not manifest until later in life after exposure to relevant allergen.
 

·
Registered
Joined
·
1,272 Posts
FatTireFred said:
That's a bit inaccurate. The immune system is not fully developed at birth, hence newborns cannot mount an immune response, i.e., allergy. There is genetic predisposition to who will develop allergies. They are not acquired in a sense that you do something and then become allergic or not do something and thereby prevent allergies. So to some degree you are indeed born with allergies, they just may not manifest until later in life after exposure to relevant allergen.
sorry. didn't want to turn this into a debate over infant IGE level elevation or genetics. I was simply trying to help the poster realize that he may not have had the condition his whole life. I'll try to be more accurate next time.
 

·
Registered
Joined
·
1,786 Posts
Jashue said:
So this new med--- Xolair--- is administered twice and month by injection and is non-steroidal. Anyone tried it? I've got an appointment with the doc later this week. I'll ask him about it.
My 16 year old son has been on Xolair for almost a year. He had used most of the products you mention (advair, flovent, albuterol, etc). The Xolair has kept him off the other drugs almost completely, He did use advair for about a week when a certain pollen was at record levels. Allergies are quite bad around St. Louis. Can't recall when he last needed albuterol.

He also has a peanut allergy and the Xolair has been found to reduce anaphylatic (sp?) reactions with some food allergies. My wife is a nurse and we administer the injections at home, eliminating the doctor's visit twice a month. Check your insurance to confirm coverage, otherwise you might be paying $1,800.00 per month (what we have been told).
 

·
Registered
Joined
·
732 Posts
Perhaps the elephant in the room with omalizumab and many other monocolanal antibody therapies is the risk of malignancy. Clearly one must consider risks and benefits of therapies like this. In the case of omalizumab, there is a 2.5 times greater risk of solid organ, and epithelial malignancies (though the absolute risk is small 0.5% for omalizumab versus 0.2% for placebo). Of course, the risk of long term use is not known, and may do nothing for cancer risk or may produce some cumulative risk. There is also the risk of developing antibodies to the antibody, and thus decreasing its effectiveness. The overall risk of a serious reaction appears to be less than a percent.
 
1 - 16 of 16 Posts
Top