Ventolin aerosol

Which inhaler format do you prefer? Powder vs aerosol or something else?

2022.12.13 22:04 hatesnoisybitches Which inhaler format do you prefer? Powder vs aerosol or something else?

I seem to have mild cough variant asthma, bit worse in winter, I just got 2 blue aerosol ventolin inhalers ~month and a half ago and just went back to get the brown preventer inhaler.
Doctor that prescribed the blue one didn’t tell me about any inhaler types or anything. They had me go to the nurse for the brown one and she had a big infographic sheet with inhaler types. Says they’re being encouraged to start prescribing the powder inhalers for environmental reasons (using NHS, UK) but I could pick (Boots has to faff with ordering it in, though).
I just chose the aerosol because I already got the spacer tube and everything and breathing in powder sounds much less enjoyable than gas. I just searched the sub and people are finding the powder feels like it burns in the lungs and another person threw up (yikes!).
Nurse also old me pharmacies have bins for old inhalers so they can incinerate the canisters and it isn’t as bad. I asked about this at the Boots and they didn’t seem to know what I was talking about?
Can anyone that’s used both tell me if they had significant preferences for or problems with one or the other? There seem to be different powder inhaler shapes like discs, is there much difference?
Google tells me there are soft mist inhalers? What’s up with those?
submitted by hatesnoisybitches to Asthma [link] [comments]

2022.10.04 04:26 Rona_season798 First attack since 2007

First attack since 2007
My Earliest memories in life came from watching the women In my family smoke around the table in the kitchen. 4 women smoking at once constantly. Always chatting it up and lighting up.
After that I would always be in the car with my mom or family friends and there would always be cigarette smoking. One of my best friends since I was a baby also had asthma when we were little. He was around the same activities.
The worst thing about it is when the doctors would tell us what I had my narcissistic mother would stand there like she was shocked at how this could happen.
My father who was divorced with her at the time didn’t care either. He thought it was something that was eventually going to ruin my chances of me being a soldier later in life. Neither of them cared.
I remember laying down for years on the couch alone hoping I would yawn out loud so I could get some oxygen in my lungs. I remember Being extremely tired and dealing with everything alone do to shitty self absorbed parents.
In my teenage years I became pretty good at sports even though I was asthmatic. Captain of wrestling and baseball teams. Decent boxer too.
Hadn’t had an asthma attack or need for an inhaler since 2007. I eventually became a smoker like an idiot but it was always around me growing up.
Had to take a trip To ER today scared and emotions all over the place. Felt like I had a 50 lb bag of cement on my upper back after every attempted breath. Was hitting that wall that I had forgotten about for so many years.
Hospital was amazing and got me steroids with breathing treatments. Boss understood what it was like. He has had breathing issues so he is just asking for doctors notes. I got my inhaler back. No more smoking again from me.
I told god if he got me through this scary moment that brought tears to my eyes I would quit for my well being.
(Side note) although I eventually became a smoker I was aware of secondhand smoke and would always find an isolated place away from children especially. It’s not hard. Cigs inside are gross. Everyone smoked when I was a child in the late 90’s early 2000’s.
Rant over. Be strong guys and girls.
submitted by Rona_season798 to Asthma [link] [comments]

2022.03.13 05:07 Bubzoluck [SAR] Alexander the Great's Little Tickle: The History of Asthma Management (Part 1)

[SAR] Alexander the Great's Little Tickle: The History of Asthma Management (Part 1)
Structure-Activity Relationship is back by popular demand and this time we are looking at Beta-2 Agonists and other drugs used in the treatment of Asthma and COPD. Today we look at the history of the world’s oldest illness: Asthma!
Disclaimer: this post is not designed to be specific medical advice. It is merely a look at the chemistry of asthma drugs and their general effect on the body. Each person responds differently to therapy. Please talk to your doctor about starting, stopping, or changing medical treatment.

Asthma is really old

Asthma is one of the first described medical conditions, ever. Ancient China described “noisy breathing” in 2600 BC and Hammurabi’s Code recorded the symptom “if a man’s lungs pant with his work,” (1792-1750 BC). Asthma comes from the Greek for ‘wind’ or ‘to blow’ and was first codified by Hippocrates (~400 BC) as panting and respiratory disease. With such an old disease, there are hundreds of nodes to describe the history of asthma but I do want to just note Lucius Anneaeus Seneca (4 BC-AD 65), the first clear personal account of asthma:
  • Seneca probably developed asthma while living in the drier, warmer climate of Egypt during his childhood. As a scholar, he joined the Roman Senate but was banished to Corsica for committing adultery with Julia Livilla (Caligula’s Sister, oof!). He returned to Rome after 8 years and became Nero’s tutor.
  • While in Rome, he became a prolific philosopher and historian. He also described in detail his suffering with asthma. Later he would credit his struggle with asthma as the reason why he so steadfastly chronicled the world around him. Nero would compel him to commit suicide only 3 years after returning to Rome after being implicated in a plot (big oof!).
Fast forward 1800 years and we land at Sir William Osler, one of the founders of John Hopkins Medical School in Baltimore, MD. He would characterize many of the defining features of asthma:
  • Spasm of the bronchial muscles, swelling of the mucous membranes, special inflammation in the lungs
  • A hereditary condition that often begins in childhood and may persist to adulthood
  • A variety of bizarre (environmental) circumstances that may induce paroxysm:
    • Climate, atmosphere (dust, hay, etc.), fright/violent emotion, diet, cold infection
If you are interested in the history of asthma, I found a very detailed blog about asthma.

Asthma is inflammation AND obstruction

There are about a dozen airway diseases. The biggest symptom of a lung disease is dyspnea a.k.a shortness of breath. This inability to catch your breath can be due to problems inhaling or exhaling. Generally we can group them into two categories:
  • Obstructive Disorders - shortness of breath due to difficulty exhaling all the air from the lungs due to narrowing of the lung airways
    • Most common causes: Chronic Obstructive Pulmonary Disease (COPD), Emphysema, Asthma, Cystic Fibrosis
  • Restrictive Disorders - shortness of breath due to difficulty inhaling enough air into the lungs due to restriction in lung expansion.
    • Most common causes: Sarcoidosis, Scoliosis, Neuromuscular disease (such as MD or ALS), Obesity, or an Autoimmune condition
While I was trained in the diagnosis of asthma, it is not my field of practice (pharmacy), but if a doctor or diagnostician would like to weigh in the diagnosis of Asthma and/or COPD, please do!

WHY CAN’T I BREATHE?

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When a person breathes, air is moved through the trachea, then the bronchi and bronchioles, and finally into the alveoli. In the alveoli is where gas exchange happens—the process of moving oxygen INTO the body and carbon dioxide OUT of the body. In asthma, the smooth muscle (remember this) surrounding the bronchioles becomes constricted causing the diameter of the airway to be decreased. Decreased diameter means less air can move in a given breath leading to that shortness of breath and choking. For those of you who are asthma free, make a tight okay sign and try reading the rest of the post like that . You may notice you need to inhale/exhale harder or faster in order to get the required amount of oxygen.
Smooth muscle constriction is not the only mechanism of asthma. Lets summarize a few other processes:
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It's important to note that asthma can be allergen mediated or nonallergic.
  • In an allergic asthma, the presence of a specific chemical (the allergen) causes the body’s immune system to react and protect itself from the nasty and dangerous invader. Fortunately, that invader is pollen, dust, or animal dander and will not kill us. Unfortunately, when that allergen reaches the lung tissue, it triggers an immune response mediated by eosinophils. These eosinophils tell mast cells to release histamine which causes inflammation and swelling of the bronchial tissue.
    • Environmental allergens - pollen (seasonal), dust mites, animal dander, mold spores
    • Occupational allergens - flour dust (Baker’s asthma is one the most common forms of occupational disease. Be careful out there! I need my pastries)
  • Nonallergic asthma is due to chemical or physician irritants or intrinsic processes:
    • Intrinsic processes - certain drugs (aspirin/NSAIDs, beta blockers), stress, GERD
    • Chemical irritants - ozone, tobacco or wood smoke, cleaning agents
    • Physical irritants - laughter, exercise, cold air, sinusitis/rhinitis
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An overview of Asthma Pathology

So ya want to treat asthma. Whatcha gonna use?

Like most organs in the body, the lungs are innervated (controlled) by the parasympathetic nervous system and the sympathetic nervous system. The PSNS is responsible for rest and digestion while the SNS controls fight or flight functions. The PSNS bronchoconstriction by activating the muscarinic receptor (M3) found on the surface of pulmonary smooth muscle. By activating M3 with acetylcholine, the smooth muscle contracts and constricts the bronchial diameter.
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Acetylcholine and Muscarine’s Structures - Both activate the Muscarinic Receptors
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Acetylcholine Binding inside the Muscarinic Receptor
Treating asthma generally falls into two fronts of attack: antagonize the cholinergic bronchoconstriction regulated by the nervous system and prevent immune-mediated histamine release. In any kind of obstructive lung disease, you will have cholinergic bronchoconstriction but only in allergic asthma do you have immune system involvement. Regardless, treating asthma requires fast acting medications for instant relief (rescue inhaler) as well as longer acting medications for maintenance.

Antimuscarinics - Nature’s Poison…I mean Medicine

As stated, asthma has been around for thousands of years and physicians have been trying to remedy the disease for just as long. While those early pioneers may not have known why their treatment worked, we can now analyze the drug contained in their products.
  • When Alexander the Great invaded India, he smoked Jimson Weed (Umathai) to help relax the lungs in the varying climate.
  • Ancient Egyptian papyrus scrolls describe patients inhaling the vapor of black henbane a.k.a stinking nightshade.
  • In a not-so-helpful method, the 1800’s prescribed arsenic for respiratory conditions (yikes).
Once it was discovered that acetylcholine was implicated in asthma, it became a race to find medications that inhibited its action. We can assume a couple of structural changes:
  • All antimuscarinics are essentially acetylcholine with at least one acetyl phenyl group.
  • Maintaining the ammonium (N+) structure is needed to fit within the hydrophobic pocket of the receptor
  • The ester moiety can be swapped for an ether or left out entirely as a simple CH bond.
Remember, these drugs act by sitting in the receptor and blocking the action of acetylcholine. Kind of like a bully that pushes you off the swing and takes your seat. Now that we have the basics out of the way, let's dive into chemistry!
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  • The first prototype of antimuscarinics is atropine, a natural product from the Atropa belladonna (yes, that belladonna) and in Alexander’s Jimson Weed. While atropine does not have the needed quaternary amine, at physiologic pH it protonates quickly into its ammonium form. Experiments found that the nitrogen is not needed to be active BUT had significantly reduced activity. Likewise, N-methyl was the optimal size as the nitrogen substituent.
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Comparing Atropine’s Size vs Acetylcholine
  • There are two chiral carbons in atropine with the stereochemistry of the phenyl carbon being most important. The R-configuration is 100x more potent than the S isomer suggesting that the specific binding of phenyl to decouple of the receptor leads to inhibition. (Note: the levo-form of atropine is Hyoscyamine)
  • The issue with atropine is that it’s initial non-ionic structure allows for great systemic absorption. This means the drug is able to cross from the lung tissue into the blood and distribute quite rapidly causing a litany of adverse effects: dry mouth, blurred vision, urinary difficulty, headaches, tachycardia (fast heart beat)
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  • An attempt to make atropine less systemic was to make the nitrogen quaternary from the beginning. Ipratropium Hydrobromide (Atrovent) is the N-isopropyl derivative of atropine. Due to its charged nature, ipratropium’s absorption into the blood is minimal and is considered a local, site-specific drug (local to the lung tissue).
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  • Another natural alkaloid (a nitrogen containing compound derived from plants) is Scopolamine, also sourced from Belladonna, Jimson Weed, and Black Henbane. Tiotropium (Spriva) is the quaternary ammonium salt of scopolamine and shows similar properties to ipratropium.
    • Unlike ipratropium (aerosolized drug), Spriva is a dry powder that is inhaled via the HandiHaler. Patients are given a blister pack of capsules and the handihaler device. They must puncture the capsule using the device and inhale the powder into the lung. A common mistake for new HandiHaler patients is to swallow the capsule instead.
    • Tiotropium has a slower onset of action (about 30 min vs 15 min for Ipratropium) but a much longer duration of action (24 hours vs <4 hours respectively).
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  • Yet to be brought on the market is Aclidinium Bromide (Almirall). This drug is still in phase III clinical trial but is showing good efficacy in the treatment of COPD. Another derivative of Scopolamine, this drug uses an N-phenoxypropyl-1-azabicyclo[2,2,2]octane. This ring structure increases affinity for the M3 receptors and decreases activity at other receptors (namely M2) resulting in an even better side effect profile. The phenoxy bond is rapidly hydrolyzed in the blood (half life of 2.4 min!) compared to tiotropium (half life of 60 min). This further decreases side effects: remember, we want NO lung drug in the blood. Higher conc in the blood = more side effects).
Nowadays, antimuscarinics have taken a backseat to our next set of drugs. That being said, they are still incredibly useful in maintenance therapy but are definitely not first line.

Inhaled agents take the spotlight

It might be crazy, but inhaling medications into the lung as a manner to treat asthma is a relatively new idea. The first idea that comes to mind is smoking one of the herbs, but that smoke is likely to irritate and exacerbate breathing troubles and/or destroy the delicate drug structure. There is increasing evidence that ingested herbs are eliminated via the lung, meaning the drug is removed from the body by being exhaled (much like how you can detect alcohol in the breath as a measure of blood-alcohol levels). By eliminating through the lung, those drugs can have action in the lung, thus causing improvement.
That being said, nowadays 99% of asthma medications are inhaled, including the ones we just went through. However they are not the first line and most efficacious agents; that would be the beta 2 agonists. These agents mimic the catecholamines Norepinephrine and Epinephrine.
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Structures of NorEpi and Epi
Both catecholamines are active at the adrenergic receptors, but for asthma we care about the activity at the Beta 2 receptor. Epinephrine has more activity than norepinephrine at the beta 2 receptor. When Epi binds to the B2 receptor, it causes smooth muscle relaxation → the lung airways stop contracting → inc airway diameter → easier breathing
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Most common ring configurations that contribute B2-receptor activity
Inside the B2 receptor, Epi has a few different interactions it needs to make in order to activate the receptor. The basic pharmacophore of the adrenergic agonists is having a beta-substituted phenylethylamine. The type of substitution will determine if it's direct- or indirect-acting or even a mixture of the two. Lets look at some modifications of Epi and how that changes the activity:
  • Epinephrine was actually first used for asthma in 1903 as an injection. Isuprel (Isoproterenol, Isoprenaline in Europe) was the first marketed inhaler. While great, isoproterenol had a HUGE tendency to slow the heart and cause people to have a super irregular and fast heartbeat.
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Isoetharine with its marketed Bronkosol Bottle
  • Starting in the 1930s, doctors were starting to make fewer house calls. Isoetharine (Bronkosol, 1936) entered the market as an alternative to Epinephrine. It had much less cardiac side effects than Epinephrine. It would be used as a nebulizer (water + drug) and administered through a squeeze-bulb inhaler.
    • The main modification, the alpha-ethyl group decreases attraction to alpha receptors (like norepinephrine) which increases the specificity of the drug.
      • At high doses though, it can still activate B1 receptors (in the heart) and alpha receptors both leading to palpitations, nausea and vomiting, and dizziness.
    • Surprisingly it wouldn’t be until 1951 that Isoetharine is actually approved by the FDA despite it being used for nearly two decades…
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  • 1961 saw Metaproterenol Sulfate (Alupent) hit the market and built on the success of isoetharine (although minimally). As an N-isopropylamine, it retains the needed B-directing properties needed for Epi. That isopropyl group was too bulky and decreased potency by about 20x compared to isoetharine (combined with the resorcinol ring system). It continued the decreased cardiac side effect profile though which is where its success really came from.
    • Similar to its predecessor, it was approved for use by asthmatics as Alupent (later Metaprel) in 1976. In 1982, it became the only prescription asthma drug to become over-the-counter due to being deemed “safe”. It was later removed due to abuse, especially in teenagers, because you can get a raging high. Read the New York Times's 1983 article describing it’s removal from OTC status here!
  • Alright, here it is: Albuterol (Ventolin). Introduced in 1966 but marketed in 1977, Albuterol changed the game with asthma management. Albuterol is a N-t-butylamine with a salicyl alcohol phenyl ring. This combo gave albuterol the best B2-selectivity.
    • “What,” I hear you say, “how can Albuterol be more selective than Metaproterenol with a bulkier group?” Good question. Let's look at the more extreme version of Albuterol, Salmeterol (Severent).
    • Salmeterol has a huge N-phenylbutoxyhexyl substituent with the same beta-Hydroxyl and Salicyl phenyl ring system. Salmeterol has the best receptor affinity of all the adrenergic agonists.
    • So why is albuterol better? Why is salmeterol best? I don’t know. I have read dozens of journal articles trying to find a concise answer and I just don't know. We think Salmeterol’s large tail allows it to interact outside the binding pocket which keeps it in place but why is albuterol better than metaproterenol? No clue. Sorry!

Chocolate’s Cousin lets you take a breath

The last drugs I want to mention today are Methylxanthines. These chemicals are naturally occurring and while you probably haven’t ingested belladonna or black henbane, I would bet anything you’ve had these. The most common source of methylxanthines are coffee, tea, and cocoa and are universally consumed for their stimulant effect. (Note: Theobromine is chocolate)
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  • The drug we are looking at first is Theophylline. Developed in the early 1930s, they are mild bronchodilators acting as Phosphodiesterase-4 inhibitors (PDE-4i). Essentially, they act on the signaling pathway inside the cell which helps stimulate the B2 agonist signal.
    • Theophylline’s effect is modest, good for being the first. It would decrease in popularity steadily as better drugs came on the market.
  • Chemically, 1,3-dimethylxanthine is both acidic (N7, top right) and basic (N9, bottom right). Physiologically, it is an acid (pKa = 8.6) and needs to be conjugated with an organic base to be soluble (like sulfate).
    • Theophylline’s real struggle comes from its metabolism. In the liver, Theophylline is metabolized through an enzyme called CYP1A2 which is notorious for drug interactions.
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Theophylline binding in the PDE4 enzyme
And that’s our story! Notice something missing? How about the inhaled corticosteroids? Stay tuned for part 2 where we go through the discovery of allergens and how the association of asthma went from neuronal to immune-mediated. Want to read more? Go to the table of contents!
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Likewise, check out our brand new subreddit: SAR_Med_Chem Come check us out and ask questions about the creation of drugs, their chemistry, and their function in the body! Have a drug you’d like to see? Curious about a disease state? Let me know!
https://www.google.com/books/edition/Asthma_The_Biography/wGwj8UYt7g8C?hl=en&gbpv=1&dq=history+of+asthma+treatment&printsec=frontcover
https://www.google.com/books/edition/A_Treatise_of_the_Asthma/hwhmAAAAcAAJ?hl=en&gbpv=1&dq=history+of+asthma+treatment&printsec=frontcover
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892047/
https://allergyandasthma.com/articles/history-of-asthma/#:~:text=In%20the%20early%201900's%2C%20allergy,the%20states%20of%20chronic%20therapy.
http://www.ask-force.org/web/Golden-Rice/Cohen-Asthma-Antiquity-Ebers-Papyrus-1992.pdf
https://www.atsjournals.org/doi/10.1164/rccm.201302-0388PP#:~:text=Theophylline%20(dimethylxanthine)%20 occurs%20naturally%20in,treatment%20for%20asthma%20in%201922%20occurs%20naturally%20in,treatment%20for%20asthma%20in%201922).
https://www.atsjournals.org/doi/10.1164/rccm.201302-0388PP#:~:text=Theophylline%20(dimethylxanthine)%20 occurs%20naturally%20in,treatment%20for%20asthma%20in%201922%20occurs%20naturally%20in,treatment%20for%20asthma%20in%201922).
https://www.atsjournals.org/doi/10.1164/rccm.201302-0388PP#:~:text=Theophylline%20(dimethylxanthine)%20 occurs%20naturally%20in,treatment%20for%20asthma%20in%201922%20occurs%20naturally%20in,treatment%20for%20asthma%20in%201922).
https://www.stonybrook.edu/commcms/bioethics/_pdf/gvandallergy.pdf
submitted by Bubzoluck to SAR_Med_Chem [link] [comments]

2021.07.21 16:12 MostPleasantPeasant Pulmonary specialists (and anyone else also welcome) please tell me what you think. History of pneumonia and respiratory infections, chest pain and sinus tachycardia

19F - 175cm - 85kg - Racial background is a mix of north African and eastern European - Living in Australia - Primary complaint is long standing pulmonary issues and chest pains, got severe enough on Monday that the chest pain, tightness and accompanying symptoms looked like a heart attack and had my manager calling an ambulance to my workplace.
Hi all, I hope I could maybe get some more insight as I can only find pieces of the puzzle myself, through reading research based and case based studies, while waiting for initial X-ray results and GP follow up.
Side note, I have ADHD so this may be a bit too detailed or over explained so apologies in advance for any tangents that will ensue😅
On arrival of the paramedic crew my vitals were:
HR: 127bpm ECG showed sinus tachycardia BP was on the lower side of normal, I can't remember the exact reading was Temp: 37.9c Blood oxygen: 94% Blood glucose: 5.7
Upon discharge from the ER, no notable findings were made in blood tests, waiting for a full report on the chest X-ray, tested negative for Covid. Fever resolved with rest and basic analgesia. All other vitals stayed about the same with the exception of spo2 rising. Chest pain gradually reduced but didn't cease and still hasn't as of me typing this right now. ER doctor suggested that CTPA imaging be done through my GP as a false positive reading for PE in the ER would start an unnecessary round of intensive radiation. Follow up with GP is scheduled for Friday afternoon.
I know that I have yet to have enough formal testing and imaging done to put together a really clear picture of what's going on, but my medical history (which I will include shortly) has a common theme of untreated respiratory illness and many signs and symptoms pointing to a potential underlying condition, either because of a predisposition to respiratory illness, or as long term consequence/complication of said respiratory illnesses.
I'm also aware of the fact that I am really young relative to the typical age groups of the conditions that my symptoms may point to, but I think that with my history, it may make sense.
Starting from the beginning (I'll do my best to keep these points short)
At age 10 I developed what our doctor thought was just the flu, did not respond to antibiotics for well over a month, most symptoms resolved over time except for a semi productive cough. Doctor couldn't figure out what was wrong and said the coughing was just habitual at this point. Over the course of the next months, I would occasionally spike fevers and cough up a lot of mucus. About 5 months into the ordeal, mum finally yelled at the doctor enough for them to order a chest X-ray because upon a physical exam, just above my collarbone/shoulder area felt crinkly and I could feel and hear what sounded like Velcro rubbing on itself. I don't remember what exactly was said, but the outcome was that the doctor had no clue what was going on, prescribed another round of antibiotics. Another 3 weeks later and I'm still coughing my guts up every 5 minutes and really starting to struggle to catch my breath at this point. Mum took me to the children's hospital emergency room and we left much later that night after being told I have a mycoplasma pneumoniae infection and that we should follow up with our GP for further treatment. Not even a week later, with the opposite of improvement, I could barely take a half breath so we went to the private hospital my parents attend and they immediately take me in for testing and imaging. Their findings were really far from ideal, I had several tears in both lungs and both were partially collapsed, escaped air around my heart and in my shoulders under the skin. Mum was very emotional, especially after the team of doctors said they couldn't treat me and needed to transfer me to the children's hospital via emergency patient transport for fear of any inhaled bacteria going directly to my heart.
All of that to say, and please correct me if I'm wrong, because of 2 cases of prolonged untreated pneumonia, I think I may have some lung scarring and/or pleural thickening.
Additional symptoms since then include:
In conclusion, I guess? I'm trying not to jump to conclusions because I haven't yet had more testing and imaging done and even if I do have an underlying condition that explains most of these symptoms, it may not need any treatment or be of any cause for concern. But I can't help but be concerned when I have an episode of building chest pain that mimics a heart attack, leaving me thinking I'm about to pass out from light-headedness along with the pain and nausea, it was just a lot and I'm worried that it's only going to keep getting worse and become more and more of a set back. Obviously I am going to be seeing my doctor to investigate this further and I'm not here to have someone take the role of my doctor, rather point me in the right direction with an educated hypothesis.
Edit to add: Remembering now that I've only been able to look at my medical history from the perspective of a potential underlying condition for the last 2 days only, I know that this could very well be seen as being exacerbated by anxiety. I'd like to assure any that may have well meaning speculations about anxiety related causes, that this was not brought on by an anxiety attack or stress. Of course I will always take my mental health into account when dealing with physical symptoms, but I strongly believe that this unfortunately isn't something that I'm able to relieve with being considerate of my mental well-being.
If you've read all of this or even just skimmed through it, thank you. If you have any ideas about the potential connections between these symptoms or other causes that you believe could be worth keeping in mind, please let me know. I understand this might be a big ask with all the information and all the possible overlaps of conditions, but I would be beyond appreciative of your input.
Thank you in advance.
submitted by MostPleasantPeasant to AskDocs [link] [comments]

2021.07.09 08:30 spartobik Proximo viaje a España.

Que tal, quisiera informarme donde se puede conseguir salbutamol en aerosol (ventolin) para el asma, soy mexicano, y pues aqui, cualquier farmacia lo vende sin receta y generico (solo el compuesto, no de patente)
¿Es neceario receta medica para comprar un inhalador? ¿Lo vende cualquier farmacia?
submitted by spartobik to es [link] [comments]

2020.12.09 01:34 Raccoon-Altruistic Muscle pain from neck to below ribcage. What can I do to keep working?

25F, 5'6", 270lbs, white, do not smoke or do drugs
The muscles are sore to the touch and become progressively more tight and painful with activity or standing.
I had covid over 3 weeks ago. I've been fever free for about 2 weeks. I had some breathing issues, fatigue, cough, and headaches after that. I returned to work (retail) and tried to take it easy but breathing issues forced me to take some more time off. I was prescribed an inhaler, an anti-inflammatory steroid, and a cough suppressant (more exact information below). My breathing issues are mostly gone as well as the cough and fatigue, so I returned to work again still trying to take it easy. The first 2 days were fine with muscle pain only being at the end of the shifts. The third day I could barely make it through even though it was a much shorter day, and had to sit down nearly every 30 minutes. That was also the first day I was off the anti-inflammatory since it was only prescribed for 5 days.
The doctor said for me to take the maximum dose of ibuprofen every 8 hours, stay hydrated with electrolytes, and rest. Ive been doing that and happen to be off of work for 2 days, but today just trying to make lunch muscle pain made me have to sit down again. I cant afford to miss anymore work. Is there any suggestions of what I can do or something to ask my doctor about?
Ventolin HFA 90 mcg/actuation aerosol inhaler - 2 inhalations inhaled every 4 to 6 hours prn shortness of breath or wheezing benzonatate 200 mg capsule - 1 cap by mouth 3 times per day prn cough prednisone 20 mg tablet - one tab twice a day x 5 days
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2020.11.27 00:13 omlech Anyone who tested positive ever have their lungs feel like they were on fire at any point?

Mind you I have never been tested for reasons I will explain in here. Back in late Feb/ early March, one person in my office got sick and was out for a week, then the guy next to him got sick and was out for a week. Unsure if they were positive or not or what they even had. I had went out to a restaurant on a Friday and started showing some kind of symptoms the next Wednesday. The first symptom I noticed was this odd crackling feeling in my lungs, the next day it went to my head where I had a headache and felt kinda congested. Then it went to my throat, not like my mouth but it felt more like down a bit in my throat, hurt quite a bit. Then I started having a mild fever, ranged anywhere from 99-100.x maybe 101 at the highest but the thermometer I bought didn't work well. I think I had a fever for 6-7 days? I had chills most of the time. I was coughing up these white phlegm nodules. At one point in the first 5 or so days I had hauled up a total of 50 lbs of cat litter at once up a flight of stairs and had to lean against the wall to catch my breath. Normally this wouldn't happen to me.
Around day 6 I called my doctor (2nd week of March?) and told them my symptoms. They asked me if I had shortness of breath and I asked how is that defined and they said can you walk across the room without gasping for breath and I said yes, that wasn't a problem. So they told me based on my symptoms, I had a viral infection and gave me 2 inhalers. No test cause I hadn't been to China and because I didn't meet the qualification for shortness of breath. Now mind you I have minor asthma, causes occasional wheezing once a month or so. Days went on and I still felt like there was an elephant sitting on my chest. That I had to focus on my breathing and breathe deeper in order to get the same oxygen as I normally require. I did a lot of deep breathing in that time when I was sick. I couldn't take too long of showers cause it was harder to breathe, I couldn't stand any aerosol sprays around me cause it aggravated me even more.
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At some point around day 12ish, I got this really cold feeling, like the core of my body was just ice cold and I was very fearful for my life cause I had never experienced anything like that. It happened for about 20-30 min then went away. At night around this time my lungs started to feel like they were on fire and I had to lean forward to be comfortable enough to even sleep. Again, never experienced anything like this before. Then the next day around the same time I got the cold feeling again, roughly the same length of time. Then that night again the burning lungs. I should note that I did take the Ventolin inhaler both of those days before my lungs hurt, may have been related. It wasn't the first time I'd taken the medicine before as I am asthmatic. At some point when I was sick I did try to sit down and play a game, but couldn't due to my general fatigue and my heart rate would accelerate to something like 130 just sitting there for 5 min trying to play. It was weird for sure. Also, I noticed that every morning when I would get up, if I breathed in deeply, I could feel this wheeze or something deep in my lungs that I would have to breathe about 3 times fully to clear it and this still happens to me today every time I lay down. The worst of the symptoms were undoubtedly breathing related. I have never had a respiratory illness in my entire life (34) so this was new territory for me.
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I stupidly never got antibody testing done and this was so long ago I feel it's likely too late to know if I had it or not. I have a friend who's a doctor and at the time I told him what was going on with me and he said it's likely I had it given the symptoms. The other day I moved a 50lb box around and my lungs were burning for a good 10 min after. These days I have to clear my chest every day in order to have my lungs feel like they're 100% clear which wasn't an issue but once every 1-2 months for a day. Anyways, if you made it this far, thanks for reading. Anyone else have any similar symptoms and tested positive?
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2020.10.13 03:58 kimboism To all my asthmatic friends: keep your inhaler out of your pups reach. [discussion]

I just dropped my sweet poodle pup off at the vet a few hours ago. He grabbed my inhaler off of the nightstand and punctured it, essentially taking 200 doses of medication in one go. Within two hours, he was visibly shaking, lethargic and obviously scared. By the time we got to the vet his heart rate was above 200 beats per minute. He’s at risk for seizures and cardiac distress among other things. He’ll be there for at least the next 24 hours being closely monitored and hooked up to an IV.
I keep all of my other medications well out of his reach. I never even thought an aerosol ventolin inhaler would pose a risk.
[Edit/Update] Thank you all for your kind words and for keeping us in your thoughts. I can’t tell you how much it means to me. I haven’t been able to talk with the vet yet this morning (it’s still early here), but I was able to call and talk with the vet tech. His heart rate is down a bit, but is still dangerously high. He’s alert, but very anxious. He’s also been reactive, which is not like my boy at all. She didn’t have much else to tell me, hopefully I will have a better update in a while.
[UPDATE 2:] I was able to speak with the vet. He had a few spikes during the night that were scary, but they were able to get his heart rate back down. His heart rate has been going down since about midnight, but is still high enough that they want to continue monitoring him. He will not eat or drink and hasn’t used the bathroom. His blood pressure is okay. The good news right now is that they don’t see any signs of neurological damage and that it seems like things are getting better. Thank you all for your concern and support.
[UPDATE] Theo is HOME!! I need to keep him closely monitored for the next 24 hours, but otherwise, it seems that we are out of the woods! The last 30 hours have been a whirlwind and I am just so glad to have my boy home. Thank you all for keeping us in your thoughts and for your kind words of encouragement. This sub truly made it easier to get through this.
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2019.11.18 17:37 shinysmileygirl I’ve been very sick for over 3 weeks. The doctors keep telling me to “ride it out” but I’m not getting better. I’m concerned there’s some underlying issue here they’re missing. Are there any tests I should ask them to run?

25F, 5’4, 160lbs, caucasian. Diagnosed with bronchitis, sinusitis and two ear infections. It’s been 3 weeks + 2 days. The only thing I’m taking currently is 500mg acetaminophen twice a day, Fluticasone 50mcg nasal spray twice a day, and cough drops and honey as needed for cough/sore throat. I don’t drink or smoke and use any recreational drugs.
Symptoms: Cough Throat pain Chest pain Shortness of breath (when exerting any energy or speaking for more than a minute) Earaches Sinus pain Sneezing Low grade fever Body aches Fatigue Dizziness (when standing up or making sudden movements) Confusion/Disorientation (when there’s too much going on around me, noises, crowds, etc. Basically just in the workplace)
On 11/5 I was prescribed the following list of medications: Amoxicillin 125mg, twice a day for 7 days Prednisone 20mg, twice a day for 7 days Fluticasone 50mcg nasal spray, twice a day until symptoms improve Ventolin Hfa 90mcg aerosol inhaler, two puffs every four to six hours Benzonatate 100mg, up to three capsules daily as needed Cheratussin Ac 10mg, as needed
I took everything as prescribed. After one week I went back to the doctor. I was not feeling any better at all. She said I could keep taking the fluticasone, ventolin, benzonatate, and cheratussin. The benzonatate doesn’t do anything for me, so I stopped that. The ventolin helps my breathing for maybe half an hour, but it makes me shaky and super anxious for the next 2 hours. So I stopped taking that as well. The cheratussin helps the cough, but makes it harder to breathe. I’ve continued using it very sparingly. Only one or two nights in the last week.
I visited a different doctor 3 days ago. I was given a chest X-ray and told I did not have pneumonia. I also tested negative for influenza. I was told I may have “caught another virus” but that there’s nothing more they can give me for my symptoms since I’ve already had a round of antibiotics and steroids. I was told to take otc cold medicine and “ride it out.” DayQuil, mucinex, etc. does nothing to help my symptoms and upsets my stomach, so I have not been taking it. I have been using cough drops and honey to help ease the cough and throat pain a little.
It may also be worth mentioning that I was sick for a week and a half at the beginning of October. Sore throat and sinus pain. I didn’t go to the doctor. I took DayQuil which did help with those symptoms. After I recovered from that I was only well again for about two weeks before coming down with this whole second round of crap.
So in summary, I’ve been sick for 3 weeks and nothing is helping my symptoms. The doctors keep telling me to let it run its course. I’m concerned that there is some underlying issue that is preventing my body from fighting this off. I have no idea what questions to ask the doctors though. Where do I go from here? Are there any tests you would recommend I request they run?
Thank you!
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2017.04.12 05:35 DennyYaDeadHomie Any docs with knowledge of Mexico Rescue Inhalers?

I've always used 100 mcg inhalers. Im interested in buying one from a friend brand new for cheap. Here is the exact box he has.
http://www.farmaciasdelnino.mx/esp/item/1368/1/bresaltec-salbutamol-aerosol-100-mg-200-dosis
This is where I get confused, at the top it says 100 MG, but down in the description it says 100 MCG.... what gives? Im so confused. Can I take this medication and be ok?
Name of the medication: BRESALTEC Comparative brand name medication: ventolin Active substance: Salbutamol Presentation: Inhaler Concentration: 100 mcg Time release: No Laboratory: Biosyntec S.A. DE C.V
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2015.04.09 17:22 areumdaum Fight with NMom leads to her admitting jealousy of my Aunt, and my actions reminding me I have FLEAS. (Long. Really long.)

Ugh, alright, just got out of a huge yelling session with NMom. Before I vent about it though, I do have a question: DAE here experience acting similarly to the Ns in their lives while around them, but never really acting the same way around non-Ns? Because honestly, dear God do I act like my NParents when I argue with them. Anyone else, and I do my best to be as calm and accommodating as possible, though with varying levels of success.
The long and the short of it is this: we live near factories because we're pretty poor. Factories let off fumes that affect my asthma and smell terrible, so I mention the smell and NMom closes the window and sprays aerosol air freshener. (Wow, that's going to be great for my asthma, thanks!) I go back to studying and she continues to complain, passive-aggressively trying to garner attention and sympathy, no doubt. I roll my eyes because it's distracting me from studying, breathe loudly because wow breathing is hard right now, and she sees. Dialogue ensues:
NM: Alright, you know what areumdaum? Don't talk to me.
Me: ??????? (Continues to struggle to breathe because haha fuck your Ventolin prescription, areumdaum!)
NM: SHUT THE FUCK UP! GO TO YOUR ROOM!
So, and I know it was stupid and a terrible move, I got extremely angry at not only being told what to do by NMom, but being told to "shut the fuck up" when I wasn't talking. I kicked the coffee table slightly, and about three papers from this really large, weird pile of bullshit papers my mother keeps on the corner of the coffee table slide off onto the floor.
NM: WHAT THE FUCK? PICK THOSE UP NOW.
Me: (Picks up papers and tries to reorganise the pile of useless bullshit out of regret)
NM: YOU DON'T KNOW WHERE TO PUT THEM! JUST FUCK OFF! GO TO YOUR ROOM!
Me: I'm an adult. I vote and pay taxes. No. You can't talk to me like tha-
Cue her going on some rant about how, even though I've had to call the police on him before and have no feelings towards him, the fact that NDad and I are on fairly good terms at the moment means we're "plotting against her" and "planning on ganging up on her" and she "knows what we're doing". So I just point out that I don't care enough to bother, that in general I don't believe in ganging up on people, and that if she was an even vaguely acceptable parent she would know enough about me to realise that. I may or may not have also called her a "paranoid, delusional lunatic" and that I was "not here for this horseshit". Keep in mind that from here onwards we're both yelling.
NM: Why don't you just move out if you hate me so much? Why don't you just leave?
Implying I'm the one who needs to do something, not her, and dredging up the fact that I have no money to actually do so because I haven't been rostered to work in almost a month. She was going for the shit-flinging high score, I guess?
Me: With what money? I can't afford rent. Why else do you think I'm still here?
NM: Move in with [Aunt], then! Get her to take you in!
Me: Are you serious? Are you serious right now?
NM: Why not? You hate it so much here. Leave!
Me: What, is this shit seriously because I've been spending more time with her and cooking with her? Is that why you're doing this, and spouting delusional shit about anyone ganging up on you and plotting against you?
NM: Oh, you just do no wrong! You don't do anything wrong and I do everything wrong and am a horrible mother. I'm quite aware of what you think of me, areumdaum, quite aware.
1) Untrue; 2) Yet it never occurs to you to... change... anything? 3) Bang up job avoiding the question, lady.
Me: Victim, victim, victim! Cut the shit.
NM: Leave! Go live with [Aunt], that bitch-
NOW IT'S WAR, MOTHERFUCKER.
The minute she starts to shit talk my Aunt it's on for old and young and I start ripping into her. I just laid into her, telling her exactly what I think of her, her picky eating habits, and about how she talks shit about my NAunt's (NDad's younger sister) oldest daughter because she's a drug dealer whose dealt in front of her son and me, but then turns around and lets her own EMother get neglected and abused by her older NBrother and leaves me to clean up after she literally shits the bed. That is an actual thing that has happened multiple times. I pointed out how he's committing neglect and fraud (he receives carer paychecks to take care of my EGrandma) and how NMom isn't doing anything - how she says she will, but she never does anything and how she can talk all she likes but it's all empty air and that she should be ashamed.
Then I (for the umpteenth time) ripped into her for having me spend what would have been my entire childhood in an abusive household. I told her (yet again, because it never sinks in) that I will never forgive her and I will never let go or trust her. How I hate her for caring more about her image of being a wife and mother than her own child's welfare (NDad neglected me whenever NMom wasn't around or my Aunt wasn't available to do the parenting for him), how selfish she is, and how she can apologise all she wants (she interrupted me part way through this just to give these creepy, dead-voiced "well, I'm sorry") but how it's also nothing but empty air if she doesn't back it up with action.
TL;DR My reaction and ripping into NMom, while I maintain was accurate, was absolutely nothing to do with the discussion at hand; I shouldn't have yelled, or kicked anything. There's no real defense for how poorly I handle any disagreement with my NParents. I just. All I felt was that I'm not here to cater to her and I felt that, before she talked shit about one of the few encouraging people in my life, I needed to tell her that she's a paranoid lunatic, a terrible excuse for a parent, and a hypocrite. She's lazy and by proxy neglects her own dying, 94 year old mother and expects her child to pick up the pieces for everything and pay full attention to her while she's being a whiny child. Sadly, I suspect because EGrandma has been doing the same thing for NMom and NUncle their whole lives. Fuck. Is it bad that I felt really good saying all of that, though? Are my FLEAS as bad as I suspect?
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