Expert: Marc Rubin, RPh Asthma Educator - 7/1/2009

Question
I was told by a dr. last year that I have asthma induced by my seasonal allergies.  He prescribed me advair, singular, flonase, astelin, allegra, and a provental inhaler.  He never did any tests other than listen to my lungs, nor did he tell me any danger signs to watch for.  He said if I was having an attack to come into the office for a treatment.  

I have lost my job and insurance.  The Dr. I was seeing was seeing me monthly and only filling the prescriptions monthly, no refills.  I have occassionally taken the allegra that was left since my allergies are acting up again.  I have also started to use the Astelin, it helps with my allergies as well.

I have noticed especially at night that my chest hurts, I am coughing (mornings too), and that I have some wheezing.  I know these are asthma symptoms but I don't know at which point it becomes an asthma attack I need to seek help for.  

Also, are there any otc meds I can take with will help to alleviate these symptoms?

Thank you very much

Answer
Hi Pam,

Sorry for getting back so late. The 3rd was my wedding anniversary, which led into a 4th of July party.

Sorry to hear about your job and insurance loss. Fortunately, the pharmaceutical industry does have product programs for people without insurance. We'll address that a little later.

Regarding your physicians care...while chest x-rays are of no value in asthmatic patients, just using a stethoscope is not a means of determining risk of attack, or severity of lung impairment. Without using the proper tools (spirometry and a peak flow meter), you cannot effectively evaluate the status of the patient or monitor improvement. From my perspective, without knowing the degree of your symptom presentation, I cannot fully comment on his therapy, but it does appear you have severe asthma. In severe asthma, rescue medication in needed on a daily basis, with frequent night time awakenings. If this was not the case, your asthma should be re-evaluated, preferentially by an allergist or pulmonologist.I'm bothered by the fact he wanted you back EVERY month, with no refills. If you are under control, you should be seen in ~ 3 months for re-evaluation, and if you are in poor control, it is generally 4 to 6 weeks. If he didn't at least perform a peak flow test, he wasn't doing a valid evaluation. Did he provide any patient education at all? Triggers? Device technique?

As far as obtaining medical care now, contact your local health department. You should qualify for medicaid at some level. You are the type of individual that this program was meant for..a working member of society that fell upon hard times. This program is where some of your weekly taxes went. It is payback time. Also, many communities have free health clinics, where the services are donated by local physicians, nurses, physician assistants and nurse practitioners. Get your records from your physician so they can have your medical history.

Regarding your current therapy, with the exception of Allegra, where you may want to try generic Claritin (loratadine) as a non-drowsy antihistamine that is OTC, non of the other products have safe OTC equivalents.

As I stated in the beginning, there are medication programs for those patients without prescription insurance. Many times, specialists will also have forms from the drug manufacturers on specific products. Here are some of the resources available:

Rx Assistance Program: 1-800-762-4636
Together Rx: 1-800-865-7211
For Advair: www.rxassist.org/pap-info/company_detail.cfm?CmpId.
For Brand Name Drugs: http://www.rxhelp360.org/drugs/brand-name-drugs.php

For Asthma self-assessment: http://www.asthmacontrol.com/

For an "Asthma Action Plan" which helps you in both personal evaluation of severity as well as the appropriate treatment at presentation. This is a plan that should be developed in partnership with your MD. It will also help you to recognize the warning signs of an impending attack: http://tinyurl.com/q5j2v

And for patient education: http://www.aaaai.org/patients.stm

Again, I'm sorry for the delay. If you need more assistance, please get back to me. Let me know how you did on the Asthma Control Test.

Sincerely,

Marc