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How can mild intermittent asthma be managed?

Q: I am a 37 years old male diagnosed with seasonal mild intermittent asthma last year. I was prescribed Romilast (10 mg) and Seroflo (250 mg). I sometimes develop wheezing after a cold and cough. I have no dust allergy. On wheezing, I always take Seroflo and I feel better with the first single dose. Is Seroflo safe if used for long?

A:Also thank you for giving a detailed history . As you note you have mild intermittent asthma during certain seasons and with viral infections. The treatment you have been following targets the mechanism of asthma- an anti-inflammatory component that decrease mucosal swelling in the lining of the air passages and a bronchodilator component that relaxes and enlarges the narrowed air passages. However I would suggest that you discuss your symptoms with your physician again to see if indeed you may have mild persistent asthma based on the frequency of symptoms. If you have only the mild intermittent variety , a short acting bronchodilator like albuterol or salbutamol may be sufficient to relieve symptoms.

To address your concern about the rare side effect of paradoxical bronchospasm you should get a lung function test with bronchodilator effect testing in a monitored setting . This will also ensure the diagnosis is still accurate. If the short acting bronchodilator is not adequately controlling symptoms you can try the anti-inflammatory inhaler like fluticasone or other inhaled steroid and continue it through the season and reassess if you have mild persistent asthma. The course of treatment your doctor has suggested may also be adequate but you must know that salmeterol does not reliably cause immediate bronchodilation and you should use a short acting bronchodilator as your doctor has suggested for symptom relief. Please discuss this email with your doctor to come up with an appropriate asthma action plan and also monitor your peak flow and avoid triggers .

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