Jo Chipchase explains how your humble blue asthma inhaler, prescribed in Spain – and sometimes available over the counter – might be making you feel worse…
COLD BUGS that persist – with weird, changing symptoms – are still doing the rounds in Granada region. This is an annual event, with the constant changes in temperature from hot to cold, damp to dry, and back again. Many people have the “lurgy” (otherwise known as “respiratory viruses“). And wherever did Covid go – it is not cool mention the C-word, these days. For those who feel strangely breathless, did you know that the simple blue asthma inhaler, prescribed for some respiratory issues, might be making you feel worse?
Personally, I have survived muddy festivals, raves, questionable campsites, and years of fiestas. And yet it turns out that this commonplace item, located in your handbag, is more likely to “do you in” than a dodgy ‘hamburguesa’ served in a field at 6am. Yes, the humble Ventolin inhaler that I’ve used occasionally, for decades, was a possibility for appearing on the Chubbyemu channel on YouTube. If you’ve never watched, this features ‘fascinating’ medical cases such as “man ate too much liquorice and had organ failure“.
The Ventolin asthma inhaler has always seemed a reassuring object, like paracetamol: something to accompany you in “allergy season”. You use it, breathe deeply, and carry on with your day.
However a few huffs too many, taken at 2,000 metres in La Alpujarra, took me by surprise. I won’t be the only one!
A long, casual relationship with Ventolin asthma inhalers
My first encounter with a blue asthma inhaler goes back to my early 20s, while living in a Victorian house in Brighton. A friend’s boyfriend, drunk in the flat above, flooded the bath, and my celling came down. Dust trapped for over 100 years soon had me on an oxygen machine at a nearby clinic.
Also, at certain times of year, I’d wheeze or feel tight-chested. Out came the Ventolin. Once, in the distant past, I had to abandon a springtime date in Lanjarón – held near some “suspicious trees”, and with “disgusting cocktails” – to get my inhaler. The date was unimpressed. The Ventolin worked. That was that. Think no more about it.
Over the years, I used the asthma inhaler intermittently during chest infections, cold viruses producing a wheeze, and high pollen counts. Never daily, never with much thought. It might disappear into a handbag and reappear months later, when the dust was flying. Like many people, I assumed that it was harmless – a tool to open the airways when needed.
Looking back, I can recall certain moments, particularly during viral infections and high pollen counts, when my legs felt oddly weak. I put it down to fatigue. It never occurred to me that the inhaler might be making me feel worse, not better. And that this is a thing; and controversial.
A ‘cortijo’ soiree at altitude and a lingering cough
Fast forward to last week, in La Alpujarra. I’d been tolerating a respiratory virus for nearly two weeks. It was clearly no longer contagious – just annoying! One evening, a group of us gathered for a soiree featuring drinks and ‘tapas’, at around 2,000 metres in a friend’s beautiful ‘cortijo’. There was wine. There was rum. There was “fresh air”. A late night putting the world to rights, followed by a mild hangover requiring coffee!
That next morning, sitting in the host’s beautiful garden, admiring the scenery, I felt short of breath. I reached for the inhaler and gave it a good few ‘huffs’. It’s years since I read the instructions, which are all in small print anyway. The cough persisted and I felt even shorter of breath. We moved to another location at 1,700m. Here, I could not open a farm gate, as it felt “too heavy”. Instead of improving, I had thoughts of the ‘medico’.
Before long, I started sweating heavily. I felt as if my heart rate was rising, blood sugar might be off, or blood oxygen low (guessing the prognosis – with Doctor Google, that always says you are dying!). My vision blurred slightly. A physical sense of panic crept in, along with tingling extremities. Chills. And then my legs began to feel weak. After lying down on a clammy-feeling bed, I started wondering whether this was becoming something cardiac. I considered a trip to ‘Urgencias’, but it seemed a bit drastic. Especially as the only car was mine and the other adult was lying prone on a sofa, scowling.
“That’s a Ventolin overdose”
After four or five unpleasant hours, “sweating and mithering”, I drove back to my own village and went straight to the local chemist (‘farmacia’). Had I been using my inhaler a lot, the pharmacist enquired.
“Oh yes,” I said. “I had a good old huff on the thing!”
“That’s a Ventolin overdose,” he said calmly.
I was a tad surprised. Salbutamol (the active ingredient in blue asthma inhalers) doesn’t just act on the lungs; it stimulates the body’s sympathetic nervous system. Used repeatedly – especially when you’re ill, dehydrated, at altitude, full of coffee, or hungover – it can cause tremors, sweating, racing heart, anxiety, blurred vision, and muscle weakness. In other words, a panic attack! Nice.
In higher or repeated doses, the asthma inhaler shifts potassium out of the bloodstream and into the body’s cells. This can cause a temporary drop in blood potassium levels, which is why people may feel shaky, weak in the legs, light-headed, or notice palpitations after heavy inhaler use. No wonder I was eying the bananas! Your body just ‘knows’.
Low potassium affects how muscles and the heart function act. In some cases, it can trigger abnormal heart rhythms. The effect is usually reversible, but it’s why escalating inhaler use can make you feel worse rather than better. That weak, wobbly feeling in the legs isn’t imagined. It’s pharmacology. It is not caused by the “pesky cold bug” or “maybe that rum was a bit cheap” – it is the dratted inhaler! Put it down!
Why it’s easy to misread the side-effects of an asthma inhaler
Altitude causes breathlessness. Viral infections can cause breathlessness. Anxiety causes breathlessness. When breathing feels harder, the instinct is to reach for the asthma inhaler again. However, the side effects of salbutamol can make breathing feel worse – and this isn’t a good way of managing asthma symptoms or your chesty virus. Or a combination of both, as pollen season is coming!
Faced with a further shortness of breath, the natural instinct can be to take more huffs on the asthma inhaler to “open those airways”.
In the UK, regulators have repeatedly warned that over-reliance on blue asthma inhalers is linked to severe asthma attacks and hospitalisation – not because Ventolin is bad, but because overuse masks a condition or fails to treat the underlying problem. In Spain, where these inhalers can still, sometimes, be bought over the counter – or are thrown at patients like Benzos – it is easy to abuse them without knowing.
Following this incident, a visit to the ‘medico’ produced – guess what – another blue asthma inhaler! Thanks! Rather like trying to prescribe Nolotil when I am on the “no Nolotil” list!
My blue asthma inhaler happened to be OTC. There was no warning about not huffing on it like a vape! And in a country where they try to give you Paracetamol for broken bones, and then try to insert a Nolotil IV drip into susceptible Northern Europeans, is it really surprising that this happened? No!
With spring coming, beware of that asthma inhaler!
I soon realised that this hadn’t been a one-off incident with blue asthma inhalers. After losing the dratted thing in one of my many handbags, I obtained a replacement. They do tend to disappear and re-emerge in spring when there is pollen. But is it the solution? Not if you take more than four puffs in 24hrs.
Thinking about it, similar episodes have occurred in the past while “treating” a respiratory bug or for “those dodgy trees beside the bar” – i.e. shakiness, weakness, fatigue. Another recent example: after leading my horse up a slope, I needed to “sit down and catch my breath”, and my legs felt shaky. This also followed heavy inhaler use. I just blamed it on the “pesky virus” and had a lie down, followed by a snooze in full riding regalia.
Those symptoms have happened so many times before! I had simply never joined the dots.
Ventolin saves lives. It remains an important tool for those with asthma. But it is not harmless – and why is there not a large, visible warning on the packet? After all, most of usl know not drink a whole bottle of codeine linctus or eat a strip of sleeping tablets! If repeated asthma inhaler use leaves you feeling weaker, shakier, or more panicked, that is not something to celebrate.
And I suspect that I’m not the only person to overlook this problem. With spring round the corner, please take care!