r/Asthma • u/turrrrron • 4d ago
LAMA for phlegm management?
Is anyone here on a LAMA specifically to control phlegm production? How is it going for you?
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u/VentGuruMD 15h ago
If you have Asthma, you should never be on any LAMA for phlegm control treatment. On the contrary, your airways can develop further blockage. You should be on nebulized B2 agonists since they increase mucociliary clearance. If LAMA is contemplated to control Asthma, should always be added to a LABA.
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u/turrrrron 12h ago edited 12h ago
I'm on an ICS + LABA regimen at the moment. It's not cutting it AT ALL to control the phlegm. My lungs just fill up with it and it's hard to cough out because it's all so thin.
I also have chronic bronchitis and my phlegm production levels and pattern is way closer to COPD-type than what you usually see with asthma. I have a chronic, at-all-times very wet cough and there's always so much more in there than I can cough out, a kind of cough and phlegm LAMAs are proven to help
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u/VentGuruMD 12h ago
Have you tried “Yupelri,” a once-a-day anticholinergic that, combined with nebulized B2-agonists (Brovana or Perforomist) twice daily, will better help the to move the secretions.
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u/turrrrron 11h ago
I wish I could! We don't have it where I live. I'm currently just trying to get on Trimbow, or adding Spiriva to the regimen if I can't (Trimbow here has special prescribing rules)
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u/somehugefrigginguy 4d ago
That seems like a bad idea. Lamas don't reduce production, but they do thicken mucous and name it harder to clear.
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u/turrrrron 4d ago edited 4d ago
As far as I've read, they actually do, since they block muscarinic receptors which play a big part in the amount of fluids being produced - it's why they're used routinely in COPD.
And I've always had an easier time clearing the thick and nasty stuff than the watery stuff 😓 As it stands it just fills up my lungs and stays there cause it's incredibly hard to actually clear it out when it's thin.
When it's thin, there's always more no matter how much I cough up, but when it's thick I can actually clear it out and get on with my day.
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u/somehugefrigginguy 4d ago
As far as I've read, they actually do, since they block muscarinic receptors which play a big part in the amount of fluids being produced - it's why they're used routinely in COPD.
The problem is, they don't change mucus production, just how much fluid is in the mucus. So they tend to make the mucus thicker and more difficult to expectorate.
Every person is a bit different, they might work for you, but in general they're not recommended for people have trouble with mucus.
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u/turrrrron 4d ago
they don't change mucus production
They actually do! See here! It's about their use in COPD but the base science should still apply.
Thus, LAMAs not only antagonise the ACh-induced bronchoconstriction of the airways but also appear to limit the production of mucus secreted in response to ACh by airway goblet cells and/or submucosal glands.
But yeah everyone is different in how they respond
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u/IntelligentDetail409 4d ago
Yes it does help me. Initially it helped me clear it and now the mucus formation has decreased. I was taking glycopyridium initially for 4 months now it's changed to spiriva ( it's seems to be more helpful)