alternative to Ventolin to open airways for steroid inhaler

There isn't an alternative to Ventolin, though Ventolin is very well tolerated by pretty near everyone, including children. As far as adults go two doses is a baby dose... especially in the case of an exacerbation and if your peak flow is in the 200’s upon waking, there are likely things that can be done better.

Firstly though, it's near impossible to overdose on Ventolin, even at greater than 20 puffs a day... mind you that would be a sign of someone who is poorly managed. In emergency dosing it's not uncommon to have 8 puffs every 20 to 30 minutes. If you have a tendency towards tachycardia and other heart problems... which you do, then it could be a problem... but, like heart problems asthma kills a number of people on a weekly basis. This is something to discuss with your respiratory physician.

Ventolin will always be in your repertoire (it's the only rapidly acting short term bronchodilator there is)... however, it's possible to go onto 200/6 Symbicort two puffs morning, afternoon and evening... with upto an additional six puffs in place of Ventolin throughout the day. But, after that twelfth puff, you need to (technically) go back to Ventolin. Having said that, I've been prescribed upto 12 puffs of 400/12 symbicort on a daily basis (but that's unconventional and technically not allowed).

Another thing to look into and doing a bit of a multi pronged attack, would be Spiriva of a morning. Spiriva and Atrovent (largely the same thing one is long acting the other short acting) work on different receptors to Ventolin.

Alvesco, is an inhaled steroid that can be used in conjunction, with the aforementioned medications.

Now, the above treatment got me from using 20 inhalations of ventolin a day (including prednisolone and seretide)), down to between four and six (with very occasional prednisolone use).

My regime is, one puff Spiriva, 2 puffs of Symbicort (200/6) and 2 puffs of Alvesco (160mcg) upon waking. Afternoon: two puffs of Symbicort (plus any additional doses I’ve needed). Evening 2 puffs Symbicort. Fexofenadine can help, but in a small percentage of the population can cause asthma like symptoms (I fell into that percentage).

As needed, I have Ventolin and Atrovent (inhalers and nebules for both), prednisolone. I can vouch for this treatment, though in Australia it’s now considered old school an epipen can be used in an emergency attack to get the airways open (but, given the heart problems it’s possibly not a good idea). I’ve been given adrenaline for asthma in the past and it works incredibly well. In fact my new GP has urged me to discuss getting an epipen in case I have a major exacerbation in a remote location.

Over the years, I’ve been on most asthma medications known to man. It's worth noting that sinusitis can cause twitchy airways as well.