Tremors: What’s The Deal?
Last updated: April 2023
My hands shake; they tremor ever so slightly. It’s a symptom I’ve experienced most of my life. Sometimes it gets worse, sometimes it’s minimal. Usually, I tolerate and forget about it. But sometimes it becomes bothersome.
So, what are tremors? Why do we asthmatics experience them? Here’s what to know.
What causes tremors?
A tremor is when you quiver or shake. It's one part of a natural response to fear. Although, some medicines we take for asthma mimic this response, causing tremors--hand tremors for me--as a side effect.1-3
What we are talking about here is your sympathetic nervous system (SNS). This system automatically causes you to respond to fear. It initiates a response often referred to as "flight or fight."1-5
You see a bear. Your brain says, “Oh crap!” as it initiates your flight or fight response. Chemicals such as adrenaline (epinephrine) are released into your bloodstream. These chemicals travel to your brain to stimulate it, making you fully aware. They travel to your lungs, dilating airways so breathing is easy. They travel to your heart causing it to pump blood faster and harder through vessels that become constricted. They travel to your muscles causing you to become tense and to tremble with fear.1-5
This is a natural and good response. It increases oxygen to your brain to increase your vigilance. It’s to make you aware and fully capable of responding.3 So, if you really saw a bear, you might run for your life.
There are medicines that mimic all or parts of this SNS response. They are called sympathomimetic medicines.6
Why do asthma medicines cause tremors?
So, some asthma medicines mimic this response. The original one that did this was called epinephrine (adrenaline). It was discovered in 1901. Soon thereafter, epinephrine was recognized as a remedy for asthma. Eventually, it was learned that it dilated airways. It was the first bronchodilator. By the 1930s it was a regular treatment for asthma.6
Epinephrine binds with beta 2 receptors in your lungs to dilate your airways. With asthma, this is the response we want: It's a strong bronchodilator.3
It also binds with other receptors lining your blood vessels and heart. This causes your blood vessels to narrow. It causes your heart rate and blood pressure to spike. This is a response we do not want. These are called vasopressor properties.3,6
Like our response to that bear, it also crosses the blood-brain barrier to cause changes in your brain leading to tremors.3
How is epinephrine used?
Sometimes epinephrine is still used for its vasopressor properties. This is an important medicine to get your heart going during advanced cardiac life support. But this effect is not needed by asthmatics. What we want is the bronchodilator effect. We want it to end asthma attacks. We want it to rescue us. Or, as with the case with some modern medicines, to keep our airways open long-term and prevent asthma attacks from occurring.3,6
Over the years since 1901, pharmaceuticals have fine-tuned the epinephrine molecule so modern bronchodilators have a stronger bronchodilator effect. They have eliminated the other effects of epinephrine, or at least significantly minimized these other effects. This makes it so side effects of our modern bronchodilators are generally considered negligible.3,6
Today, there are two types of bronchodilators:3
- Short-acting bronchodilators (SABA). These open airways very fast. They are usually referred to as rescue inhalers. Examples include albuterol and levalbuterol. They usually last from 4-8 hours. Albuterol and levalbuterol are also available as solutions to be nebulized.
- Long-acting bronchodilators (LABA). These keep airways open long-term. They are combined with an inhaled corticosteroid to help control asthma. These two medicines work together to keep airways open long term. Long-term is generally considered 12-24 hours. Examples here include Advair, Symbicort, Dulera, and Breo. These are called asthma combination or controller inhalers. There are also nebulizer solutions too, such as Brovana.
I used to have poorly controlled asthma. This was in the days before modern controller inhalers. So, back in the day, it was the overuse of SABAs that made my hands tremor. Today, I rarely use my SABA. However, to control my asthma, I use a LABA (in Symbicort) every day. And this, I think, still causes me to tremor just so slightly.
Do your asthma meds make your hands tremor?
Like I said, it’s barely noticeable most of the time. If I find I need to use my rescue inhaler between Symbicort puffs, it might be more prevalent for a while. I’m usually able to tolerate it well. I usually only notice it when I’m at public events such as weddings. I might notice my plate shaking, and use my other hand to steady it. But even that is rare when my asthma is controlled and I’m rarely using my albuterol.
So, what about you? Do your asthma inhalers make your hands tremor? Please share your experience in the comments below.
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