Sacks et al. (2005) reported the case of a 72-year-old man, described as professionally successful, intelligent, and cultivated, with polymyalgia rheumatica, who after being treated with prednisone developed a psychosis and dementia , which several behavioral neurology and neuropsychiatry consultants initially diagnosed as early dementia or Alzheimer's disease .  Large dosage variations in the patient's medication (including a self-increased dosage from 10 mg/day to as much as 100 mg/day for at least 3 months) produced extreme behavioral changes, from missed appointments to physical altercations, and eventually admission to a psychiatric ward and later to a locked Alzheimer facility. During this time, neuropsychological testing showed a decline in the patient's previously superior IQ as well as deficits in memory, language, fluency, and visuospatial function, which given the patient's age was considered to be compatible with early dementia. When the steroid treatment ended after a year, the patent's confusion and disorganized appearance stopped immediately. Within several weeks, testing showed strong improvement in almost all cognitive functions. His doctors were surprised at the improvement, since the results were inconsistent with a diagnosis of dementia or Alzheimer's. Testing after 14 months showed a large jump in Full Scale IQ from 87 to 124, but mild dysfunction in executive function, memory, attentional control, and verbal/nonverbal memory remained. 
Hi Anne, Thank you for your question. The answer depends on the type of inhaler you are using, and the specific effect. For example some inhalers for asthma and COPD are associated with tolerance after regular use while others aren’t .You can become tolerant to the desired effect of an inhalant or drug, or tolerant to the associated adverse effects. Tolerance means a specific effect associated with a drug decreases over time with repeated use, despite taking higher or more frequent doses. This is really bad news for people with chronic pain that take strong pain killers. Yes, you can become tolerant to some asthma inhalers such as Albuterol, Formoterol and Salmeterol. The tolerance associated with regular or overuse of Albuterol is most widely discussed. This explains why some people become seriously ill from their asthma as they delay getting appropriate care, by taking more and more frequent doses of their reliever inhaler for several hours or days (without doing anything else). Formoterol (the generic name of Foradil, also an ingredient of Symbicort) and Salmeterol (the generic name of Serevent also an ingredient of Advair) are long-acting bronchodilators that are firmly entrenched as controllers (according to 2007 NIH asthma guidelines) for treatment of more persistent asthma. Tolerance may occur, particularly to their impact on preventing exercise induced asthma, but clinical studies have not been consistent. These inhalants should always be taken regularly (as controllers) as prescribed by your doctor. They generally work well even if there is a degree of tolerance. They are rarely prescribed alone since the Black box warnings came out. They are thought to be more safely taken as combination inhalants (with inhaled steroid). Again, tolerance in the asthma inhalant sector has been most widely appreciated with medications that contain Albuterol (ProAir HFA, Proventil HFA, Ventolin HFA, Maxaire and generic Albuterol- an incomplete list). Taking more frequent doses of these inhalants when asthma is active is recommended, but other steps are important in order to reverse the increased inflammation often associated with this situation. These steps should be established by your doctor (a written action plan is important). Good Luck! J. Thompson, MD
Monoamine oxidase inhibitors (phenelzine, isocarboxazid), clonidine , selegiline , guanethidine, and ergotamines (ergotamine tartrate, dihydroergotamine mesylate) may increase blood pressure when used at the same time as ephedrine. Methyldopa or reserpine may reduce ephedrine levels in the blood and thereby lessen the effectiveness of ephedrine. Tricyclic antidepressants ( desipramine , amitriptyline , doxepin , and imipramine ) may block the effect of ephedrine. The carbonic anhydrase inhibitors acetazolamide and dichlorphenamide may increase ephedrine blood levels and the risk of side effects from ephedrine. Patients taking any medications should consult with their physician or pharmacist before starting OTC ephedrine.