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Thursday, July 17, 2008

Ventolin does not prevent asthma -- my opinion

When I was 15 and a patient at National Jewish in Denver, all of us asthmatic kids were forced to take 2 hits off a Ventolin inhaler prior to working out.

"Why do this now, when I'm going to need it as soon as I finish working out," I said once. My gym instructor made me run an extra lap for my mouth. So I learned not to speak up, regardless of my opinion.

Still, as soon as I was done with an aerobic session, I found that I needed a little hit of Ventolin regardless of the pre-workout dose. Not always, but there was still that bit of tightness after working out.

In retrospect, I think that even 18 years ago, long before I would even think of entering RT school, I was questioning doctor orders. Still to this day I do not think that Ventolin is a preventative medicine, but it's still ordered that way.

Why else do you think doctors order it QID on COPD patients who show no signs of being short-of-breath, or TID or even Q4 for that matter. At least in the hospital, I see no need to order Preventolin. A steady dose of Allbetterol might work better for some of the sick patients we have, but not Preventolin.

The other morning I had to give a treatment of Ventolin 30 minutes prior to a stress test. This was on a lady who had a history of asthma, but has not had a problem this visit. If she's SOB I see no problem with this, but not just because.

"Well, she has exercise induced asthma," my RT co-worker said.

"So, that's not a preventative medicine."

Is it? I have heard this talk all my life, but on me personally, taking a hit of Ventolin has never prevented asthma. There are other more appropriate medicines that can work preventatively, like Flovent, Atrovent, Singulair, Advair, Azmacort, Spiriva. These are medicines made to help prevent asthma. Ventolin does not prevent.

I have talked to an Internist of whom I really respect, and I asked her if we could DC the treatments that were ordered QID on a COPD patient who had been on treatments for two weeks, but never indicated any signs of SOB.

She said, "NO. We need to keep the Ventolin in his system to prevent an attack. You know that!" She looked at me like I was a dufass.

Oh well. That's all I can do is state my opinion. I have that right. I have a right to my opinion, I have a right to be wrong. I have a right to be stupid. We all have a right to form opinions, as have all the doctors and nurses.

It's one of the better parts of living in America.

Again, I have had asthma almost my entire life. I have been using Bronchodilators off and on since I was about five, have had my own inhaler to abuse since I was 10 (Alupent), have had a prescription to Ventolin since 1991, and have never noticed Preventolin (that's what I call Ventolin when it's used to prevent asthma) ever having an effect on me.

If I was going to have an exercise induced asthma attack, it's going to happen regardless of whether I take a hit of Preventolin. In fact, that's why I take Advair and Singulair, to prevent me from having problems while running. And I do run (okay, since you want to be technical, I jog) 2.5 miles every other day without having asthma, and without using Preventolin. I also do not use Ventolin after I work out.

I've never noticed it to prevent anything. I do notice it treats bronchospasm, but that's old school now I guess. Now that Ventolin comes packaged and marketed as the next coming of holy water, it seems to have unlimited uses.

For more uses for Ventolin, check out my list of 'olins at the bottom of this blog. Of course this is all in good fun, and it's all at the expense of stupid doctor orders -- my humble opinion of course.

Please feel free to agree or disagree with a comment.

2 comments: said...

I couldn't agree with you more. Albuterol is not long -acting enough to prevent anything.

I wont even deal with internists anymore. If I have a question regarding improper use of bronchodialators ,I deal directly with the Pulmonologist...and sometimes even they're wrong.

Old habits are hard to break,but stick to your guns on this one. Albuterol is a fast acting ,short lived, bronchodialator. Does nothing more, nothing less ( except maybe treat Hyperkalemia ).

Anonymous said...

Albuterol is definitely not preventive. Something like Intal would be a much better choice for exercise-induced asthma. Why it is that so many physicians think that Albuterol is preventive is waaaaaay beyond me, because as you stated, it's a bronchodilator to be used when the patient is bronchospasming. No more, no less!