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Wednesday, November 11, 2009

Your RT Queries: How do you treat thrush?

Every week I check my statcounter to see who's typing things into Google or Yahoo and being linked to my RT Cave blog. Assuming the queries were not answered, I provide in this spot each week my humble responses.And, hey, if the query is comical, it deserves a comical response. If it's serious, I treat it as serious. That in mind, here are this weeks queries:

1. can atrovent be given q2: Absolutely. This is a very safe medicine that can be used Q2 hours and even continuous if needed in the emergency room. However, I wouldn't recommend using it any more frequently than Q4 at home. You really should have no reason to use it more often than that. If you do, you ought to be calling your doctor.

2. can a albuterol inhaler cause high co2 in your blood?: No. Albuterol in no way is related to CO2. Albuterol is a bronchodilator that relaxes the air passages in your lungs and can make it easier to breath.

3. would symbicort stop croupy cough?: Symbicort is a medicine that is meant to be taken no more often than twice a day and is not recommended to be used for acute asthma symptoms. Symbicort will not relax the muscles in the throat and should have no effect on croup or a croupy cough. However, some asthmatics get a croupy cough as one of their signs of asthma, and if this is the case a rescue medicine like Albuterol might help. Again, symbicort should never be taken more often than twice a day (BID).

4. advair substitute: Symbicort is the best substitute for Advair. There are also some generic Symbicort inhalers available.

5. ippb therapy: My co-writer for this blog is going to write a post for the RT Cave stating that IPPB is good in some rare cases. So, stay tuned!!!

6. ventimask 50% bad: It depends. If 50% FiO2 is required to maintain an SpO2 of at least 90% then this can be a good thing.

7. atrovent in tx of croup: I can find no documented evidence that Atrovent does anything for croup. However, if you can find any such evidence let me know and I will publish it on this blog.

8. can i smoke while on ventolin: Yes you can. Smoking is good for your lungs and is highly recommended, especially if you have asthma. Just Kidding! Of course you should stop smoking if you need to use Ventolin. Smoking is a trigger of both COPD and asthma and any doctor wouldl highly recommend you quit.

9. white stuff growing on roof of mouth inhaler: Sounds like thrush. This is a common side effect if you are using a steroid inhaler. This can be prevented by rinsing your mouth after each use. It can be treated by calling your doctor and getting either a pill or a rinse. I prefer the pill because you only have to take it for four or five days. For more information click here. I mention the medications that will help here.

10. respiratory therapist who became a physician: I think I've written about this before, that I think RTs would make the best doctors. I highly recommend every doctor step on the RT rung of the ladder on the way to the more prominent career of physician.

If you have further questions for me please contact me.


kerri said...

Hey Rick,
I LOVE when you do these :). They're fun to read, especially the silly ones.

One thing about Symbicort--while I don't think it's approved in the States, in some places (Britian, Canada), it's approved as the SMART program [Symbicort Maintenance and Reliever Therapy], and can also be used as a rescue inhaler between morning and evening maintenance dosages.

Still, no more than 8 puffs a day should ever be used, and of course it's always prescribed by a doctor.

Rick Frea said...

Anyone interested in learning more about the SMART program can click here.

Rick Frea said...

Thanks Kerri. I know Advair should never be taken more than twice a day, so I guess I just assumed Symbicort was the same. That's what I get for assuming, hey. However, since the FDA has not approved Symbicort to be used more than twice a day, I imagine that might still be a concern. Thoughts?

kerri said...

I'm no medical person or anything, but I think it may be the difference between formoterol and salmeterol that cause this difference in dosing.

Since salmeterol takes longer to take effect, it makes it kind of useless as a rescue medication, since it takes 15-20 minutes to start working. Formoterol starts working within 1-3 minutes, making it a lot more appropriate as a rescue med.

(From experience, when I started Symbicort, and did my first hit in the doctor's office, I was already feeling different by the time I hit the elevator less than five minutes later! I can't really say anything about Advair, because for the few weeks I was on it, it made me WAY worse so I went back to Symbicort).

While I'm not on SMART [the turbohaler deters me from using it in public], I do wonder why it's been approved some places and not others. The extra corticosteroid boost that would accompany the bronchodilator makes a lot of sense if you're using it within the SMART program, to beat down on the extra inflammation present.

My doctor gave me the option of doing SMART, which I declined. She did say though, I can be flexible with my Symbicort dose [not going over 8 puffs a day, obvioulsy! :)]

However, I don't see it making much of a difference of taking 3-4 puffs at a time [morning/evening] if you're flaring as opposed to taking 2 puffs in the morning and increase throughout the day if you need to. In that regard, it's much more flexible (ex. I've had times where I wake up feeling okay, but by 2 pm I've used my Ventolin a couple times, so at this point I increase my Symbicort and keep it increased for a few days).

When I increase my Symbicort, I still find the first day I need my Ventolin more than usual [Now if I start yellow-zoning, for the first 24-48 hours I do Ventolin scheduled every 4 hours, and then PRN if I've improved in the first block of time, then drop my Symbicort back down after a couple days]. I think, for me anyways [and I may be wrong], the extra formoterol just doesn't do much anymore and I'm just bumping up the ICS dosage.

What are your thoughts about SMART?