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Friday, October 1, 2010

Respiratory Medicine Q&A

I occasionally check my statcounter to see what Google inquiries or searches lead someone to the RT Cave. If I think the landing page did not answer the question, I humbly try to provide the answer in this post.

1. switching from symbicort to advair: Essentially, these medicines are both combination inhaler that contain both a long acting bronchodilator to prevent bronchospasm and inhaled corticosteroid to prevent and treat chronic inflammation. The main difference is the long acting bronchodilator in Advair takes about an hour to treat acute asthma symptoms, and symbicort takes only about 15 minutes. Therefore, symbicort is recommended as a rescue inhaler in some countries, although with a maximum number of puffs per day at 8.

2. difference between albuterol and atrovent: Albuterol is a medicine that sits on beta adrenergic receptor sites on the bronchiol muscles of the air passages (bronchioles) in your lungs. Once joined, the reaction causes the muscles to relax, and this results in bronchodilation to make breathing easier. Atrovent is a medicine that sits on cholinergic receptor sites to block the cholinergic response. The cholinergic system is responsible for causing bronchospasm. While Albuterol is used as a rescue inhaler, Atrovent is sometimes added to the medicine regime if Albuterol alone is not enough.

3. Why do people die from taking symbicort: I believe people die from using symbicort because they abuse this medicine when they are having acute asthma symptoms instead of calling their doctor or going to the hopsital. I don't think it's the medicine per se that kills, but the belief this inhaler will make an asthmatic feel better. If you take your symbicort as instructed, and your rescue inhaler (albuterol) as instructed, and you are still having asthma symptoms, you MUST call or visit your doctor or a local emergency room. Check out this post to learn more about why you shouldn't be afraid of using a medicine like symbicort despite the red flag. To read more about why you should not be afraid to use Symbicort, check out this link.

4. vaponephrine dosing: Where I work we have a unit dose of 5mg vaponepherine (racemic epinepherine) that is mixed with 3cc of normal saline. This dose is given to all patients regardless of age.

5. ventolin and potassium: Ventolin is known to decrease potassium. Even one breathing treatment can reduce potassium, as you can see in this post.

6. aerosol ventolin treatment duration: A treatment should last until the mist starts to sputter. There is evidence that once the last minute of a breathing treatment is mainly just water, so there's no point in inhaling or tapping to get the rest of the medicine. A normal breathing treatment duration depends on the flow. In the hospital setting a treatment can be run at a flow up to 10lpm, while home compressors usually have a lower flow. Yet some home compressors allow for higher flows, and these patients are now able to take faster treatments. Another thing that makes a treatment last longer is # of medicines and normal saline dumped into the nebulizer cup. Also, see #7 below.

7. what's the difference between albuterol and albuterol and ipratropium: See #2 above. Albuterol is a medicine that stands alone as a bronchodilator, and usually comes in an amp premixed with 3cc of normal saline. Atrovent and Albuterol combination solution is called Duoneb, and is mixed with 3cc normal saline. If you add one amp of Atrovent and 1 amp of Albuterol to the treatment, this will make the duration of the treatment last longer because you'll be getting the medicine plus 6cc of normal saline. If you use one Duoneb amp, the treatment will last just as long as a ventolin treatment, as you are likewise just getting the medicine and 3cc of normal saline.

8. what happens when you stop taking advair: Advair is a medicine you should take daily, even when you are feeling well -- especially when you are feeling well. This medicine has a corticosteroid in it that reduces inflammation in your lungs, and therefore makes your lungs stronger and better able to deal with your asthma triggers. If you are taking it, and you get a cold for example, the cold may still effect your asthma, yet not as bad as if you weren't taking it. Therefore, I highly recommend all asthmatics on Advair take this medicine unless your doctor says otherwise. Check out this post for more.

9. how atrovent works on the respiratory track: Atrovent is a backdoor bronchodilator that works to prevent the cholinergic response that causes bronchospasm. See #2 above. Check out this post about the latest information about atrovent.

10. When should I take a medicine like Advair: I'd recommend a patient take Advair if you find other medicines do not work to control your asthma. For example, if you are using your rescue inhaler (Ventolin) more often than 2-3 times in a two week period, chances are you need better control of your asthma. Your doctor may have you try a daily singulair pill first, and if that doesn't work, he might have you try an inhaled corticosteroid like Flovent. If that still doesn't work, then Advair is the next option. Advair is currently the most prescribed and most effective asthma medicine. For more information about which medicine works best for you, check out this link.

If you have further questions please contact me.

1 comment:

Anonymous said...

great post