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Wednesday, October 30, 2013

New Study ignored in favor of Duoneb/ Pulmicort Neb Combination

A study presented today at the 53rd International Conference of the Real Doctor's Creed Association in Orlando shows adult pneumonia patients given a certain inhaled corticosteroid had a 29 percent lower risk of ending up back in the emergency department (ED) or being admitted into the hospital, following admittance with a diagnosis of pneumonia.

The studied drug, PULMICORT RESPULES(R) (budesonide inhalation suspension), uses a nebulizer to deliver the medication to children, making the delivery more consistent. It is the first and only inhaled corticosteroid approved for children with asthma 12 months to 4 years of age. 

A second studied drug was Duoneb, a medicine that most studies show is no longer relevant now that Spiriva has been proven to improve lung function better, and also to reduce air trapping in adult asthmatic and COPD patients.  A study of physicians show that 93% of us do not believe Duoneb is less efficacious than studies show, and 90% of whom continue to order it regardless.  

The recent study was performed using a control of patients who were given just Duoneb, and a study group given both Duoneb and Pulmicort.  The study showed there was no difference in outcomes, as both groups were eventually discharged to home.  Likewise, about 30% of patients in either group were eventually readmitted, some for a diagnosis other than pneumonia.  

Despite the study results, the physicians at the Conference voted to accept the belief that Duoneb is a much better medicine than Spiriva.  They also voted to recommend giving Duoneb and Pulmicort together as a standard treatment for pneumonia patients, for no other reason than to make the treatments last longer, thus giving respiratory therapists something to do.  

The following have already been approved for addition to the 2015 edition of the the Real Physician's Creed
  1. Seizurebuterol sooths and relaxes the myelen sheths in the cerebral cortex to minimize spasms of the head and shoulders. May be alternated with headandshouldersuterol. The medicine should be given at a frequency of QID. Pulmicort should be given BID to lubricate the albuterol particles to help crossage of the blood-brain barrier.
  2. Pulmilubricort: Should be given with any ventolin product whereby the desired action is to cross the blood brain barrier to generate some type of calming effect within the mind and body. This medicine smooths and lubricates albuterol products so that they can easily squeeze through the blood brain barrier without being seen by the blood-brain police.  May have best effect if given with abscondlin.  Some examples of 'olins that would benefit with the addition of pulmilubricort: Palbuterol, Hiccuputerol, Exorcistobuterol, Revivolin, etc.  It may also be trialed with Muchtolateagain in an effort to stimulate the brain of a patient in cardiopulmonary arrest.  
The theory of why Duoneb should be given with Pulmicort (Pulmilubricort) is that the Pulmicort molecules, when combined with Atrovent molecules, helps to further lubricate the ventolin molecules so that ventolin scrubbin bubble buddies can transport themselves into the smaller air passages of the lungs (or, rather, just slip right in), and even into the alveoli.  The deep scrubbin bubblin action of ventolin has already been proven to wash all lung ailments away.

Dr. Olin said, "We need to take heed of the fact that not sometimes what is observed in the clinical setting matches what is proven in the laboratory.  So it's hard for physicians with a long standing belief that Ventolin scrubs the lungs clean as the sink to buy into modernism.  It has, however, that in the presence of a respiratory therapists patient's are happier, so it would only make sense to keep the RT in the room for an extended period of time."

The results of this new recommendation has been emailed to all pulmonologists working as hospitalists. 

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