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Friday, June 19, 2009

Atrovent Happy doc may be on to something

We have a doctor here at Shoreline who orders Atrovent on every person who is ordered up on a treatment. The idea is, if you require a treatment, you get Atrovent. In fact, if you require a continuous Albuterol, you also require continuous Atrovent.

When she's working, I stock up on Duoneb. And yes, she also gives it to kids.

When she started working here I questioned her excessive Atrovent orders, but she's the kind of doctor who knows what she wants and orders it regardless of what you think.

In fact, in RT school back in 1995, we learned that Atrovent should never be given more often than every four hours.

I've often wondered what she has read that has her so up on Atrovent. One study I found was that Atrovent can benefit asthmatics, even those having acute symptoms. But that was just one study.

Another study showed that Atrovent given in conjunction with Albuterol resulted in more patients improving in the emergency room and being discharged, compared with those just given Albuterol.

So, perhaps Dr. Atrovent knows what's she's ordering.

When I was a kid I used to take Atropine for my asthma. Back then it was common to use it for asthma. In fact, when I was first put on it by my doctor at National Jewish in Denver when I was a patient there in 1985, I was told it was a preventative medicine more so than a rescue medicine, which is basically true even as it is used today.

Then I was put on Atrovent when it came out because the side effects were less. Then I was taken off the medicine altogether because it was no longer recommended for asthma.

However, anticholinergics have long been recommended for COPD. In fact, the newest anticholinergic used is Spiriva, which has been proven (via tests) to actually improve lung function in such patients.

Yet, according to Allergy and Asthma: Practical Diagnosis and Management, "A subset of asthma patients may respond favorably to inhaled... anticholinergics such as (Atropine and now Spiriva). Although this class of medications alone is not considered sufficient as therapy in asthmatic patients, it may be a useful adjunct in some patients."

Then the author adds this, which is why I wrote this post: "There is limited experimental evidence in animal models that this class of medications may potentially limit airway remodeling, thus potentially expanding the future role of these drugs in asthma. However, at present there is not enough evidence to make such a recommendation."

Perhaps, in some asthma cases, Atrovent or Spiriva might prove beneficial. Perhaps our ER doc who is Atrovent happy is on to something. And besides, even if the Atrovent doesn't result in immediate results, there are basically no side effects so what can it hurt to try.

1 comment:

Glenna said...

"not considered along to be sufficient therapy". That's interesting becuase we use a lot atrovent too in our assess & treat protocol BUT lately I've been seeing several docs writing for Q4 Atro tx's and nothing else. I don't get it. Atro alone has never been the standard.