Will LABAS end useless breathing treatments?

For the past several years one doctor orders Pulmicort BID instead the patient use his Qvar QID.  We RTs have hated it, because it makesk treatments last longer.  Now I'm wondering if this is the wave of the future, and that it's for the best.

Hear me out, folks, because Pulmicort BID treatments may be good for us.

Last fall I gave my first Brovana breathing treatment.  I had no idea what this medicine was, so I did a Google search.  After doing this I realized I had heard of Brovana before: it's Foracort.  This is a LABA: a long acting broncho dilator.

Think of this:  Both Brovana and Pulmicort only need to be taken twice a day!


You heard it here first, folks.  Remember a few years back I wrote about a talk I had with a doctor (you can view it here).  I asked her why she orders Q4 Ventolin treatments when the patient is not short of breath.  She said, "Because we want to prevent bronchospasm."  I said, "Then why don't you prescribe Serevent?"  She gave me a wry expression, hissed, and left the room.

That was ten years ago.  Yesterday a homecare representative visited me in the RT Cave, and he told me most of his patients now get Brovana and Pulmicort.  He said it's great because it improves compliance.  "Think of how much easier it is for patients to only take two breathing treatments a day, with Ventolin only if needed?" he said.  "Our doctors are buying it."

He convinced me.  If doctors truly believe all these patients need a bronchodilator, and all these procedures are burning us RTs out, and doing nothing for the patient, then why not at least try BID Brovana and Pulmicort with prn Ventolin or Xopenex?

Surely we can have further debates, such as will this put us out of a job?  Yet we'll delve into that in a later post.  Or, better yet, I'll leave it to you guys.  I just wanted to bring this subject up and let you know it's a possibility for the future.

This may be the RT Revolution we need?

Furosimide nebs may decrease COPD dyspnea

One of the main reasons COPD patients seek medical attention, and why they are introduced to us RTs, is because they experience air hunger or dyspnea.

While there are a variety of steps we take in helping these patients overcome their dyspnea, one of which involves nebulized bronchodilators, there are new studies out that show that nebulized furosimide (Lasix) might work to help reduce dyspnea.

According to the Reuters Health Information, a report by Canadian researchers has revealed that "Inhalation of furosemide relieves exertional dyspnea in some patients with chronic obstructive pulmonary disease (COPD)."

Likewise, the article reports: "Exercise endurance time increased by an average of 21% (1.65 minutes) after treatment with furosemide compared with placebo, the authors report, and dyspnea intensity during exercise decreased by 0.9 Borg units with furosemide compared with placebo."

The writers of the report note that Lasix mainly worked for "patients with advanced COPD".

If this is accurate, then a 21% improvement to me seems pretty remarkable. A question I have is why? Why would Lasic work to improve dyspnea?

Druglib.com had the best answer I could find:

"Recent evidence suggests that inhaled furosemide relieves dyspnoea in patients and in normal subjects made dyspnoeic by external resistive loads combined with added dead-space. Furosemide sensitizes lung inflation receptors in rats, and lung inflation reduces air hunger in humans. We therefore hypothesised that inhaled furosemide acts on the air hunger component of dyspnoea."

In doing further research on this, I found another study (click here) of 20 COPD patients that reveals the opposite, that Lasix has no effect on COPD patients.

Yet, here (click here) is yet another study that shows that Lasix does work, and here for yet another.

So, as one of the researchers of the report mentioned in the Reuters article listed above concludes, "This study therefore supports the rationale for future assessment of inhaled furosemide as a therapeutic intervention for patients with COPD with incapacitating dyspnea."

Still, I wonder what the significance of giving furosimide would be. And why is it that this drug is not researched further in the U.S., or are there plans to do so? Is this supposed to work better than current therapies for COPD patients, or just as another alternative like Xoponex is an alternative to Albuterol.

I also wonder what the significance would be for us RTs who give the treatments. Currently, when I do Mucomyst treatments, I stay out of the room as best I can. I'll watch the patient from a distance, but I don't want to be breathing that stuff in.

So, would us RTs need to be concerned about breathing in Lasix?

Having a bunch of RTs rushing to the bathroom every five minutes wouldn't be so bad, but what if we were to do Morphine or Ativan nebs? I can't imagine they'd be wanting us RTs in the room with the patient while these treatments were running.

These aerosol therapies are currently being studied too, and I have the results to some of them for a later post. It's interesting to wonder what we RTs might be up to in the years to come.