Brovana: A better COPD medicine

A relatively new medicine on the market that is slowly gaining acceptance by the medical community is aformoterol (Brovana).  The medicine is quickly gaining acceptance by the medical community to the benefit of the many patients with chronic obstructive pulmonary disease (COPD).

There are four reasons why Brovana is gaining acceptance

1.  It's fast acting beta adrenergic (SABA) like albuterol (Ventolin).

2.  It's long acting beta adrenergic (LABA) like Salmeterol (Serevent), a medicine in the common inhaler Advair

3.  It's only available as a solution, and must be taken using a nebulizer.

4.  The nebulizer route allows better airway distribution in patients with airflow limitation as compared with the Advair inhaler.

5.  It can be taken with Pulmicort to get the same medicinal benefits as Advair.

6.  Both Brovana and Pulmicort only need to be taken twice a day, once in the morning and once in the evening.

7.  Ventolin can still be prescribed for as needed use between doses of Brovana.

Answers to your web search querries

Here are my responses to Internet search engine questions that lead someone to my blog.

1. do respiratory therapists still do floor bronchodilator therapy: It really depends on where you work. In most hospitals I'd say yes. But I have a co-worker who used to work in Detroit, and he said the RTs didn't have time to do floor therapy. After the initial set-up, floor therapy was basically done by the RNs. At most hospitals, though, RTs do floor therapy.


2. serevent and pneumonia: I don't see what good Serevent would do for pneumonia. Serevent is a bronchodilator, and bronchodilators dilate bronchioles. Bronchodilators are not made to go into the alveoli where the pneumonia is. So, unless there is some kind of underlying bronchocontriction going on, I see no benefit from using Serevent. That's my humble opinion based on scientific research. Some doctors, however, will disagree with me, and they have a right to.


3. overdoing albuterol: How do you define overdoing? Is overdoing Albuterol what you refer to bronchodilator abuse? If that's the case, how do you define abuse? Is abuse using it more than the guidelines recommend? If that's the case, guidelines don't take into consideration individual uniqueness.


4. cardiac asthma: To make it simple, this is where the left side of the heart fails, causing fluid to back up into the lungs. This causes an increased pulmonary blood pressure, which in turn squeezes the bronchioles and causing them to wheeze. This is not the same as bronchospasm, and therefore bronchodilators will not work to fix this problem. To solve this problem, cardiac medications and, perhaps, some diuretics are the therapy indicated here. However, since the lung sounds are annoying to most doctors and RNs, a bronchodilator is often ordered, even though it has no effect on cardiac asthma or the cardiac wheeze it creates.


5. i don't want to be a respiratory therapist anymore: You have to remember that this IS a job, and the purpose of any job is to make a paycheck. And, one must also take into consideration that the grass is not always greener on the other side. Likewise, a job is what you make it to be. If you do not like your job the way it is, you can make it what you want it to be. Or, there is always the unpopular option of complaining.


6. body therapy: If you are bored, you can always blow some Albuterol over your skin. It has the effect of smoothing it out and, at the same time, it's relaxing.


7. respiratory therapists frustrated with doctors: It happens. Some doctors write stupid orders.


8. fake acls cards: What would be the purpose of this?


9. lizer liposuction: I don't think Ventolin will help you lose weight. Oops, hold on! It can. Check this link out. So Ventolin might be an option. What should we call this? Liposucion-olin? I don't know much about liposuction (not my game), but I've heard it benefits some people. I have no idea why this question lead someone to my sight.


10. what stops the hypoxic drive: Oxygen. The hypoxic drive is real, it's the hypoxic drive theory that is a fallacy.

If you have any further questions, check out the q&a link to the right, or feel free to contact me anytime: Freadom1776@yahoo.com.

My response to your websearch queries

Here is my weekly response to Internet search engine questions that lead someone to my blog.

1. side effects of respiratory therapy: I will consider a side effect as something negative that could happen. I think that the #1 side effect is burnout, followed closely behind by frustration at not having more control over who gets respiratory therapies, not having more protocols, etc. In some rare cases there has been seen complete animosity toward this profession, which is probably no different from any other career.

2. can i take only serevent for asthma: It's recommended that if Serevent is indicated, Flovent should be taken with it. Thus, if both are prescribed, the patient should talk to his or her doctor about taking Advair, which is a combination of both drugs and only requires one puff in the morning and one at night. For more information regarding Serevent, click here.

3. mixing mucomyst with albuterol: It is mandatory that if Mucomyst be given that Albuterol be given with it. While Mucomyst is supposed to break up thick mucus, it can also cause bronchospasm.

4. what do people think of respiratory therapists: I think that most people don't even know who RTs are until they see us in the hospital. But, once they get to know us, I think we are highly thought of by most patients. We do our own surveys here at shoreline, and most of the comments are excellent when it comes to "what do you think of your RT services."

5. albuterol steam machine: I think you are thinking of an air compressor and a nebulizer. When the air passes through the nebulizer, it forms a mist not steam. And, breathing in this mist is what causes the medicine to get into the lungs and do what it's supposed to do, which is relax bronchial muscles.

6. what are post-op crackles in the lungs caused by?: Can be caused by a lot of things actually, but the general idea is that they are caused because abdominal or thoracic pain from the surgery is preventing the patient from taking in deep enough breaths and stretching the alveoli in the bases of the lungs, and thus making them more prone to pneumonia. Likewise, some pain medicines and sedatives can also make a person take shallow breaths, and this too can cause crackles. It is for this reason we encourage post op patients to use an incentive spirometer and to do cough and deep breathing exercises, of which I wrote about right here.

7. what to do when you dread going to work: We all have those days. What I do is go to work and hope for the best. It's also a good idea to get a good nights (or in my case days) sleep.

8. respiratory school formulas printout: I actually have a list of the relevent formulas I can post if you want me to.

9. how often should a patient use combivent: Recommended QID or no more than Q4. If you need it more often see your doctor. However, there are exceptions to this guideline.

10. how does ventolin work in the respiratory system: The Ventolin particles are nebulized into a particle size of 0.5 microns and work their way into the bronchioles, where they bind with beta adrenergic receptor cells and cause bronchodilation.

11. does nasal cannula make pneumothorax worse in children : Why would it?

12. advantage of using a mist tent over nasal cannula : A mist tent is good for use with a child with croup in that it provides a cool mist to help reduce swelling in the throat. However, at Shoreline we've decided the mist tent more or less just gets in the way of caring for the child, and we've pretty much scrapped them. If a child need oxygen, we use nasal cannulas. However, the mist tent is still always an option.

13. which is stronger ventolin mdi or ventolin aerosol mask: According to scientific data obtained, an MDI used with a spacer and used correctly should be just as effective as a Ventolin nebulizer treatment. And, a nebulizer taken with a mouth piece is more effective than via a mask, and a mask is more effective than a blowby treatment.

14. does singulair make it easier to cough up flem from lungs? : Not that I know. Singulair blocks the release of leukotreins which cause bronchospasm.

15. which should be given first if both are ordered serevent or flovent: Good question. Check out my answer to #2, and then I'd have to say Serevent because it's a bronchodilator. Considering neither has an immediate effect, I would guess that it doesn't matter. Any one else care to chime in here?

16. best respiratory therapist: Who decides? Is the person who loves button pushing really better than the RT sage? I wouldn't think so.

17. using bipap in place on ippb : I have debated this with some of the older RTs who will defend the IPPB machine to the death, but I think that all the IPPB does is over distend the good alveoli. I can produce some reliable studies that have come to the same conclusion.

18. continuous albuterol with bipap vision: Connect the neb as close to the mask as you can get it and have at it.

19. what does a respiratory therapist wear: Well, I wear scrubs and a white lab coat. Boring hey?

If you have a question I have not addressed here, or if you want an answer right now, feel free to contact us anytime and we'll get you an answer ASAP. You can contact me at Freadom1776@yahoo.com.

Some good asthma/COPD drugs get a bad rap

When I was researching Singulair, I found an article here on the Internet about how Singulair may be linked to depression and suicide thoughts. There were so many complaints of this, that the company that makes Singulair decided to put this as a side-effect on the insert.

You can check out a related link here from Allergy notes, or click here for a full article from Forbes.com.

The same thing happened a few years ago about Serevent. There have been people who have died after taking Serevent. It became so bad that there was talk of actually taking the medicine off the market.

Needless to say, I disregarded both these scares, and now I take both Serevent and Singulair, and neither do I suffer from depression, I also have not died -- at least not yet.

People die of asthma. And it just so happened that in a majority of the cases where an asthmatic has died in recent years, the person was taking Serevent. So some people came to the conclusion that Serevent was a bad med and should be taken off the market, and released statements (like this one, or this one) that scared people.

Yet, as it turned out, there really was nothing wrong with Serevent. Serevent is a good medicine that helps asthmatics better control their asthma. Yet some people decided to abuse Serevent, use it like it were a rescue inhaler instead of one puff twice a day. More than likely, the abuse of Serevent caused the heart to become overstimulated, and the asthmatic dies.

However, and thankfully, the powers that be decided the problem was not so much with Serevent, but with people abusing an otherwise good medicine.

For the record, here is a link to what all doctors should tell their patients about Serevent: click here.

National Jewish makes light of the fears of using Serevent on its website, and in its effort to make sure its patients are fully educated, issued the following statement:

"In a large asthma study, more patients who used Salmeterol died from asthma problems compared to patients who did not use salmeterol. This has received much attention in newspapers and magazines. While the relationship between Serevent® and deaths due to asthma remains unclear, proper use of this medicine can decrease any risks"

To read the rest what National Jewish has to say about Serevent, click here.

The company that makes Singulair, and doctors, have issued statements to their patients that if a patient is currently taking the medicine, and have not had a problem, then they should continue to take it as they have -- as prescribed. If they have a problem, if they have symptoms that are new since they started taking the med, they should stop taking it and talk with their doctor.

That's common sense there, but for PR and legal purposes it has to be said. Likewise, it's something doctors should do anyway -- or at least the pharmacist. Personally, I have never had a doctor go over with me how to use a medicine, or possible side effects. That seems to be a job reserved for RTs and RNs.

But, what if a patient doesn't have contact with an RT or RN? How do these people get proper education on the medicines they take? Is that not the job of the doctor? Or is it the pharmacist?

The pharmacy here gives patients a printout about new medicines, but that's only something knew they've been doing. Only once in my life did a pharmacist ever pull me over and say, "Hey, do you think maybe you are using that thing too often?"

I might have told that pharmacist something like, "Yep, I'll try to behave myself in the future." And then went home and continued to abuse whatever medicine I was abusing -- probably Albuterol at the time.

My doctor never one time told me that I was using this medicine too much. Never. In fact, the only time my doctor ever said anything to me about this was when I brought it up. Then I got the feeling he was telling me what I wanted to hear, and then he promptly left the room before I could ask another stupid and annoying question.

While it is possible that Singulair might have a small chance of causing depression, there is also a good possibility this occurrence of depression was a mere coincidence.

I see this a lot right here in the hospital with Ventolin. I give a breathing treatment with Ventolin to a person, he coincidentally vomits, and the next day I come into work and the patient is ordered on Alupent because the doctor decided the patient was allergic to Ventolin.

Now we have this new drug on the market called Xoponex, which is marketed by the company as not causing the same side effects as Albuterol, and yet, when I give Xoponex, those patients get just as jittery as they were when they used to take Albuterol. Recent studies show there is no difference between the two drugs when it comes to side effects, yet each doctor still holds his or her own opinion.

Many times I meet an extremely short-of-breath patient in the emergency room and note the heart rate is 130. Then I give two breathing treatments to this patient, the doctor goes into the room, notes the heart rate, and says to the patient, "I'm not worried about your heart rate. I think it's just because of all the stimulation from the breathing treatments."

Then the doctor orders another treatment, this time with Xoponex. I don't have a chance to tell the doctor that he is foolish, that the heart rate was up before the patient even had one dose of Albuterol. And, chances are, that his heart rate was up because he was in distress and hypoxic, not because of any medicine he was given.

Now I'm not saying these medicines don't have side effects, nor am I concluding here that Singulair does not cause some people to have suicidal thoughts (however I have yet to have them), or that Albuterol never increases your heart rate (I don't see it very often though), but I think that many of these medicines get a bad rap.

I think these medicines get a bad rap, despite all the good they do, because people who are doing the judging of them refuse to use a little good old fashioned common sense. Instead of assessing the entire situation, they just blame the medicine.

If you take a medicine and you truly notice that something new or different is occurring, then you should stop taking it and consult your doctor. Let's just make sure it's truly a side effect, and not simply an aberration.

Yes, some medicines that are supposed to have euphoric results turn out to be bad after all, like that one medicine that was supposed to be the ideal weight loss medicine that ended up causing cardiac problems. But some medicines that are good, are simply misjudged.

And I certainly pray they don't take a good drug off the market based on a misconception, or symptoms or death that results from lack of patient education more so than the medicine itself; especially when these medicines have the potential to help so many people.

That, my friends, is the thought of the day.

Serevent really is the 'true asthma miracle drug'

Today I wish to channel my energy better than I did in my previous post. Today I wish to talk to you from an asthmatic/RT perspective. The topic for today is Serevent and Advair. What I write about today should not only benifit asthma patients and parents, but provide useful information for RTs and Drs as well.

Serevent really is the 'true asthma miracle drug', and while I had trouble taking it at first, I discovered a method of actually weaning myself onto it, and my asthma has never been better. Before I go into more detail, bear with me here, because I'm going to give you a bit of background.

First off, I want you to know that Advair is a combination of Flovent and Serevent, and in this post I do not intend to talk much about the Flovent part of Advair, but I will have no choice but to mention it briefly. In general, this post is about Serevent whether you get it by itself or in a combination with Flovent.

Serevent has been around for more than ten years now. It's a medicine that acts as a long acting bronchodilator and is used to prevent asthma attacks, and is not to be used as a rescue drug. Some people have used it as a rescue drug, and I think that's how Serevent gets a bad rap in the media at times. When used appropriately, Serevent is a very safe and effective drug.

Essentially, the Serevent particles sit in the lungs, and, every hour or so some of the particles open up and the bronchodilator portion of the particles connects with the Beta 2 agonist cells in the lungs and works to dilates the bronchioles.

(For more information about Serevent, check out this link to National Jewish Medical and Research Center. Believe it or not I spent time there once for my asthma, so I'm going to link to them often.)

In this way, the lungs of a person taking Serevent should always be dilated, decreasing the need for a rescue inhaler.

Flovent is a steroid inhaler. It works to reduce inflammation inside the bronchioles and, thus, making the lungs stronger. Likewise, Flovent also works to create more Beta 2 receptor cells for the beta agonist (Ventolin or Serevent) to bind with, thus making those medicines work better.

For some asthmatics, Flovent alone works fine. For some asthmatics, Serevent alone works fine. However, if you need both, it's much more convenient, and makes us patients much more compliant, when we can simply take one puff of Advair twice a day. In that way, Advair is a great medicine.

But that's only half the story.

Ten years ago I spent 10 days in the hospital because of my asthma. In fact, that was the last time I ever had to go there because of my asthma.

After that visit, I was first introduced to Serevent and Flovent by my doctor. At this time I was still using my Albuterol inhaler on a regular basis throughout the day. And, as you might expect, the combination of the two bronchodilators made me extremely jittery. It was so bad it actually effected my work, so I quit (taking Serevent, not my job).

Many of my patients and asthmatic friends told me they had a similar experience with Serevent, whether they used Ventolin on a regular basis or not. So I had determined that Serevent was simply not a good drug.

In the meantime, though, continued taking Flovent (a new drug at that time), which was a much stronger and far more convenient inhaled steroid for me considering I was allowed to take it twice a day, instead of taking Azthmacort (another steroid inhaler) four puffs four times a day. Plus that bulky Azthmacort inhaler was too bulky to carry with me, and I wasn't very compliant with it, which is probably one of the reasons I ended up in the hospital in the first place.

Okay, back to Serevent.

I have an asthmatic friend that I graduated the RT program with, of whom is also currently a fellow RT of mine at Shoreline, and her asthma was so bad she ended up in the hospital three times with severe asthma. It was so bad one time she came close to a vent. It was not pretty.

Five years ago she tried Advair, and it worked like a charm. In fact, she told me it worked so well for her that she almost didn't need to ever use her Ventolin inhaler. Like me, she had been known to sleep with her inhaler in her hand. Not anymore.

Not only does she no longer use her Ventolin, she hasn't been admitted to the hospital, nor even had a small asthma attack in five years. Of course she, like me, makes a gallant effort to stay away from things that trigger her asthma. That, too, is a very important and difficult challenge for us asthmatics.

She recommended that I try this drug, "It's the true miracle drug," she said to me one day. So I tried it again, with the same result, and I quit again. I decided this simply wasn't the medicine for me.

That changed a year ago. I told my doctor that I wanted to try Advair. I took the recommended dose initially, and I again became jittery. So I quit taking it for two weeks. But I was bound and determined that this time I was not going to give up so easily.

I decided to try something different. Something that no expert, and no doctor, and no RT, had ever recommended to me before. Also, I had never read about this in any RT related article nor any blog. This was something I came up with completely on my own. I went against conventional wisdom and decided I was going to wean myself onto this drug, and off my Ventolin at the same time.

So, to start, I took one puff of Advair every other day for a month. At the same time I tried as hard as I could not to use my Ventolin. It was a challenge at times, but so far so good. In the second month, I took a puff of Advair once a day. In the third month I took one puff the first day, and two puffs every other day, and the fourth month I was at the recommended frequency of twice a day; once in the morning and once before bed.

Lo and behold, it worked. By this point, I was able to work a 12 hour shift without using my Albuterol once. And, I find if I do feel short of breath, and I wait a bit, I can feel the Serevent taking effect. In this way, I find I can avoid using my rescue medicine completely.

Keep in mind that I still use my Ventolin, and usually just when I wake up. I'd say, overall, I use it as often as every six hours or sometimes I can go 12 or 16 or even 24 hours without using it. That is a major accomplishment for me, a person who had been addicted to Ventolin (or Alupent before that) for 25 plus years.

I've been doing this for a year now. It works. Advair really works. And if I sound like I'm excited, I am. But not nearly as excited as I was when I was able to also wean myself off of my Theophyln tablets after I had decided I was never, never, never going to be able to do that.

My point here is that Advair, like my fellow RT asthmatic friend told me, really is the "true miracle drug," when it comes to asthma.

The neat thing is, based on my experience here with Advair, I have told this story to some of my co-workers, friends and patients who also have had bad experiences with Advair. I told them not to just start taking it and quit as soon as they get jittery, but to wean themselves onto it like I did.

It's well worth it.

Serevent, or Advair in general, have turned me into a new person. While before a year ago there was no way I could ever leave the house without checking my pocket to make sure I had my rescue inhaler in there, I no longer have to do that.

Likewise, up to a year ago I would have an asthma attack if I forgot to take my theophylin. If I went on vacation without it, I'd be stressed. Not anymore. Now I have weaned myself completely off theophylin. I haven't taken it now in, oh, about two months. (But I'm still not ready to get rid of the full bottle in my medicine cabinet).

And, instead of taking a bunch of different drugs, all I take it Advair, with the occasional puff of Ventolin and that's it. I highly recommend other asthmatics try Advair, and I highly recommend that doctors and RTs teach the weaning onto it method I discovered.

Perhaps I should patent this idea.