Brovana equal to Ventolin as a quick relief inhalant

Brovana (aformoterol) is best known as the only long acting beta adrenergic (LABA) available as a solution to be taken with a nebulizer. Better yet, evidence suggests it is equally effective as Ventolin as a rescue medicine.

A 2011 study by Das et al studied the efficacy and tolerability of both nebulized Ventolin and Brovana as a rescue medicines on 50 chronic obstructive pulmonary disease (COPD) patients in the acute care setting. (1)

The researchers concluded:

Our study has shown that both salbutamol and arformoterol are equally effective as a reliever medication as nebulizing solution in acute non-severe asthma. Improvement in PEFR was demonstrated in both the groups and following each dose of the drugs. The absolute increase in the PEFR after the first and the second dose were more with arformoterol than with salbutamol, but the increase in the PEFR after the third dose was similar with these two drugs. (1)

The researchers further explains why it is rapid acting when salbutamol, that active ingredient in Advair, is not:

Relatively, hydrophilic drugs such as salbutamol have a rapid onset of action due to their ability to reach the β2 receptor from the aqueous phase. Formoterol is a moderately lipophilic drug, about 300 times more than salbutamol. The aqueous portion rapidly activates the β2 receptor, whereas the lipophilic portion is taken up into the cell membrane from which it diffuses slowly to stimulate β2 receptor over a prolonged period. This accounts for rapid on set along with long duration of action of formoterol. Our study has also proved that arformoterol has a rapid onset of action. (1)

Many COPD experts now prescribe Brovana for twice a day, with Ventolin or Xopenex as needed in between.  Tiotropium Bromide (Spiriva) may also be prescribed for once a day use in combination with Brovana. (2)

References:

1. Das, Sibes K., Indranil Biswas, Arun K. Brandyopadhyay, Tapan D. Bairagya, and Somnath Bhattacharva, "A comparative study of efficacy and safety of aformoterol an salbutamol nebulization as rescue therapy in acute non severe asthma," Indian Journal of Pharmacology, 2011, July-August, 43 (4), pages 463-465
2. King, Paul T, "Review: Pharmacotherapy of Chronic Obstructive Pulmonary Disease: Focus on Aformoterol Tartrate," Clinical Medicine: Therapeutics, 2009:1, pages 1321-1327, study copy write by Libertas Academia

It's a democracy, so why are they taking away our asthma choices

Warning!!!! There are people who want to decide for you what is good for you.  They will say that you have a choice.  Yet what they will not tell you is it will be a choice between fewer options.  It will be a sort of control over you, yet you won't even see it, or feel it, or even know it's coming.

These people, many of whom already exist all over the world -- including right here in the good old United States of America -- think most people are not capable of making the right decision for themselves. They believe the American Experiment has failed.

So what is this American Experiment anyway?  Well, allow me to define it:

American Experiment:  Can man rule himself?

The American Dream:  Everyone has a chance to succeed no matter color, creed or station in life.  We are all smart enough to make our own decisions.  We are all smart enough to weigh the rewards against the risks.  We all have an equal opportunity to improve our lot in life.

Then there are two different types of people in this country:

1.  Equal justice:  These are those who believe in the American Dream, and believe the answer to the American experiment is YES.  They believe you are smart enough to rule yourself.  That you, asthmatics, are smart enough to make the right choices no matter how tough.  You are equally smart.  You are intelligent.

2.  Social Justice:  These are those who believe in the American Dream, yet believe the answer to the American Experiment is NO.  They believe you are not smart enough to rule yourself, and therefore not smart enough to make the right choices.  Their experts, therefore, must nudge you in the right direction.  One of the ways to do this is to limit your choices.  You are stupid.

They both call their system of government a democracy (they say this even though we are a republic, not a democracy).  The main difference is in equal justice you are allowed to weigh all your asthma medicines and decide what ones work best for you, and in social justice your choices are limited so you don't make the wrong one.

For the first 160 years of this Nation we were a democracy (republic actually)  run under equal justice, yet ever since about 1895 there have been people by insidious means who have been working hard to change this.  They believe that the Industrial Revolution brought about change in society that would require change in the way society was run.

Today, those who believe in social justice have gained much power not just in America but around the rest of the world.  Hitler ruled by the extreme measures of social justice, and so did Stalin and Mussolini.  Yet what few people know is that the term was coined right her in America during the term of President Woodrow Wilson. 

It has been a slow process.  After early failures they decided it was best to take baby steps.  They slowly worked to change the minds of Americans and those of the rest of the world.  After Wilson, FDR was their next great leader.  While Wilson planted the seeds, FDR created the regulations that allowed those seeds to grow into full, flourishing trees. 

They are trying to create a healthcare system that limits your choices, yet they will tell you otherwise.  They will trick you into believing that you have many choices, yet they know the choices are limited.  You will have fewer doctors to choose from, and fewer health insurance companies.  And you might even have fewer options of how you die and when you die.  Yet you won't know it until it's too late.  They'll just kind of slip by unnoticed.

They have already limited our asthma medicinal choices.  Remember when I wrote this:  Seven Classic Asthma Medicines To Be Discontinued.  The medicines you no longer get to choose from are:  Tilade, Intal, Alupent, Azmacort, Aerobid, Combivent, and Maxair.  You did not decide, they did for you.

These are all your CFC inhalers.  CFC destroys the ozone they say.  The ozone is more important than human life.  You aren't smart enough make and purchase medicines that don't destroy the ozone, so they had to "nudge" you in that direction. The market did not make this choice.  You did not make this choice.

I know you didn't because I read your cries that HFA inhalers don't work as well, or that you want to continue taking Intal and Combivent, medicines that have worked so well to control your asthma, or your COPD, or your cystic fibrosis for years.  You want control.  You want to decide what medicines you take.  Or you want your doctor to decide.

Yet in the new America, the new world, the one where social justice supersedes equal justice, and where you are "nudged" to make the "right" decision, you no longer get to decide.  It doesn't matter what works best for your disease, because the planet is more important than you. 

It doesn't matter whether you agree or disagree with theories that say man is causing global warming and destroying the ozone.  I'm in no way saying I don't respect these theories.  What I'm saying here is the government shouldn't be deciding what's best for you, YOU should be deciding what's best for you.  You are SMART.  Yet they think you are not smart enough to make the right decision.

A few years ago they tried to take away Serevent.   They even tried to take away -- or thought about it -- Advair and Symbicort.  They were scared about these drugs based on the belief that Serevent and Foracort were believed to make asthma worse, or kill asthmatics.

Yet even the FDA says Advair and Symbicort are safe for use, and that the benefits outweigh the risks.  Basically what this means is that your risk of dying of an asthma attack are far greater if you do nothing than if you take Advair and Singulair.  Yet YOU decide.

While I think Primitine Mist is a bad asthma choice, it has been available over the counter for years.  Many ashtmatics live by it.  It's their choice.  Yet recently the FDA banned all CFC over the counter asthma medicines, and any chance these will ever be available OTC again. 

I say they will never be OTC again because Primitine Mist has been on the market so long it was grandfathered in as an OTC medicine.  Yet any new HFA Primitine Mist will have to be prescribed, something no doctor will do.  Therefore it's not worth the investment to make an HFA Primitine Mist.

The market didn't decide this -- they decided it for us.  They had to because they believe we aren't smart enough to make the right decision.  They nudged you so now you have to see your doctor to get the best care.  You SHOULD in my opinion see your doctor and have a Ventolin in my opinion and the opinion of most asthma experts -- yet in a world of equal justice I wouldn't get to decide what's right for you.

More recently some wanted the FDA to ban Singulair  (also check these links).  It didn't matter what you thought.  They decided if you took it you were at an increased risk of suicide.  It didnt' matter there were no scientific studies to show this. 

The FDA did an extensive study on the Sinulair suicide risk, and decided there was no evidence.  They even reported this: FDA concludes there is no Singulair suicide risk.  Yet those who believe in social justice didn't care about the evidence, and there is a big black box warning on Singulair to scare people away from it, and perhaps from getting their asthma under control.

That's what black box warning do, you know, they scare people away from getting their asthma under control. 

Another example is more recent.  As of March 2, 2011 the FDA is ordering companies to stop making and shipping over 500 allergy and cold medicines.  Obviously since these are on the market they were being purchased by people like you, and I never heard one drop of a cry that these medicines were linked to any problems.  So why all of a sudden limit our choices?   Fishy, hey?  At least I think so.

In fact,  according to Web MD, Doctor Harold Nelson of National Jewish Health had this to say about this recent effort by the FDA:

"These are well-recognized drugs that have been used for decades and there is no reason to suspect that there is a risk involved. If there were risks such as hypertension or stroke with oral decongestants, it would be more appropriately addressed by eliminating the ingredient from all products whether those that are grandfathered in, available OTC, or FDA-approved.  These drugs haven’t cleared certain safety hurdles yet, but that doesn’t mean they are unsafe."

New medicines are studied intensely.  The FDA has such a rigorous screening process for approving new medicines that the chance of an unsafe medicine being approved is near zero.  I'm not implying mistakes can't be made.  That doesn't matter to those who believe in social justice:  YOU MUST BE NUDGED.

I'm not implying we shouldn't be careful when taking new medicines -- or old medicines for that matter.  Yet what I am implying is we need to make smart decisions, do our own research, and weigh the advantages with the disadvantages on our own, and not be pushed, bullied or forced into making a "choice" that is not truly democratic.

Yet that seems to be the direction we are going in.  It's scary to me.  I see it.  I hope other asthmatics do too, asthmatics with good, strong voices and pens that are willing to stand up and fight.
 
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Modern inhalers may equal better asthma control

The neat thing about asthma is it can be controlled. At present, the most recommended medicine to control asthma is inhaled corticosteroids. Is it possible, depending on your asthma severity one inhaled corticosteroid might be better than another? Is it possible the new HFA inhalers are better than the old CFC ones?

Recent evidence might suggest this true. While it has been proven that Flovent and Pulmicort work better than inhaled corticosteroids of old, such as Azmacort and Vanceril, mainly because they are stronger. Yet even more recent evidence suggests that a medicine called QVAR might work better if your asthma episodes involve the smaller airways as opposed to the larger airways.

As you may know, your lungs branch out like a tree (as you can see by the picture). You start out in the trachea, and from there air travels to the chorina where air can travel into your left lung or right lung. The chorina would be like the trunk of the tree.

Yet whichever way air travels (to the right or left lung), the next branch is the bronchioles. Air starts out in the large bronchioles, which would would be represented by the larger branches of a tree. As the bronchioles branch out, they get smaller and smaller. Thus, the small bronchioles would be represented by the sticks at the end of larger branches.

Now consider when you are a kid and have inflammation in your airways. This inflammation makes your lungs sensitive to your asthma triggers. When exposed to your triggers, this inflammation worsens, and this causes blockage of your airway that is the asthma attack.

In children and most asthmatics, the worsening inflammation will cause your peak flow readings to decrease. Yet, as you grow older and your airways become larger, the inflammation in your airways becomes smaller in comparison to your now larger airways. Thus, while your lungs grow, the inflammation stays the same.

So, in some asthmatics, some degree of shortness of breath can occur and this not effect the peak flow at all. This is because your peak flow readings represent what your large airways are doing. If inflammation in your large airways increases, your peak flow readings will go down. This is because air is trapped in your larger airways.

However, if your lower airways are blocked and the upper airways are not, your peak flow readings will remain the same. This, according to some asthma experts, might indicate that your asthma symptoms are the result of increased inflammation in your smaller airways.

So, while inhaled corticosteroids have been proven to benefit all asthmatics, what if you take inhaled steroids (like Flovent) and you still have asthma symptoms. Is it possible that there is an inhaled corticosteroid that does a better job of getting down to the smaller airways and reducing inflammation down there.

According to Sally M. Wenzel, MD, who is an asthma expert over at Medscapes.com, the answer to this question is yes, or probably. In answer to a question on this topic, she said, "The literature on particle deposition is actually pretty good for Qvar. It does get much better overall delivery to lungs, which means larger amounts to small airways (and alveoli). One small study (Annals Allergy) did show that adding Qvar to Flovent, as opposed to increasing the Flovent, produced slightly better symptom and lung function changes, particularly in measures of small airways. But, OBVIOUSLY each person's disease is slightly different and there are no guarantees that this will work."

Another neat thing I discovered is the following from a book I have called, "Asthma for Dummies," by Dr. William E. Berger. He notes that the U.S. government forced the phaseout of CFC propellants for inhalers like Albuterol.

Berger writes, "As a result... Proventil HFA, Ventolin HFA, and QVAR-HFA are the first oxone-friendly products on the market with this propellant, which delivers medications to the lungs more effectively than CFC propellants developed in the 1950s.

"In most cases," Berger continues, "because of a lower velocity propellant spray and smaller particle size, a non-CFC propelled product allows more of the medication to get into the smaller, more peripheral airways of your lungs."

So this adds to the growing evidence that HFA inhalers, and not just QVAR, are able to get the medicine deeper into the lungs, and to the smaller air passages.

However, it should be noted that studies have been limited, and ongoing research is necessary. Still, it's interesting to note there have indeed been some highly qualified asthma experts thinking along these lines.

So, perhaps, simply going to HFA inhalers may actually benefit chronic lungers using this medication, allowing for better overal asthma, COPD control.

What's a good replacement for Intal

Every day at MyAsthmaCentral.com we get lots of asthma related questions. Below are some questions I thought my readers at the RT Cave would enjoy.

Question: my mom says i cant drink or eat anything cold cause it "affects my asthma"

My humble answer: I have never heard of hot or cold foods being listed on any asthma trigger list. For a current list of asthma triggers check out this link.

Question: does singulair have steroids in it and could it cause weight gain. would like to know for my daughter who just turned 6 and she has been gaining weight?

My humble answer: I have never heard of Singulair causing weight gain. For a complete list of possible side effects of this medicine check out this link.

Question: My asthma symptoms are only present when I run, do I need to take meds when I am not running?

My humble answer: Your doctor is wise. Advair is a medicine that works so well to control asthma that it may actually prevent your exercise induced asthma (EIA) from occurring. Most asthma experts now believe that EIA should be treated as any other type of asthma. Since you are having asthma symptoms while running, chances are you have some underlying (chronic) inflammation in your lungs that is only aggravated when you run, thus causing your asthma symptoms. If you treat this underlying inflammation, you may be able to exercise without asthma symptoms. Advair is a great medicine to not only treat this underlying inflammation, but prevent any bronchoconstriction (airway narrowing) that might occur when you exercise. You may also learn that after being on Advair a while you may not even need to use your Maxair anymore. But, as always, whatever you decide to do please talk with your doctor first.

On a side note here, I can tell you from personal experience that Advair works great. I use it to control my asthma, and I am now able to exercise without my asthma flaring up (most of the time). My advice to you is try it and see what happens. You may really like the results.

Question: Intal is being discontinued. Is there any alternative medicine I can use.

My humble answer: Intal was once a top line asthma therapy for treating inflammation and preventing asthma and it was very safe. In fact, for about 15 years I used it. In fact, I used it way back in the 1980s when it had to be taken with a spinhaler which has been obsolete for quite a few years now.

With the advent of newer asthma wisdom, and the advent of medicines like Advair and Symbicort that are better at treating inflammation and equally safe, Intal is no longer considered a top line asthma therapy. Intal works rather well, but you may find that trying medicines like Flovent, Advair, Symbicort or Singulair may work even better than Intal at managing your asthma.

Personally, while Intal worked great for me for years, I find that Advair works much better. However, I have learned that many people I talk to that are on Intal today are on it because they had a bad reaction to the above mentioned medicines. If this is the case, your best option is to work with your doctor to find the best available medicine to help you.

At least now you have some options you can discuss with your physician. For more information, here is an excellent post you should read.

If you have any further questions email me, or Visit MyAsthmaCentral.com's Q&A section.

A guide: Which asthma meds are best for you?

Since I didn't have an asthma post published last week at MyAsthmaCentral.com, I thought I'd take this opportunity to share with you a post written by fellow asthma expert Kathi MacNaughton called, "Which Asthma Medication Is Best?"

I think she outlined better than I ever could which asthma medicines work best. I highly recommend any person recently diagnosed with asthma to read this post. It also might be beneficial for any long time asthmatic to read this for a nice refresher course, as perhaps there are better asthma meds available for you that what you are currently on.

The first line of defense, she writes, per the asthma guidelines (and I humbly agree) are inhaled corticosteroids to reduce the chronic underlying inflammation of the air passages in your lungs.

Common corticosteroids are as follows:

• Pulmicort (budesonide)
• Qvar (beclamethasone)
• Asmanex (mometasone)
• Flovent (fluticasone)

She writes: "There are also steroid pills. Being on long-term steroids in pill form can have a number of bothersome or even serious side effects. The good news, though, is that inhaled steroids have very few of the same side effects, because they are mostly limited to acting in your airways, where they are most needed.

"Unfortunately, inhaled steroids are not always successful in controlling asthma for every person. They do work great for most of us, but people with severe asthma may need to try something additional or something different altogether."

Other choices are:

1. Leukotriene modifiers: These medicines (Singulair and Accolate) block leukotrienes that are released when you are exposed to your allergens (asthma triggers) . Since leukotriences can cause bronchospasm, blocking them can help you control your asthma. This works well for some asthmatics.
2. Combination asthma inhalers: These include Advair and Symbicort. These contain both a corticosteroid to help manage underlying inflammation, and long acting bronchodilator to to keep your air passages relaxed. These are used "When Singulair or an inhaled steroid alone don't adequately control asthma symptoms."

Other choices:

1. Inhaled long acting bronchodilators: This would include medicines like Serevent and Foradil. Studies have found if asthmatics need long acting bronchodilators they should also be on an inhaled corticosteroid to control underlying inflammation. Using this medicine alone is no longer recommended by the FDA to control asthma.
2. Oral bronchodilators: This would include theophylline. This was once the cornerstone of asthma therapy, but due to side effects and better medicines (as noted above), this is no longer used except for in cases of severe persistent asthma where front line medicines are lacking in controlling asthma.
3. Oral steroids: These used to be used more often to treat chronic asthma, however due to side effects they are used less often today except for in cases of severe excacerbations, and usually only short term. A common oral steroid is prednisone.
4. Mast Cell Stabilizers: This would include Intal and Tilade. These were very common in the 1980s, and have very few side effects. But due to better asthma medicines listed above, these are less often used today.

So, she writes, which asthma medicine is best for you. "Unfortunately, the only really correct answer to this question is, 'It depends...' Every pharmaceutical company will try to convince you that their drug is best. And if you talk with other asthmatics, chances are they'll tell you whatever they take is best. But the truth is, we are each of us different, with slightly different things going on in our bodies.

"So, how you will react to a specific asthma medication is not entirely predictable. Asthma treatment is very much a case of trial and error. Your doctor will prescribe something for you and wait to see how well it works."

Well stated.

On vacation & forgot your meds: what can you do? How long do drugs last in the med cabinet?

Every day at MyAsthmaCentral.com we get lots of asthma related questions. Below are some questions I thought my readers at the RT Cave would enjoy.

Question: I forgot my nebulizer at home i dont have any of my asthma meds what can i do im felling very tight. I normally carry a resuce inhaler with Albuteral and use it in my nebulizer as well but i left everything at home

My humble answer:
First of all, know that you are not the first nor the last asthmatic to do something like this. I've done it, and so do many other asthmatic vacationers I see in the ER.

I have a couple options for you.

1. Most pharmacies allow prescriptions to be transferred. If you go to a Walgreens back home, for example, you can go to the Walgreens wherever you are vacationing and just have them transfer over your scripts. You won't be able to get a new nebulizer this way, but at least they should be able to get you a rescue inhaler. Other pharmacies that will do this are Rite Aid, Walmart, Kmart, etc.

2. In fact, I'm pretty sure any pharmacist would understand your predicament and help you out. I've gone to random pharmacies before and have never had a problem having my prescriptions transferred.

3. Don't be afraid to go to the nearest emergency room. The people that work there will understand your predicament, give you a quick breathing treatment in the ER, and send you home with a rescue inhaler. If you need it, they can also contact the local home health care company and have them supply you with a machine to use until you go home. The doctor there can also write prescriptions for any other medicines you might have forgotten. Since you should never wait too long to treat your asthma symptoms, this might be the best option for you.

4. You might be able to go to whatever home health care company in the area you are vacationing and see if they can hook you up with a nebulizer and vials of meds to last you until you get back home. I'm not positive exactly if they would be able to help you, but you could try.

Good luck!

Question: What is the shelf life of Theodur

My humble answer: Here is a neat article I found concerning the shelf life of medicines.

Basically, most new drugs like Theodur (theophylline) are good for 2-3 years from the date of manufacture. However, once the "original container is opened for use or dispensing, the expiration date on the container no longer applies." When the product is repackaged for you -- the consumer, it is "usually" dated by the pharmacist to expire within one year.

The expiration date of a medicine is the predicted date at which the drug will lose10% of its potency, according to this ABC News post.

The expiration date also assumes you are storing the medicine at the recommended temperature and humidity. According to our own site, theophylline should be "stored between 59-86 degrees F (15-30 degrees C) and away from light and moisture." This means that it should not be stored in the bathroom where it will be exposed to high humidities during and after showers.

While most drugs like Theodur are not hazardous if used after their expiration dates, the efficacy of the medicine after that date can no longer be guaranteed. Thus, if you are using an expired medicine you may not be getting the expected results.

Question: Is breathing-in more difficult for Asthma patient or breathing-out ?

My humble answer: Believe it or not, asthma is a disease of air trapping. What happens is air comes in, the airways constrict and swell, and air gets trapped in the lungs. While it may feel as though you can't get air in, the reality is you can't get air out. In fact, this air trapping is one of the reasons that during an asthma attack it often feels like you can only take in half a breath, or a quarter of a breath.

Those in the medical field may think of this air trapping as intrinsic PEEP. PEEP is air that is left in your lungs after you exhale. Normally PEEP is 2-3 CWP. During an asthma attack, this PEEP increases, thus causing hyperinflation of the lungs (which can be seen on an x-ray). If this intrinsic PEEP gets severe enough, it can lead to a severe asthma attack, and (possible although rare) even death.

This air trapping is also one of the reasons that diaphragmatic breathing is a technique often taught to asthma and COPD patients. The idea is if you give your lungs more time to exhale some more air might escape your clamped down air passages. Of course you probably know your rescue inhaler also works to relax your air passages to, thus letting out this trapped air.

Question: Intal versus Advair for asthma: have problems with asthma (wheezing sometimes) and respiratory allergies. Age 62M. I heard that Advair is a "ramp up" medication for sicker people and has more side effects and causes weight gain. Is Intal less problematic and am I better off with it if it helps or will I create more long term problems by not using Advair right away? Thanks

My humble answer:
You are wise to ask this question. Intal was a popular controller med for asthma in the past, (in fact I was on it in the 1980s) but it is less commonly used today due to much better medicines. It is a anti-inflammatory medicine, but I rarely ever see it used anymore, especially with adults.

The most common asthma controller medicines used today for asthma are inhaled corticosteroids such as Flovent (a ramp up from Intal). Flovent is much more effective for treating inflammation than Intal (at least most asthma experts conclude this).

If you continue to have trouble with your asthma despite inhaled corticosteroid use alone, your doctor might prescribe Advair (or Symbicort). Advair (a ramp up from Flovent) is a combination drug with both Flovent and a long acting bronchodilator called Serevent in it. Advair has been very effective in controlling asthma for many asthmatics, including myself.

There used to be a fear that inhaled corticosteroids had the same side effects as oral corticosteroids (prednisone), but many studies have been done to prove this is not true. If you take your Flovent or Advair properly, and you rinse really well after each use, side effects from these meds should be rare.

In my opinion, if Intal is working for you great. Your doctor may have been wise to have you try it before resorting to inhaled corticosteroids.

If, as you describe, Intal is not working, you might want to talk with your doctor about other options, such as the Advair you mention. Either way, it's always a good idea to keep in touch with you physician as I'm sure you are doing.

Good luck getting your asthma under control.

If you have any further questions you can contact me by clicking the "contact me" icon above.

Susphrine used to be a great asthma drug

When I was in RT school I questioned the head of the RT department about a drug called Susphrin. I remembered it from when I was a kid. Every time I went to the ER I received one shot of Susphrin, watched the clock, and within five minutes I'd be breathing fine.

That medicine saved my life many times when the air passages of my lungs were inflamed and spasming and contorted so that I wasn't able to get rid of air trapped within them. This meicine was great before the days of Alupent and later Albuterol.

Yet, in 1995 when I started RT school, head of the RT department had no clue what Susphrine was. And, to my surprise, when I looked up this asthma wonder drug in the Physician's Drug Reference, it was not there. I googled it, and it was not there either.

For the next 13 years I asked doctor after doctor if they had ever heard of this medicine, and none of them had a clue what it was. I asked a few pharmacists, and I asked nurses and RTs -- none of them had a clue what Susphrine was.

Yep, I was just making it up. Nope. Finally, a few months ago, I realized a major flaw in my memory of this drug. It was spelled with a p. That's right. So I looked it up under the correct spelling, and it was still not in the PDR. However, I did find it under Google. It is also mentioned at Healthsquare.com.

Of course the Susphrine on that site isn't necessarily the same Susphrine I remember. You'll see what I mean when you read my post I link to below. The Susphrine I'm referring to is a longer acting version of Epinepherine, a medicine that is still marketed and used on occasion for severe excaservations of asthma (status asthmaticus).

So, for you asthma history buffs, I finally found that there really is (was) a drug called Susphrin, and I wrote every thing I found out about it (and my experiences with the miracle asthma drug of old) in my asthma blog at MyAsthmaCentral.com.

There, click that last link and you will be morphed over to the article I'm referring to, or just click here.

Susphrine: The asthma wonder drug of old
by Rick Frea Monday, January 12, 2009 @ MyAsthmaCentral.com

There have been treatments for asthma for at least a thousand years. The ancients used jimson weed to relax the muscles surrounding the large airways in the lungs (these are known as anticholinergic agents for you drug nerds out there).

When epinepherine (epi) was first discovered in 1903, it provided instant relief by relaxing the bronchial tubes in the lungs that tense up during an asthma attack. (The Chinese used the herb Ma-huang, the plant species Ephedra sinica, because it mimicked epinephrine.)

Even though there were ways to treat asthma way back then, I couldn't imagine being an asthmatic in those days. In 2004, thr FDA banned products containing ephedra because the risk of injury, illness and death. Jimson weed can be toxic. The problem with epi is that it was a nonselective drug -- it didn't just dilate the bronchioles, it also affected the heart, a bad deal for the elderly and those with bad hearts.

In the 1970s and 1980s when I was growing up with severe, persistent asthma, a new selective medicine called Alupent was available. It was inhaled directly into the lungs and worked quicker and had fewer systemic side effects. Still, epi was more powerful a bronchodilator, so doctors used it in the ER for severe asthma.

Then there was a longer-acting version of epi called Susphrine (or Sus-phrine)that was popular among the medical community in the region where I grew up. I was two when I got my first Susphrine shot in 1972. When my family went on vacation across the country to California in 1976, my doctor wrote a note for mom to carry with her just in case my asthma struck:
"This boy is a known asthmatic undergoing hyposensitization program. If hehas severe asthma attack without fever he will respond well to 0.2cc Susphrinesub q stat; observe 20 minutes. Thank You, Dr. Gunderson."

The years 1980 to 1985 were the asthma years I remember the most. Mom or dad took me to the ER for asthma many times and each time I got a Susphrine shot. One October in 1984, I sat in the ER cot lumbering for air.

An RT in a white lab coat came into my room to give me Alupent. I wanted Susphrine. My chest burned. It felt like a herd of elephants was sitting on me.

About five minutes later, a nurse came in the room to finally give me the shot I needed. It was 3:45. I kept my eye on the clock, watching the red second hand mosey its way round and round. I looked at dad. His hair was disheveled. He had wrinkles from sleep on the left side of his face, and circles under his eyes. Perhaps he was wishing he could trade places with me. I wouldn't wish this on him, though, because he'd probably panic -- I was experienced and knew how to handle this kind of distress.

I peered back at the clock concentrating on each breath. It was 3:47. I thought I could take in a deeper breath, but it was just my imagination. Then, 3:48, I took in a deep breath. Finally. Relief.

A feeling of euphoria rushed through me. I'm telling you folks, there is no better feeling than going from near suffocation to taking a full, deep breath in less than ten minutes. If you go through that even once, you will never take breathing for granted again.
Thirty minutes later I felt like bouncing around the room. The adrenaline was taking its systemic effect. Despite that, I felt like a million bucks.

Susphrine is no longer used in ERs anymore. In fact, it's not even produced anymore, nor is it listed in the Physician's Desk Reference (PDR). Epi is still used on occasion, but it is basically reserved as a last ditch option for stubborn asthma.

Recently, I stopped our big pharmacist as he lumbered down the hall. I said, "Hey, Mike, do you remember an old medicine called Susphrine. When I was a kid, that stuff saved my life more than once."
"Oh, yeah," he said after he racked his brain, "I remember it. We used to use it quite a bit in fact until about 10 to 15 years ago when they took it off the market. Asthmatics loved it." He was the only person I quizzed who remembered the drug.

It's amazing that asthma medicines have improved so much even since I was a kid. Most asthmatics who use their preventative medications compliantly don't even need to make visits to the ER anymore. But, those who do will NOT get a shot of the asthma wonder drug of old, but they'll get new asthma wonder drugs that are proven faster and safer.