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.
Showing posts with label asthma meds. Show all posts
Showing posts with label asthma meds. Show all posts
Tuesday, October 13, 2009
Monday, August 10, 2009
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:
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:
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:
- 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.
- 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:
- 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.
- 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.
- 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.
- 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.
Tuesday, July 28, 2009
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.
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.
Wednesday, May 13, 2009
Primitine mist not a good option for asthma
I promised some of my readers a while ago I would discuss Primitine Mist and why it should never be used to treat asthma. I believe the following Question from the Q&A section of MyAsthmaCentral.com followed by my humble answer should put this topic to rest.My boyfriend has asthma and resists using the Advair as much as possible because he's concerned about long-term steroid use and because it's so expensive. Instead he regularly uses Primatine mist - I've heard this is even worse. Any feedback on this? He is almost 58 and his asthma is moderate. He is 5'9 and around 165-170 lbs. - very active (cyclist and skier).
I will provide you with some info you can share with your boyfriend:
1. Primitine Mist has a medicine called epinepherine in it, which is basically adrenaline. Adrenaline is a natural chemical in your body that increases when you are under a highly stressful situation or exercising. It dilates your lung passages to make it easier to breath, and constricts your vasculature to increases your blood pressure, elevates your heart rate, and force oxygen to vital organs. It can also make you extremely jittery or hyperactive.
When you use Primitine mist to treat asthma, you are actually adding more adrenaline to your system. If your adrenaline is already high from stress or anxiety of the attack, or you are abusing the primitine mist, this can lead to cardiac arrhythmias that can lead to death.
2. Primatine mist is not a medicine that is recommended by physicians, yet was grandfathered in as an over the counter medicine and is still available. However, as you can read here, the medicine may be phased out by 2010. So he'll have no choice but to find another option. It's already not on the shelves where I live.
3. By using primitine mist your boyfriend is only treating the acute asthma symptoms. Advair treats the underlying chronic inflammation that can actually prevent asthma from ever happening, and may even eliminate the need for a med like P. mist. I wrote about the importance of using Advair as prescribed in this post.
4. Unlike systemic corticosteroids like Prednisone, the corticosteroid in Advair is inhaled directly into the lungs and, therefore, systemic side effects are minimized (click here for list of possible side effects of Advair). Most asthma experts now believe that the advantages of Advair for most asthmatics far outweigh the mild side effects.
5. It is true Advair is expensive. He may chose to discuss this with his doctor because there are other less expensive options available. Or, if you are really strapped for money, you can call the pharmaceutical company for financial assistance (click here for more information).
3. By using primitine mist your boyfriend is only treating the acute asthma symptoms. Advair treats the underlying chronic inflammation that can actually prevent asthma from ever happening, and may even eliminate the need for a med like P. mist. I wrote about the importance of using Advair as prescribed in this post.
4. Unlike systemic corticosteroids like Prednisone, the corticosteroid in Advair is inhaled directly into the lungs and, therefore, systemic side effects are minimized (click here for list of possible side effects of Advair). Most asthma experts now believe that the advantages of Advair for most asthmatics far outweigh the mild side effects.
5. It is true Advair is expensive. He may chose to discuss this with his doctor because there are other less expensive options available. Or, if you are really strapped for money, you can call the pharmaceutical company for financial assistance (click here for more information).
6. Of course if you are on Advair you will still need something to use as a rescue inhaler for those acute asthma symptoms that may occur from time to time. The medicine doctors recommend most is Albuterol. This is the same type of medicine as Adrenaline in that it dilates the air passages in the lungs, yet it is fine tuned so systemic side effects are minimized. Therefore, Albuterol has very minimal side effects.
7. Actually, most doctors agree that you cannot overdose on Albuterol. However, if you are to the point you are using it more often than recommended by your physician your asthma is probably not controlled and you should either call your doctor or come to visit an doctor in an emergency room.
8. Albuterol comes at a reasonable cost even if you are without insurance. If you remain strapped for cash most pharmaceutical companies offer assistance programs so you don't have to go without the medicines you need.
On a side note here, I never bought a Primitine Mist inhaler for my asthma, as I've always been fortunate enough to have access to good health care. Yet I had a freind purchase one once for himself and he never used it, so he gave it to me.
This was back when I was a hardluck asthmatic bronchodilatoraholic, and I used that sucker up in a few days. Yeah I walked around like a lit up lightbulb for a few days, but it didn't really do much for my asthma. To me, it seemed Albuterol is twice as strong as Primitine Mist anyway.
So, not only is Albuterol 110% safeer than Primitine Mist, it is much more effective in my humble opinion. Yet, ironically, Primitine Mist is available over the counter and Albuterol is not. Someday soon, however, Primitine Mist will be a distant memory.
There, I think that should pretty much answer all your questions about Primitine Mist.
Tuesday, May 12, 2009
Q&A about Advair and Symbicort
What follows are some of the most common questions asked in the Q&A section of MyAsthmaCentral.com and my humble answers.Keep in mind that both Advair and Symbicort are generally the same type of medicine, both having a long acting bronchodilator to prevent bronchospasm, and a corticosteroid to treat the underlying inflammation prevalent in most asthma patients. They are also used for other respiratory illnesses, like COPD.
1. Can Advair cause you to bruise easily?: Even though bruising is not listed as a side effect of Advair, I know a lot of people who use Advair who complain of bruising. Yet, if this is an actual side effect, I also wonder if it could be eliminated with proper technique, i.e. rinsing after using it. I suspect this might be true, but I don't know for certain.
It is true that inhaling Advair directly into the lungs is supposed to eliminate systemic side effects, like bruising. At the same time, not rinsing your mouth out after using it can cause your body to absorb a small amount of the medicine, thus causing some minor systemic effects.
I'm interested in reading what other experts might have to say about this.
2. How long should anyone use anAdvair Diskus and can I use it every now and then? Advair is a medicine that is intended to treat chronic inflammation associated with asthma and prevent bronchospasm. It usually takes 2-3 weeks of continued use to fully get into your system. Therefore, it is an asthma controller medicine that must be used all the time, whether you are feeling good or not.
The corticosteroid component of this medicine (Flovent) strengthens you lungs, reduces inflammation, and creates more receptor sites for your rescue medicine to sit on, and thus makes your Ventolin work better. The long-acting bronchodilator component (Sevevent), works to prevent bronchospasm.
In this way, if you have Adviar in your system at all times, when you are exposed to your asthma triggers your lungs will be better able to prevent them from causing acute asthma symptoms, or make asthma symptoms less severe. And, in this way, the Advair may be working and you not even realize it.
So if you quit taking it on a daily basis you take away all the benefits of Advair, and risk even worse asthma symptoms when you are exposed to your triggers -- and no asthmatic wants that.
So, to answer your question, this is the type of medicine you may need to take forever to control your asthma. Do not change your asthma medicine regimen or dose without first talking to your physician.
For more information, check out this link.
It is true that inhaling Advair directly into the lungs is supposed to eliminate systemic side effects, like bruising. At the same time, not rinsing your mouth out after using it can cause your body to absorb a small amount of the medicine, thus causing some minor systemic effects.
I'm interested in reading what other experts might have to say about this.
2. How long should anyone use anAdvair Diskus and can I use it every now and then? Advair is a medicine that is intended to treat chronic inflammation associated with asthma and prevent bronchospasm. It usually takes 2-3 weeks of continued use to fully get into your system. Therefore, it is an asthma controller medicine that must be used all the time, whether you are feeling good or not.
The corticosteroid component of this medicine (Flovent) strengthens you lungs, reduces inflammation, and creates more receptor sites for your rescue medicine to sit on, and thus makes your Ventolin work better. The long-acting bronchodilator component (Sevevent), works to prevent bronchospasm.
In this way, if you have Adviar in your system at all times, when you are exposed to your asthma triggers your lungs will be better able to prevent them from causing acute asthma symptoms, or make asthma symptoms less severe. And, in this way, the Advair may be working and you not even realize it.
So if you quit taking it on a daily basis you take away all the benefits of Advair, and risk even worse asthma symptoms when you are exposed to your triggers -- and no asthmatic wants that.
So, to answer your question, this is the type of medicine you may need to take forever to control your asthma. Do not change your asthma medicine regimen or dose without first talking to your physician.
For more information, check out this link.
3. I am using Symbicort twice daily can I use anything else to back it up for occasional relief
When I started taking Advair, which is a similar medicine to Symbicort, I had the same question.
The answer to your question is YES! Even though you are taking Symbicort twice a day you may still feel short-of-breath on occasion, and on these occasions it is safe to use your rescue medicine (Albuterol, Xopenex, Pirbuterol) as needed or as directed by your physician.
The answer to your question is YES! Even though you are taking Symbicort twice a day you may still feel short-of-breath on occasion, and on these occasions it is safe to use your rescue medicine (Albuterol, Xopenex, Pirbuterol) as needed or as directed by your physician.
4. What is an alternative to advair and symbicort with less of an oral thrush side effect? There really is no alternative to Advair and symbicort, as they are the only meds that have both the long acting bronchodilator and the corticosteroid combination to prevent bronchospasm and combat chronic inflammation.
However, it's such a great medicine for asthma I'd hate to see you quit using it due to thrush. Thankful, there is a way to prevent and treat thrush. Check out this link here for some solutions.
5. could long time use of advair cause sore, white spotted tongue and red roof of mouth: The answer is YES.
The steroids that settle in your mouth may wipe our the normal bacteria that live in your mouth that prevent the buildup of yeast or candidiasis in your mouth. Absent this bacteria, yeast may build up and cause white patchy spots in your mouth called thrush.
However, it's such a great medicine for asthma I'd hate to see you quit using it due to thrush. Thankful, there is a way to prevent and treat thrush. Check out this link here for some solutions.
5. could long time use of advair cause sore, white spotted tongue and red roof of mouth: The answer is YES.
The steroids that settle in your mouth may wipe our the normal bacteria that live in your mouth that prevent the buildup of yeast or candidiasis in your mouth. Absent this bacteria, yeast may build up and cause white patchy spots in your mouth called thrush.
After using inhaled corticosteroids for over 25 years I I had thrush only once and my doctor prescribed Diflucan. It is a pill I took for only five days, and it worked great. Nystatin is a rinse that works fine too.
Here is a good tip: The best way to prevent thrush is to rinse and spit after every use of Advair or any other inhaled corticosteroid.
Here is a good tip: The best way to prevent thrush is to rinse and spit after every use of Advair or any other inhaled corticosteroid.
6. Can inhaled steroids like Advair cause cavities?: I did read recently that inhaled corticosteroid use has been linked to cavities too, and it is a good idea to brush your teeth after using an inhaled corticosteroid along with rinsing.
If you have any further questions about asthma you can set up an account at MyAsthmaCentral.com. Or you can email me any question at freadom1776@yahoo.com
Saturday, May 9, 2009
It's time to bring back Susphrine
When I was a kid growing up in the 1970s and 80s doctors would often give me a shot of Susphrine when I was short of breath, and send me home. Now that I'm an RT the medicine isn't even in the physicians desk reference.
In RT School I asked my teachers about this wonderful medicine that saved my life so many times, and they had no clue what it was. A while back I wrote about my experience with Susphrine, and I could hardly find any information about it.
A few days ago, however, a doctor left a comment on the article I wrote (Susphrine: The asthma wonder drug of old) over at MyAsthmaCentral.com that finally gave me some information about this medicine.
The comment was this: .
Then he'd order a shot of solumedrol (or whatever steroid was given back then). Although I didn't care about this shot. It didn't give me the relief of the Susphrine. Yet, it was both meds together that allowed the doc to send me home. I know that now.
Thankfully today we have so much better asthma wisdom and so much better medicine to prevent asthma in the first place most kids probably never need Susphrine.
But there are definitely some cases (especially for those hard luck asthmatics out there) where a longer acting epinepherine would come in handy.
Perhaps it's time to bring Susphrine back again.
In RT School I asked my teachers about this wonderful medicine that saved my life so many times, and they had no clue what it was. A while back I wrote about my experience with Susphrine, and I could hardly find any information about it.
A few days ago, however, a doctor left a comment on the article I wrote (Susphrine: The asthma wonder drug of old) over at MyAsthmaCentral.com that finally gave me some information about this medicine.
The comment was this: .
I have been, (and still am), an ER doc for 21 years. I truly miss Susphrine. I found this story by searching for it to see if anyone still makes it. Yes, the newer drugs are great, but every once in awhile, there is a pt who comes to the ER that doesn't respond to anything but epinephrine. When that happens now, that pt has to be admitted, since epi will wear off in about 3 hours or so. Susphrine (which stood for "sustained epinephrine") was used in these pt's in the past since it would last 6 to 8 hours. By then, the steroids we gave these pt's would "kick in" and prevent the relapse. It is unfortunate that we no longer have Susphrine in our arsenal.
"Also, Susphrine was "sustained epinephrine" because it was epinephrine in an oil base that allowed it to be absorbed slowly.
I was so happy that doctor responded to my article and shared his wisdom. And what he says makes perfect sense too.
I remember going to the ER or doctor's office, and sitting on the bed all frogged up gasping for air. The doc would order Susphrine, and within five minutes I'd be breathing great.Then he'd order a shot of solumedrol (or whatever steroid was given back then). Although I didn't care about this shot. It didn't give me the relief of the Susphrine. Yet, it was both meds together that allowed the doc to send me home. I know that now.
Thankfully today we have so much better asthma wisdom and so much better medicine to prevent asthma in the first place most kids probably never need Susphrine.
But there are definitely some cases (especially for those hard luck asthmatics out there) where a longer acting epinepherine would come in handy.
Perhaps it's time to bring Susphrine back again.
Wednesday, May 6, 2009
Thoughts about Advair and alternatives
As I blogged about yesterday, many people have been asking about alternatives to Advair and Symbicort due to the high cost of these meds. I have listed some options here on this blog as they've come to me.
Today I have another option that has popped into my always thinking head. I'm a very curious person, and therefore sometimes I find myself thinking of things other people may never have considered. I'm not saying they'll work, I'm just thinking here.
It's something that's far out there, but actually it isn't. Since Advair** is an expensive mixure of a corticosteroid (Flovent) and long acting bronchodilator (Serevent) meant to treat both the chronic inflammation and prevent acute bronchospasm, why can't a mixture of less expensive meds be used as a replacement for Advair.
Of course Advair is the asthma wonder drug of choice not just because of what it prevents, but because it's easy to carry around, easy to use, and only needs to be taken twice a day. It's highly convenient, and makes asthmatics much more compliant than in years past. If cost were no obstacle, Advair is the medicine of choice.
The only problem with Advair (aside for some minor side effects), is that it costs an arm and a leg. And, since it costs so much, people who do not work, are poor, or have no health insurance have no way of gaining access to it. And it's these people we see in hospital emergency rooms.
So, as a replacement for an Advair discuss that costs $120 a month, why can't Asthmatics (and COPDers too), take Vanceril at $38 a month and Ventolin, which costs $42. That's still a chunk, but it's $40 less than Advair.
I can see a doctor switching a patient from Advair to Vanceril or some other generic corticosteroid (like Azmacort, Beclovent, Aerobid, etc). But instructing every asthmatic to take Ventolin every four hours is frowned upon. Why?
The asthma guidelines themselves say that any asthmatic who needs Ventolin more than 2-3 times in a two week period does not have control of his asthma. If that is true, then why are people who need Serevent in their systems all the time considered under control? Aren't they the same type of medicine, except one lasts for 12 hours and the other 4-6?
And yet, while the asthma guidelines recommends Advair and frown upon overuse of Ventolin (overuse would consist of using it more than the asthma guidelines recommend), it seems every single patient admitted to the hospital with Asthma or COPD is given Ventolin*** every 4-6 hours regardless of whether their disease is exacerbated. Ventolin lasts in the system about that long.
So a wise man asks: Why is it okay to order Ventolin every four hours as a preventative medicine in the hospital, but not okay to order it the same way for outpatient therapy?
A doctor recently gave me an answer when I questioned why she keeps ordering Ventolin Q4 on all her patients. She said, "Because they need it in their system to prevent shortness of breath."
Okay? So, if a patient needs it in his system while in the hospital to PREVENT shortness of breath, then why does this philosophy not apply outside the hospital? Either Ventolin is a preventative medicine or it is not?
I know Ventolin doesn't prevent for me because I had a pre and post PFT done to prove this. But doctors rarely order PFTs to determine if the Ventolin they are ordering on all their patients is working.
That would make too much sense. Better sense would be to use common sense and not order ventolin at all unless it is needed, or at least proven to be effected, which could be a subjective or objective measure.
But actually assessing to determine effectiveness would mean an actual assessment, which would be way to much work for some doctors to bother with. So they just order what feels right, not what is right (Kind of like Washington Politics, hey!).
I suppose you can create a third angle with this argument. If Ventolin should never be used unless a patient is having an exacerbation, then Serevent should never be used period. If the corticosteroid is doing its job, the patient should never get short of breath in the first place.
Yet that may not be a reasonable claim for many patients. Still, Serevent and Ventolin are the same medicine. And, while a patient is taking Serevent on a daily basis, it is still considered safe to use Ventolin with Serevent ( but never safe to use Serevent more than twice a days).
So, if you still need to use Ventolin every day regardless of being on Serevent, is the Serevent even doing it's job? Is it really preventing bronchospasm?
Or, is the reason Advair improves the lives of asthmatics so much more do do with the fact it's easy to use, convenient to carry around, and only needs to be taken twice a day, and not because it has both a corticosteroid and long acting bronchodilator. In other words, would a discus of Flovent alone work as well as Advair?
If the answer is yes, then any patient on Advair that costs $120 could easily be switched to a medicine like Vanceril which costs $38, and not lose any of the benefits. However, there would be one big if here: the patient would have to be as compliant with the Vanceril inhaler as he is with the Flovent discus.
Vanceril may be needed 4 times a day instead of the convenient two. Plus those patients who are now taking Vanceril will also have to lug around a bulky spacer. Obviously we're supposed to carry one around with our Ventolin too, but you and I both know most asthmatics (especially guys) don't carry spacers with them.
Ideally, Advair is better all the way around, except for cost. But, if you are strapped for money, perhaps an alternative generic corticosteroid may work just as well as the Advair, if proper technique is used. That means you have to use a spacer.
And perhaps, if you or your doctor thinks Serevent works so well for you, then why not take Ventolin every 4-6 hours round the clock too, regardless of what the guidelines say.
If I haven't lost you with my rambling here, tell me where you think I'm wrong (or right).
* costs listed are estimates.
**Advair and Symbicort are basically the same med, so when I refer to one, I'm also referring to the other.
***Xopenex may be ordered as well, and if it is the frequency is usually every 4-8 hours because that's how long the medicine lasts.
Today I have another option that has popped into my always thinking head. I'm a very curious person, and therefore sometimes I find myself thinking of things other people may never have considered. I'm not saying they'll work, I'm just thinking here.
It's something that's far out there, but actually it isn't. Since Advair** is an expensive mixure of a corticosteroid (Flovent) and long acting bronchodilator (Serevent) meant to treat both the chronic inflammation and prevent acute bronchospasm, why can't a mixture of less expensive meds be used as a replacement for Advair.
Of course Advair is the asthma wonder drug of choice not just because of what it prevents, but because it's easy to carry around, easy to use, and only needs to be taken twice a day. It's highly convenient, and makes asthmatics much more compliant than in years past. If cost were no obstacle, Advair is the medicine of choice.
The only problem with Advair (aside for some minor side effects), is that it costs an arm and a leg. And, since it costs so much, people who do not work, are poor, or have no health insurance have no way of gaining access to it. And it's these people we see in hospital emergency rooms.
So, as a replacement for an Advair discuss that costs $120 a month, why can't Asthmatics (and COPDers too), take Vanceril at $38 a month and Ventolin, which costs $42. That's still a chunk, but it's $40 less than Advair.
I can see a doctor switching a patient from Advair to Vanceril or some other generic corticosteroid (like Azmacort, Beclovent, Aerobid, etc). But instructing every asthmatic to take Ventolin every four hours is frowned upon. Why?
The asthma guidelines themselves say that any asthmatic who needs Ventolin more than 2-3 times in a two week period does not have control of his asthma. If that is true, then why are people who need Serevent in their systems all the time considered under control? Aren't they the same type of medicine, except one lasts for 12 hours and the other 4-6?
And yet, while the asthma guidelines recommends Advair and frown upon overuse of Ventolin (overuse would consist of using it more than the asthma guidelines recommend), it seems every single patient admitted to the hospital with Asthma or COPD is given Ventolin*** every 4-6 hours regardless of whether their disease is exacerbated. Ventolin lasts in the system about that long.
So a wise man asks: Why is it okay to order Ventolin every four hours as a preventative medicine in the hospital, but not okay to order it the same way for outpatient therapy?
A doctor recently gave me an answer when I questioned why she keeps ordering Ventolin Q4 on all her patients. She said, "Because they need it in their system to prevent shortness of breath."
Okay? So, if a patient needs it in his system while in the hospital to PREVENT shortness of breath, then why does this philosophy not apply outside the hospital? Either Ventolin is a preventative medicine or it is not?
It would seem to me if a patient does not respond well to Serevent, then Ventolin is a viable option. Of course you must consider what works for one patient does not work for all.
Personally, I don't think Ventolin prevents anything for most patients. The pre-use of Ventolin has never prevented me from having a bronchospasm. However, the pre-use of a corticosteroid has. However, I'm not saying Ventolin won't prevent for some patients.I know Ventolin doesn't prevent for me because I had a pre and post PFT done to prove this. But doctors rarely order PFTs to determine if the Ventolin they are ordering on all their patients is working.
That would make too much sense. Better sense would be to use common sense and not order ventolin at all unless it is needed, or at least proven to be effected, which could be a subjective or objective measure.
But actually assessing to determine effectiveness would mean an actual assessment, which would be way to much work for some doctors to bother with. So they just order what feels right, not what is right (Kind of like Washington Politics, hey!).
I suppose you can create a third angle with this argument. If Ventolin should never be used unless a patient is having an exacerbation, then Serevent should never be used period. If the corticosteroid is doing its job, the patient should never get short of breath in the first place.
Yet that may not be a reasonable claim for many patients. Still, Serevent and Ventolin are the same medicine. And, while a patient is taking Serevent on a daily basis, it is still considered safe to use Ventolin with Serevent ( but never safe to use Serevent more than twice a days).
So, if you still need to use Ventolin every day regardless of being on Serevent, is the Serevent even doing it's job? Is it really preventing bronchospasm?
Or, is the reason Advair improves the lives of asthmatics so much more do do with the fact it's easy to use, convenient to carry around, and only needs to be taken twice a day, and not because it has both a corticosteroid and long acting bronchodilator. In other words, would a discus of Flovent alone work as well as Advair?
If the answer is yes, then any patient on Advair that costs $120 could easily be switched to a medicine like Vanceril which costs $38, and not lose any of the benefits. However, there would be one big if here: the patient would have to be as compliant with the Vanceril inhaler as he is with the Flovent discus.
Vanceril may be needed 4 times a day instead of the convenient two. Plus those patients who are now taking Vanceril will also have to lug around a bulky spacer. Obviously we're supposed to carry one around with our Ventolin too, but you and I both know most asthmatics (especially guys) don't carry spacers with them.
Ideally, Advair is better all the way around, except for cost. But, if you are strapped for money, perhaps an alternative generic corticosteroid may work just as well as the Advair, if proper technique is used. That means you have to use a spacer.
And perhaps, if you or your doctor thinks Serevent works so well for you, then why not take Ventolin every 4-6 hours round the clock too, regardless of what the guidelines say.
If I haven't lost you with my rambling here, tell me where you think I'm wrong (or right).
* costs listed are estimates.
**Advair and Symbicort are basically the same med, so when I refer to one, I'm also referring to the other.
***Xopenex may be ordered as well, and if it is the frequency is usually every 4-8 hours because that's how long the medicine lasts.
Tuesday, May 5, 2009
Can't afford Advair? Here's another option for you
With the economy the way it is, and so many people without jobs and/ or without insurance (and even people with insurance), we have been getting lots of questions such as the following:
I think this is a very important topic, because asthmatics who take their meds exactly as instructed by a doctor can really lead a normal life, and can do things that any other person can do, like run a marathon.
On the other hand, not taking your controller meds is a "contributing factor in asthma deaths," according to the authors of Fatal Asthma. And those most likely to be non-compliant with their asthma meds are those who of the low income variety. A tough economy can make many of us poor.
And, with poverty, comes the unfortunate outcome of having to make cuts in the budget. And, unfortunately, when those among us lose our insurance, and the cost of Advair shoots up from $10 a month to $150.00, this becomes an easy place to make the cut.
That's understandable. But don't use this as an excuse to stop taking your asthma meds. If you simply cannot afford Advair (or Symbicort), there are options for you.
A few months ago I addressed this topic here at the RT Cave with this post "8 ideas for those who can't afford Advair." This post was a list not just of ideas I came up with on my own, but ideas many of my readers
The best option on my list is the one that allows you to continue taking Advair at a cost that is affordable to you. This option involves calling the pharmaceutical company to see if they have a program available to help you afford Advair.
Joy Buchanan, producer at MyAsthmaCentral.com, offered the following advice for the above question.
There are a lot of COPD and Asthma patients who have benefited a great deal from Advair. If your wallet is a little thin, at least this gives you another option to try to keep that Advair in your system.
UPDADE: CHECK OUT MY NEW POST: HOW TO GET HELP PAYING FOR ASTHMA MEDS AND PHYSICIANS
"I have COPD and will be getting laid off at the end of this month, and without insurance, the pharmacy said advair discus will be about $150.00 per month. But I do not think there is a generic. Is there?"
I think this is a very important topic, because asthmatics who take their meds exactly as instructed by a doctor can really lead a normal life, and can do things that any other person can do, like run a marathon.
On the other hand, not taking your controller meds is a "contributing factor in asthma deaths," according to the authors of Fatal Asthma. And those most likely to be non-compliant with their asthma meds are those who of the low income variety. A tough economy can make many of us poor.
And, with poverty, comes the unfortunate outcome of having to make cuts in the budget. And, unfortunately, when those among us lose our insurance, and the cost of Advair shoots up from $10 a month to $150.00, this becomes an easy place to make the cut.
That's understandable. But don't use this as an excuse to stop taking your asthma meds. If you simply cannot afford Advair (or Symbicort), there are options for you.
A few months ago I addressed this topic here at the RT Cave with this post "8 ideas for those who can't afford Advair." This post was a list not just of ideas I came up with on my own, but ideas many of my readers
The best option on my list is the one that allows you to continue taking Advair at a cost that is affordable to you. This option involves calling the pharmaceutical company to see if they have a program available to help you afford Advair.
Joy Buchanan, producer at MyAsthmaCentral.com, offered the following advice for the above question.
"Our expert, Dr. James Thompson, has written a post about saving money on managing your condition here. Also, you should contact Advair's manufacture, GlaxoSmithKline at 1-866-518-4357. Companies have programs to provide their brand name drugs to patients for cheap (or, sometimes, free) if they meet the income qualifications. GlaxoSmithKline's program for Advair is called GSKAccess. Also, try these organizations for help with your prescriptions:* Partnership for Prescription Assistance* RxAssist.org* RxHope.com* TogetherRx
There are a lot of COPD and Asthma patients who have benefited a great deal from Advair. If your wallet is a little thin, at least this gives you another option to try to keep that Advair in your system.
UPDADE: CHECK OUT MY NEW POST: HOW TO GET HELP PAYING FOR ASTHMA MEDS AND PHYSICIANS
Monday, May 4, 2009
5 asthma meds you must take as directed
Asthma is perhaps one of the most furtive diseases on the disease market. You could have asthma your whole life and not know it, or you could have had asthma your whole life, and it all of a sudden seems to disappear.
In that sense, it can fool you.
Some asthmatics know they have the disease, yet they feel so good they simply decide to quit taking their meds. They become fooled by the furtive disease.
We see this quite often with Sometimer Asthmatics who only take their meds when it's convenient for them, and most often with Goofus Asthmatics.
Yet, as what happens way too often, no sooner do they quit taking their controller medicines their doctor prescribed and their asthma hits them hard as a mack truck on an expressway: it takes their breath away.
Don't be that fool who is fooled by the furtive disease called asthma.
Or, perhaps they are reluctant to take their meds because they're afraid of the side effects, or don't want to put un-needed chemicals into their body.
Look, folks, asthma wisdom has come so far in the past 20 years there is no reason anyone should ever suffer from uncontrolled asthma, and most of the little asthma attacks can easily be avoided simply by sticking with the medicine regime agreed upon by you and your physician.
Don't be fooled by the disappearing asthma trick.
Likewise, most medicines are proven safe for asthmatics if used appropriately, and they are easier to use and more convenient too.
It's fine if you need to come to the ER because you didn't know any better and your asthma got the better of you, or if you so happen to be a hardluck asthmatic. But, hey, don't be the foolish asthmatic who needs to make a trip to see me in the ER because he quit taking his medicines.
In a recent post at MyAsthmaCentral.com I listed five of the most important asthma medicines of 2009, and why it is important to use them exactly as prescribed.
Click here and I will morph you over to my asthma blog. Don't hesitate! This click may actually save you money, a wasted trip to the ER, your breath, and perhaps even your life.
5 Common Types of Asthma Meds & Why You Should Use Them As Prescribed
by Rick Frea Tuesday, February 10, 2009 @ MyAsthmaCentral.com
It's frustrating for us RTs (and RNs and DRs too of course) when an asthmatic comes to see us in the ER and then we find out he stopped taking his meds meant to "prevent" such an attack.
It's equally frustrating when an asthmatic comes in only because his inhaler ran out. We know that most of the time if he would have come in right away instead of taking those extra puffs his asthma would not have gotten so bad.
That in mind, I have come up with a list of five types of asthma meds commonly prescribed for asthma, and why it is essential they be used as instructed:
1. Rescue inhaler: (Albuterol, Xopenex) Ideally, Albuterol is to be used every 4-6 hours and Xopenex every 4-8 hours as needed for shortness of breath caused by narrowing of the airways (bronchospasm). It is meant to STOP an asthma attack. If it doesn't work, you should avoid abusing it.
Sure you may have realized -- as many asthmatics have -- that side effects to this drug are minimal, so abusing it is easy. Still, the fact you are still short of breath after two extra puffs of your rescue inhaler should be an indicator you need to see your doctor, and not that you need more puffs.
Of course it is acceptable that you take an extra puff or two occasionally for mild asthma symptoms, and some of you may need it to prevent excercise-induced asthma, but if you need more than the occasional extra puff, this means that -- for a majority of you asthmatics -- your asthma is not controlled.
The fact you need this medicine more than recommended means that you are trying to manage your asthma on your own instead of calling your doctor and letting him do what he is trained to do.
(If you want some more tips on when to come into the ER for your asthma, check out this post, "Having asthma symptoms? Here's five tips to help you decide what to do.")
2. Inhaled Corticosteroids: (Flovent, Pulmicort, Aerobid, Azmacort, Vanceril) These meds reduce inflammation in your lungs and ultimately make your lungs stronger so your lungs are better able to handle your asthma triggers, and your rescue inhaler works better when you need it.
It's takes 2-3 weeks for this medicine to get into your system and take full effect. And, therefore, if you wait until you are having an attack to start using it, the med will do you no good.
3. Long acting bronchodilators: (Serevent, formoterol) These are bronchodilators that last up to 12 hours and prevent asthma attacks. Normally, for asthma, they are given in conjunction with corticosteroids (Advair, Symbicort).
This med group usually takes up to 20 minutes to start working, and therefore will have little effect if used to stop an astha attack. Likewise, abuse of this medicine is believed to be a leading cause of death for asthmatics.
The FDA, however, has noted that the benefits of using this medicine far outweigh the risks, but this med is meant to be taken once in the morning and once before bed and NEVER more. It is also meant to be taken in conjuction with a corticosteroid. The FDA ruled that asthmatics, in general, are probably better off taking a combo drug, i.e. Advair or Symbicort.
3. Leukotriene inhibitors: (Singulair) This is an excellent medicine used to prevent allergies. It is more commonly prescribed for asthmatics because it blocks the leukotrienes from being released when your body is exposed to allergens, and thus prevents bronchoconstriction during an asthma attack.
This medicine should be taken once daily by mouth even when you are feeling good, and it also takes up to 2-3 weeks to start working. This is a preventative medicine that is most effective when it is well established in your system. It should not be taken to stop an attack.
There are, however, some exceptions you may want to discuss with your doctor, as this med can also be used 2 hours prior to excercise to prevent excercise induced asthma.
4. Anti-inflammatory agents: (Cromolyn and Tilade) This is a classic asthma preventative medicine used to reduce swelling in your airways. It's also a mast cell stabilizer that prevents the release of hystamine, a chemical that can cause allergic reactions, and leukotrieins, a chemical that causes bronchospasm.
This type of medicine does not work to stop an asthma attack, and usually takes 1-2 weeks of continued use before it starts working. Therefore, if you stop using this medicine it will not prevent an asthma attack.
There is one other thing I can say about #2-4 above that may sometimes be overlooked, but I know from personal experience it is true:
If you take your preventative medicines exactly as prescribed, when you do have asthma symptoms these symptoms are likely to be less severe and more easily treated with your rescue inhaler (#1 above).
So don't be the goofus asthmatic who abuses his rescue inhaler until it runs out before rushing to the ER, and don't be the asthmatic who makes a trip to the ER just because she decided to stop taking her preventative meds.
Instead, be the gallant asthmatic who is thankful science has provided you the opportunity to control your asthma, and take care of yourself.
In that sense, it can fool you.
Some asthmatics know they have the disease, yet they feel so good they simply decide to quit taking their meds. They become fooled by the furtive disease.
We see this quite often with Sometimer Asthmatics who only take their meds when it's convenient for them, and most often with Goofus Asthmatics.
Yet, as what happens way too often, no sooner do they quit taking their controller medicines their doctor prescribed and their asthma hits them hard as a mack truck on an expressway: it takes their breath away.
Don't be that fool who is fooled by the furtive disease called asthma.
Or, perhaps they are reluctant to take their meds because they're afraid of the side effects, or don't want to put un-needed chemicals into their body.
Look, folks, asthma wisdom has come so far in the past 20 years there is no reason anyone should ever suffer from uncontrolled asthma, and most of the little asthma attacks can easily be avoided simply by sticking with the medicine regime agreed upon by you and your physician.
Don't be fooled by the disappearing asthma trick.
Likewise, most medicines are proven safe for asthmatics if used appropriately, and they are easier to use and more convenient too.
It's fine if you need to come to the ER because you didn't know any better and your asthma got the better of you, or if you so happen to be a hardluck asthmatic. But, hey, don't be the foolish asthmatic who needs to make a trip to see me in the ER because he quit taking his medicines.
In a recent post at MyAsthmaCentral.com I listed five of the most important asthma medicines of 2009, and why it is important to use them exactly as prescribed.
Click here and I will morph you over to my asthma blog. Don't hesitate! This click may actually save you money, a wasted trip to the ER, your breath, and perhaps even your life.
5 Common Types of Asthma Meds & Why You Should Use Them As Prescribed
by Rick Frea Tuesday, February 10, 2009 @ MyAsthmaCentral.com
It's frustrating for us RTs (and RNs and DRs too of course) when an asthmatic comes to see us in the ER and then we find out he stopped taking his meds meant to "prevent" such an attack.
It's equally frustrating when an asthmatic comes in only because his inhaler ran out. We know that most of the time if he would have come in right away instead of taking those extra puffs his asthma would not have gotten so bad.
That in mind, I have come up with a list of five types of asthma meds commonly prescribed for asthma, and why it is essential they be used as instructed:
1. Rescue inhaler: (Albuterol, Xopenex) Ideally, Albuterol is to be used every 4-6 hours and Xopenex every 4-8 hours as needed for shortness of breath caused by narrowing of the airways (bronchospasm). It is meant to STOP an asthma attack. If it doesn't work, you should avoid abusing it.
Sure you may have realized -- as many asthmatics have -- that side effects to this drug are minimal, so abusing it is easy. Still, the fact you are still short of breath after two extra puffs of your rescue inhaler should be an indicator you need to see your doctor, and not that you need more puffs.
Of course it is acceptable that you take an extra puff or two occasionally for mild asthma symptoms, and some of you may need it to prevent excercise-induced asthma, but if you need more than the occasional extra puff, this means that -- for a majority of you asthmatics -- your asthma is not controlled.
The fact you need this medicine more than recommended means that you are trying to manage your asthma on your own instead of calling your doctor and letting him do what he is trained to do.
(If you want some more tips on when to come into the ER for your asthma, check out this post, "Having asthma symptoms? Here's five tips to help you decide what to do.")
2. Inhaled Corticosteroids: (Flovent, Pulmicort, Aerobid, Azmacort, Vanceril) These meds reduce inflammation in your lungs and ultimately make your lungs stronger so your lungs are better able to handle your asthma triggers, and your rescue inhaler works better when you need it.
It's takes 2-3 weeks for this medicine to get into your system and take full effect. And, therefore, if you wait until you are having an attack to start using it, the med will do you no good.
3. Long acting bronchodilators: (Serevent, formoterol) These are bronchodilators that last up to 12 hours and prevent asthma attacks. Normally, for asthma, they are given in conjunction with corticosteroids (Advair, Symbicort).
This med group usually takes up to 20 minutes to start working, and therefore will have little effect if used to stop an astha attack. Likewise, abuse of this medicine is believed to be a leading cause of death for asthmatics.
The FDA, however, has noted that the benefits of using this medicine far outweigh the risks, but this med is meant to be taken once in the morning and once before bed and NEVER more. It is also meant to be taken in conjuction with a corticosteroid. The FDA ruled that asthmatics, in general, are probably better off taking a combo drug, i.e. Advair or Symbicort.
3. Leukotriene inhibitors: (Singulair) This is an excellent medicine used to prevent allergies. It is more commonly prescribed for asthmatics because it blocks the leukotrienes from being released when your body is exposed to allergens, and thus prevents bronchoconstriction during an asthma attack.
This medicine should be taken once daily by mouth even when you are feeling good, and it also takes up to 2-3 weeks to start working. This is a preventative medicine that is most effective when it is well established in your system. It should not be taken to stop an attack.
There are, however, some exceptions you may want to discuss with your doctor, as this med can also be used 2 hours prior to excercise to prevent excercise induced asthma.
4. Anti-inflammatory agents: (Cromolyn and Tilade) This is a classic asthma preventative medicine used to reduce swelling in your airways. It's also a mast cell stabilizer that prevents the release of hystamine, a chemical that can cause allergic reactions, and leukotrieins, a chemical that causes bronchospasm.
This type of medicine does not work to stop an asthma attack, and usually takes 1-2 weeks of continued use before it starts working. Therefore, if you stop using this medicine it will not prevent an asthma attack.
There is one other thing I can say about #2-4 above that may sometimes be overlooked, but I know from personal experience it is true:
If you take your preventative medicines exactly as prescribed, when you do have asthma symptoms these symptoms are likely to be less severe and more easily treated with your rescue inhaler (#1 above).
So don't be the goofus asthmatic who abuses his rescue inhaler until it runs out before rushing to the ER, and don't be the asthmatic who makes a trip to the ER just because she decided to stop taking her preventative meds.
Instead, be the gallant asthmatic who is thankful science has provided you the opportunity to control your asthma, and take care of yourself.
Sunday, May 3, 2009
Asthma rule #1: Take your Singulair as ordered
I know (I know-I know) asthma experts like me preach you should never tinker with your medicine. And I know (I know-I know) we preach you should always take your medicine exactly as prescribed by your doctor.
But I did it anyway. I decided that Singulair is way too expensive at $30 per month, or $1 a pill. And that is with insurance. For those who don't have insurance you get 30 pills for $79, which comes to about $2.63 per pill.
Either way, that's a lot of money. And since there are no generic Singulair type medicines available, my insurance requires me to pay a certain percentage of the actual cost. Otherwise, for prescriptions that are reasonably priced I pay a $10 co-pay.
So, in order to try to spread out my prescription over two months, I decided that since I was feeling so well I'd take a pill every other day instead of every day. For the first month this seemed to be working quite well and I thought I was on to something.
But then over this past weekend it hit me. Thankfully I didn't have trouble with my asthma (thanks to Advair), but I did have a major case of the eye itches, sneezes, and runny nose.
Of course this could have been a coincidence, as it is true that many experts note that Singulair is not an antihystamine to stop the symptoms I describe, but a leukotriene blocker intended to block allergies from causing bronchospasm.
Yet I'm quick to attribute this to my Singulair trial, especially considering last spring I showed no symptoms of allergies for the first time in my entire life.
Some people who don't have as severe of allergies as me (I'm allergic to pretty much everything outdoors) may be able to get by taking a pill every other day, but that strategy won't work for me -- at least during the spring season.
I know (I know-I know) I shouldn't tinker with my medicine, but on occasion I find this is a good thing to do, for no other reason than to prove to yourself that the medicines you are on are working great, as opposed to just assuming (as some doctors do).
It's kind of a checks and balance system I like to use. So now I'm back to taking it every day, despite the high price.
I imagine some of you guideline followers might email me a "Smack!" or a "Kick" in the rump for doing something so stupid. Go ahead and do so, because I deserve it.
"Achoooooooo!"
Tuesday, April 14, 2009
COPD: Is Spiriva, Advair or Xopenex right for you?
The following question was emailed to me, and I've decided the answer would be of interest to many of my readers.
Your Question:
Hey - I'm a student therapist right now but I was talking to my manager about her mother and she has emphysema. She's on home oxygen and her doctor prescribed xopenex BID via HHN, advair BID, and spiriva QD. I'm wondering if this is a little excessive considering xopenex and salmeterol are both beta-adrenergic bronchodilators and considering xopenex is a short acting bronchodilator while salmeterol lasts much longer why is the doctor prescribing the xopenex? She doesn't have asthma so I don't believe she has a need for a fast acting bronchodilator. Also since shes taking salmeterol (in advair) twice a day, is the spiriva really needed as well?
My Answer:
Great question. I think your doctor is right on track with the Advair and spiriva. Advair has both a long acting bronchodilator and corticosteroid component to prevent bronchospams and control inflammation. Spiriva, believe it or not, has been proven to improve lung function, something every emphysema patient could benefit from.
Xopenex should definitely be ordered, but only on an as needed (prn) bases to treat acute episodes of shortness of breath due to bronchospasm. In my opinion, there is no added benefit from pre-set frequency of Xopenex unless the patient is often short of breath despite all the other medicines.
Here's an exception to that last statement: some COPD patients have trouble deciding when they need to use their rescue medicine. For these patients, a set frequency may be indicated. For the most part, however, Xopenex should only be used if it is needed.
One of the neat things about Spiriva only being needed once a day, and Advair twice a day, is this improved patient compliance with these meds. With improved compliance, the rescue medicine (Xopenex and Albuterol) should be needed less often.
Note: All asthma and COPD patients should have either a xopenex or Albuterol inhaler handy at all times, and perhaps, if indicated, the capability to take breathing treatments.
Your Question:
Hey - I'm a student therapist right now but I was talking to my manager about her mother and she has emphysema. She's on home oxygen and her doctor prescribed xopenex BID via HHN, advair BID, and spiriva QD. I'm wondering if this is a little excessive considering xopenex and salmeterol are both beta-adrenergic bronchodilators and considering xopenex is a short acting bronchodilator while salmeterol lasts much longer why is the doctor prescribing the xopenex? She doesn't have asthma so I don't believe she has a need for a fast acting bronchodilator. Also since shes taking salmeterol (in advair) twice a day, is the spiriva really needed as well?
My Answer:
Great question. I think your doctor is right on track with the Advair and spiriva. Advair has both a long acting bronchodilator and corticosteroid component to prevent bronchospams and control inflammation. Spiriva, believe it or not, has been proven to improve lung function, something every emphysema patient could benefit from.
Xopenex should definitely be ordered, but only on an as needed (prn) bases to treat acute episodes of shortness of breath due to bronchospasm. In my opinion, there is no added benefit from pre-set frequency of Xopenex unless the patient is often short of breath despite all the other medicines.
Here's an exception to that last statement: some COPD patients have trouble deciding when they need to use their rescue medicine. For these patients, a set frequency may be indicated. For the most part, however, Xopenex should only be used if it is needed.
One of the neat things about Spiriva only being needed once a day, and Advair twice a day, is this improved patient compliance with these meds. With improved compliance, the rescue medicine (Xopenex and Albuterol) should be needed less often.
Note: All asthma and COPD patients should have either a xopenex or Albuterol inhaler handy at all times, and perhaps, if indicated, the capability to take breathing treatments.
Monday, April 6, 2009
The best dose of Xoponex for neonates & infants
The following question was asked at MyAsthmaCentral.com. I thought the answer here would benefit asthmatics worldwide:
WHAT WOULD BE THE NORMAL DOSE OF XOPENEX FOR A NEONATE OR INFANT?
Great question. Most experts agree that the adult dose of 1.25 mg xopenex es equally safe for kids. I think the main reason for this is because the airways of kids is much smaller than the adult airway and so disposition of the medicine into the lungs is greatly diminished.
Likewise, the most common method of delivery of the medicine to neonates is by blowing the med by the patoent's face (blowby treatment), and this results in most of the medicine being wasted to the atmosphere (perhaps even as much as 80% of the medicine wasted).
In fact, according to respiratory therapy experts (read this article) the use of the blowby is not recommended. However, with neonates, we have no real other options. Therefore, the 1.25 mg dose is recommended.
A preferred method to blowby is using a face mask, but still 50% of the medicine is wasted to the atmosphere. The best method is using a mouthpiece, but that's not possible with the neonate population.
However, despite what I have written here, the best dose of xopenex is whatever dose works best for your child with the least side effects, and whatever dose your doctor recommends. Most doctors where I work prescribe the 1.25 mg dose, however, on occasion, they recommend the lower doses.
The same holds true for Albuterol. The best dose for neo and infants is 0.5cc Ventolin.
I hope this helps. Any further questions let us know
WHAT WOULD BE THE NORMAL DOSE OF XOPENEX FOR A NEONATE OR INFANT?
Great question. Most experts agree that the adult dose of 1.25 mg xopenex es equally safe for kids. I think the main reason for this is because the airways of kids is much smaller than the adult airway and so disposition of the medicine into the lungs is greatly diminished.
Likewise, the most common method of delivery of the medicine to neonates is by blowing the med by the patoent's face (blowby treatment), and this results in most of the medicine being wasted to the atmosphere (perhaps even as much as 80% of the medicine wasted).
In fact, according to respiratory therapy experts (read this article) the use of the blowby is not recommended. However, with neonates, we have no real other options. Therefore, the 1.25 mg dose is recommended.
A preferred method to blowby is using a face mask, but still 50% of the medicine is wasted to the atmosphere. The best method is using a mouthpiece, but that's not possible with the neonate population.
However, despite what I have written here, the best dose of xopenex is whatever dose works best for your child with the least side effects, and whatever dose your doctor recommends. Most doctors where I work prescribe the 1.25 mg dose, however, on occasion, they recommend the lower doses.
The same holds true for Albuterol. The best dose for neo and infants is 0.5cc Ventolin.
I hope this helps. Any further questions let us know
Subscribe to:
Posts (Atom)