The Bloom Credit Card Size Inhaler

Considering the design of the inhaler has not changed since it was invented in 1957, we are long overdue for a revolutionary breakthrough. Say hello to Bloom, an inhaler the size of a credit card that can easily fit into a wallet.

Traditional inhalers are nice in that they are small, lightweight, easily portable. Yet they are still bulky, and -- let's face it -- they are easy to forget. How about an inhaler that is always with you, snug nice and secure inside your wallet. When you need it all you do is open your wallet and there it will be. 

Now, the idea here is you purchase a regular inhaler. You take out the cannister and insert it into the top of the Bloom inhaler. You then squirt it six times. Bloom saves the medicine without wasting any of it. Now you place Bloom inside your wallet for safe keeping. Six puffs will be available whenever you need them. No need to worry about forgetting your inhaler. No need for stuffing that bulky inhaler inside your pocket. 

The product does cost $40, so it may be more of a fashion product at this point, only reserved for those with the desire to look cool. Still, it is available for anyone who uses an inhaler. Considering over 300 million people worldwide have asthma, and millions more have other lung diseases and need an inhaler, there are many potential customers for such an interesting product. 

When you need it, you just take it out of your wallet and use it as you would any inhaler with the open mouth technique. Of course here in lies a problem with this device, is that you cannot use it with a spacer. Still, if you are in a crunch, or if you are mainly concerned with fashion, this would be an ideal inhaler. Or, considering most people don't use inhalers correctly anyway, what difference does it make. 

The Bloom is compatible with any metered dose inhaler. It's a neat concept, anyway, worthy of consideration. If you want to learn more, click on over to bloominhaler.com.

Please note that this is not an endorsement of the product. This is just a post letting you know that people are working on new and improved inhaler designs to make life better for those of us who need to have a rescue inhaler on hand at all times.

Let me know what you think in the comments below. 

Nebulizers -vs- Inhalers for COPDers

The follow
ing was originally published at healthcentral.com/copd on May 20, 2015

Inhaler -vs- nebulizer: which one is best for COPD

One of the best ways of controlling COPD is by inhaling COPD medicine. To do this, some use an inhaler with a spacer, some use a nebulizer, and some use both. So which one is the best way to deliver COPD medicine to your lungs?

To learn about inhalers, check out my post “What is an inhaler?” To learn about nebulizers, check out my post “What is a nebulizer?”

Both inhalers and nebulizers allow patients to inhale a low dose of a medicine to receive a more rapid response (sometimes immediate), with fewer side effects than taking the medicine systemically. So they both work great for people with lung disease.

That said, let’s delve into this subject a little deeper and compare the two.

Medicine Distribution. Many studies have been done comparing inhalers with nebulizers. Most suggest that, when used properly, inhalers used with a spacer work equally well as nebulizers. So, it would appear at first that there’s no difference between the two, as far as getting the most medicine.

Cost. Your first nebulizer will cost anywhere from $50 on up. It includes the nebulizer and the air compressor used to power it. You’ll need to purchase supplies a few times a year, plus the medicine each month. Albuterol inhalers cost about $50, although other inhalers (such as Advair), may cost upwards to $200 plus each month. However, any cost for COPD medicines can usually be picked up by co-pays and Medicare.

Medicinal Waste. Most people who use inhalers don’t realize this, but most of the medicine is wasted. Furthermore, it does not matter whether you are using an inhaler or a nebulizer. Studies suggest that when an inhaler with a spacer is used, only 15 percent of the medicine gets to the airways. When a nebulizer is used, only 12 percent of the medicine gets to the airways. However, this fact is accommodated for by the dosing.

Convenience. Nebulizers require an air compressor and a power source and about 10-20 minutes of your time. Inhalers with spacers are small, compact devices, are convenient for travel, can be used anywhere, and require no power source.

Coordination. Studies show most people don’t use inhalers correctly. This has been confirmed by many studies. Age, and disease severity, may also impact your ability to use inhalers correctly. Poor technique means less medicine gets to your lungs, resulting in less benefit from the medicine. Inhalers often require training and practice to get it right. Nebulizers require less training. They simply require breathing normal through a mouthpiece. This assures an ideal dose and ideal benefit.

Airflow Limitation. Some people cannot generate enough flow to operate inhalers. This may occur during asthma attacks, COPD flare-ups, and during the end stages of COPD. Nebulizer treatments allow you to inhale the medicine over a period of time regardless of flare-ups or disease severity. Nebulizers, therefore, appear to work better during flare-ups, and for severe COPD.

Decision. There really is no winner or loser here. The convenience of inhalers makes them ideal for most people. However, if you have severe COPD, or frequent flare-ups, nebulizers may work better. Still, the best way of learning which one is better for you is by talking to your physician.

Further reading:

• What is an inhaler?
• What is a spacer?
• What is a nebulizer?
• National Jewish Health: Inhaler Instruction Videos
• Most People Don’t Use Inhalers Correctly
• Most aerosolized medicine is wasted
• RT Magazine: Nebulizers VS Inhalers: And The Winner Is?

Asthma/COPD Inhalers: Why They Cost So Much

Some of my asthmatic friends constantly criticize pharmaceuticals as run by a bunch of evil rich people who are greedy and make money at the expense of the sick.  Their evidence is the fact that newer, non-patented, asthma medicine costs so much.  I would like to argue that pharmaceutical companies (or most of them) are run by people who simply want to make enough profit to stay in business.

It is true that asthma medicine costs too much. Consider that if your doctor prescribes Advair to control your asthma, it will cost you about $250 a month if you pay out of pocket.  If you have a copay the cost will be about $70 per month.  This copay is high, considering a typical copay for generic medicine is between $20 and $40 a month.

 Consider the following facts as reported by medicine.net, "Drugs: Why they cost so much?"

• The high price of Advair is not the result of greed, but of regulation. In fact, pharmaceuticals are constantly looking to find new medicines to help people.  They continue to do this even though they know that only one out of every 10,000 discovered compounds actually becomes approved by the FDA
• The early stages of development are not only expensive, but much of the expense incurred will not become approved drugs.
• It takes about 7 to 10 years and an average cost of 500 million dollars to develop each new drug. Keep in mind this money is spent before the FDA approves the drug. This means that if the drug is not approved, the company loses the money. 
• These expenses must be covered by the revenue from compounds that successfully become approved drugs (like Advair). 
• Moreover, only 3 out of every 20 approved drugs bring in sufficient revenue to cover their developmental costs, and only 1 out of every 3 approved drugs generates enough money to cover the development costs of previous failures. This means that for a drug company to survive, it needs to discover a blockbuster (billion-dollar drug -- like Advair) every few years. 
• After a drug is approved, millions of dollars are spent on marketing in educating healthcare providers and conducting post-marketing studies. Drug companies spend a lot of money on marketing because of the stiff competition they face from other drug companies for their drugs, and in order to develop each drug's highest revenue-generating potential. 
• Given the poor odds of discovering another successful drug, it is more efficient to maximize the returns on a drug that is already on the market through advertising. In this sense, drug companies are no different than any other type of company. They exist to make a profit by helping people.
• In addition to maximizing returns on their investment through advertising, drug companies also spend money to find new uses for drugs or better ways of using them. These efforts increase the use of the approved drugs and also benefit patients. 
• Additionally, drug companies donate millions of dollars to charities and provide free drugs to individuals or countries that cannot afford medications. In fact, it was through a program that I was able to get free Breo for a year (otherwise, I cannot afford it and I have insurance). 

Surely any person working for any company wants to become rich, but in order for this to happen the company they work for must develop, market, advertise, and sell a successful product. Due to the high risk of failure and the low risk of actually gaining FDA approval, the medicines that are approved will have a hefty cost.

Further reading:

• medicine.net, "Drugs: Why they cost so much?

Patients must learn proper inhaler technique

It is important that healthcare providers -- particularly respiratory therapists, nurses, and physicians -- adequately teach respiratory patients the proper technique for using inhalers.  This is especially important now that there are so many different types of inhalers on the market.

One recent issue that came up were reports to the American Association of Poison Control Center's National Poison Data System and the FDA about patients ingesting the capsules rather than inhaling them. Poison control probably had to educate people that swallowing the capsules would not poison them, as acids in the stomach would break down the medicine before it gets to the system.  

So the safety issue here was not so much poison, as it was that these patients were not getting the benefits of the medicine.  The bottom line is that ingesting the capsules rendered them useless.

This is a quintessential example of poor inhaler training.  It's also a perfect example that shows that it should not be assumed that patients can figure out how to use inhalers on their own.

The fact of the matter is, not even the most well educated and seasoned asthmatics use their inhalers correctly.  Therefore, it should never be assumed a patient will figure it out on their own, or that even the most seasoned asthmatics are using their inhalers properly.

Most experts now recommend that all patients be educated on trained on proper inhaler use when they are given new inhalers, and then the patient should be asked to demonstrate proper use with each subsequent visit.

In February, 2008, The FDA issued a public health advisory highlighting the correct way to use Foradil. The purpose was to assure healthcare providers were aware patients were using them wrong, in order so they could make sure their patients are using them correctly.

The FDA has also been made aware that similar occurrences were reported regarding the Spiriva HandiHalter (tiotropium). That issue was also addressed.

In the past ten years there have been a ton of new inhalers enter the market.  Many times I have had to Google how to use an inhaler before teaching it to a patient.  While using most of these inhalers is generally easy, they can also be confusing and even frustrating to patients.

Bottom line: every time we as healthcare providers  -- and this included respiratory therapists, nurses, and physicians --see chronic lungers we ought to be asking them if they have inhalers, and we should be making sure they are using them correctly.

• FDA Safety Update: Asthma Medicines
• Most people don't use inhalers correctly

Stiolto Respimat new option for COPD

Patients with COPD and asthma have yet another medicinal option as Stiolto was approved in May of 2015 by the U.S. Food and Drug Administration (FDA). The medicine should now be available in pharmacies around the U.S.

The medicine is another in a now increasing line of combination medicines approved for asthma and COPD. Stiolto contains:

• Tiotropium bromide (Spiriva), a long acting anticholinergic (LAAC)
• Olodaterol (Striverdi), a long acting beta adrenergic (LABA)

A 2008 study showed Spiriva by itself improved lung function. A 2009 study showed that Spiriva used in combination with Symbicort, a medicine that contains both a LABA and an inhaled corticosteroid, improves lung function by as much as 62 percent.

It should be said here that every time a new respiratory medicine is made it works a little bit different than its predecessors. So if you continue to have trouble with your COPD or asthma, this medicine is yet another option for you to try.

Further reading:

1. RT Magazine: COPD Treatment Stiolto Respimat Available in U.S.
2. Spiriva with Symbicort may improve lung function
3. Study: Spiriva improves lung function

Get Free Breo for one year

If you take any inhaled combination medicine -- Advair, Symbicort, Dulera, Breo, or you are supposed to take one and cannot afford it, GlaxoSmithKline (GSK) has an offer you simply cannot pass up: Free Breo for a full year.

The most common and best selling combination inhaler is Advair.  However, while asthmatics have been waiting for a generic Advair to hit the market, thus lowering the price, it does not look like this will happen in the foreseeable future. 

And even if it does happen soon, you can't beat free offer because they surely don't come around very often.  

Of course there's a reason for the offer.  GSK is hoping that after taking their medicine for a year that you will fall in love with it and stick with their product after their eventually is a generic Advair. 

Breo is the newer version of Advair.  It only needs to be taken once a day, which is nice.  It is a little stronger and a little better than Advair.  It is only approved by the FDA for COPD, but Advair is only approved for Asthma. However, they are both proven effective for both diseases, and physicians are legally allowed to prescribe them for any patients they think it will be helpful for.  

Regardless of their intentions, click on over to mybreo.com and get your free Breo today.  Or share this with your family, friends, and patients with asthma or COPD.

Pretty much, the only requirement is a prescription for Breo from a physician.