FAQ about Leukotriene Blockers for asthma

What follows are some of the most common questions asked in the Q&A section of MyAsthmaCentral.com and my humble answers. Today's focus is Leukotriene blockers.

What is an allergy/ asthma attack? It is an immune response. Your immune system is normally reserved to protect your body from enemies, like bacteria and viruses. But, at some point the bodies of us asthmatics became sensitive to things that are not supposed to be considered as bad guys, such as dust, mold, trees, certain foods and medicines, etc.

When our bodies are exposed to any of these things our immune system triggers a response. In essence, it sends out chemicals that cause cells in your body to release the army, which in this case are called chemical mediators. Histamine and Leukotrienes are two such mediators that irritate us unfortunate souls with allergies and asthma.

What are Leukotriene blockers? Leukotrienes are chemical mediators released by your body when you are exposed to something you are allergic to. When released they attack to cells in your lungs and trigger your air passages to become inflamed, produce excessive secretions, and contract (bronchospasm). All of this results in a narrowing of the air passages in you lungs, thus causing asthma.

Leukotriene blockers literally block the action of leukotrienes, and thus prevent asthma. However, these medicines only work if taken every day, even when we are feeling good.

Why can't I just take an antihistamine like Claritin? Antihistamines are what the word says: anti-histamine. They block the chemical mediators called histamine from attaching to your nose, eyes and throat. This prevents allergy symptoms like itchy, watery eyes and sneezing. Histamines do have an effect on the lungs, but not as much of an effect as leukotrienes.

What are some common Leukotriene blockers? Accolate and Singulair are the leukotriene blockers available at this time. (For a list of all asthma medicines check out this link).

Which one is the best? Where I live and work Singulair seems to be the most commonly prescribed (and is what I take). However, I'm not sure if it is any better than the others.

Since medicines can have different effects for different patients, which one works best may depend on the patient. Likewise, which one is prescribed may also be based on the personal preference of the patient and/or prescribing physician. And, while side effects are rare, if you have a side effect to one of these meds your doctor may prescribe one of the alternatives.

For many asthmatics this type of medicine is the only medicine that is needed to control asthma. For other asthmatics, a combination of this and other asthma medicines are necessary.

Do all asthmatics benefit from these meds: According to The Harvard Medical School guide to taking control of asthma, 40% of asthmatics notice no benefit from these meds. Likewise, it is not possible to predict who will benefit from this medicine.

Are Leukotriene blockers a steroid: No. This is great because these medicines help reduce inflammation without the use of a steroid. However, some asthmatics may still need a steroid to help with chronic inflammation. A combination of the two medicines has worked great for many asthmatics, including myself.

What are the side effects of these meds? That's one of the nice things about this medicine is that there are relatively few side effects. However, as any Gallant Asthmatic, you should always be vigilant for possible side effects, especially when you first start taking a new medicine.

I hate taking meds all day long. Can I take it just once or twice a day? Accolate is taken twice a day, and Singulair is taken only once. This makes compliance a breeze. Singulair is recommended to be taken after you brush your teeth before bed. Accolate should be taken when you brush your teeth in the morning and then again before bed.

How long does it take to start working? It takes 5-7 days to really get established in your system, and therefore should be taken every day for the treatment of chronic asthma, and not as a treatment of accute system.

However, there is one exception. Both Singulair and Accolate have been found to work well for asthmatics who only have asthma symptoms when exercising. These meds may be used 1-2 hours prior to exercising to help with excercise induced asthma.

Hey, if you have any further questions about Leikotriene blockers or any other respiratory medicine, feel free to ask in the comments below or email me at freadom1776@yahoo.com or in the question section at MyAsthmaCentral.com

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!"

My answers to your RT queries

Every week I check my statcounter to see who's typing things into Google or Yahoo and being linked to my RT Cave blog. Assuming the queries were not answered, I provide in this spot each week my humble responses.

And, hey, if the query is comical, it deserves a comical response. If it's serious, I treat it as serious. That in mind, here are this weeks queries:

1. career change respiratory therapist to rn : While I think that RT is a noble profession just like RN, we RTs are still working on developing the same kind of respect RNs have in the medical profession. We have made major strides just in the 10 years I've been an RT. But we have much farther to go. That in mind, there are some struggles in the RT community. Likewise, pay is not as great as for RNs. Fair? Well, if you don't think so, you can always become an RN yourself. Still, can you go from a mucus sucker, frivolous Scrubblin-Bubblin giver, roamer of the entire hospital to a poop scooper person who has to take care of the same patient all night. For the advantages and disadvantages of being an RT, click here.

2. how to break up wet lungs: Despite the myth that aerosolized sulfate will bind to the fluid particles in the lungs forcing the body to "exhale" the fluid, this IS -- my friends -- just a myth. Actually, if you have a patient with wet lungs, a diuretic is the best method of getting fluid from the lungs to the Kidneys and out of the body through the urinary tract. For more information about diuretics, click here. If by "break up" you are referring to pneumonia, the only thing that will "break up" pneumonia is the human body's defense system, and sometimes with a little assistance of an antibiotic.

3. what is the indication for albuterol with atrovent? It's basically the preference of the doctor. Some studies do indicate slight improvements when Atrovent is used in conjunction with Albuterol in emergency rooms. Others show that it works well for COPD to improve lung function long term (click here for more). Most studies show Atrovent is not beneficial for asthma patients. Whether they want to believe every study that's out there is up to the discretion of each individual doctor. Out of the hospital Atrovent is no longer used as a rescue bronchodilator. It is used as a "preventative" asthma medication. For more information about Atrovent as a bronchodilator click here and here.

4. coarse lung sounds: There is no such thing as coarse lung sounds. If you are hearing coarse, then what you are really hearing is rhonchi. Click here for more information.

5. dont give incentive spirometer to copd patietns: This is a fallacy. There is no reason a COPD patient couldn't benefit from good old fashioned deep breath with a breath hold followed by a cough. In fact, I would recommend it.

6. will unprescribed ventolin hurt children? Not any more than prescribed Ventolin, unless it was obtained by some illegal source; or unless it is outdated. Still, if you decide to use some other person's prescription, you should at the very least call your or your child's doctor.

7. baby's chest caves in while crying: This could be a sign of respiratory distress. Click here and check the other signs of respiratory distress.

8. atrovent pulmonary oedema: I have not seen any studies that show Atrovent does anything for pulmonary edema. If you find any studies to the contrary I would love to read about it.

9. when to stop singulair for asthmatics: Of course I'm no doctor, but I think the general consensus is you do not ever stop taking medications that are preventative in nature unless some better and safer med comes along, OR if you experience side effects that effect your quality of life. Singulair is a medication that works to prevent you from responding to your allergens, and there fore if you stop taking it you could have trouble with allergies and asthma. Asthma medicine should never be stopped without the explicit direction of a physician.

10. dummies guide to respiratory care: Sometimes that's how I think of this blog. However, none of my readers are dummies. You are all brilliant.

Singulair NOT linked to suicide thoughts, FDA says

Good news for us asthmatics and allergy sufferers who are taking or thinking about taking Singulair.

According to MyAsthmaCentral.com:

"(R)esearchers for the American Lung Association Tuesday announced that they've found no link between the asthma drug Singulair and an increased risk of suicide and depression."

I hate to gloat. I really do. But I have to quote myself here from a post I wrote aptly titled: Some good asthma/COPD drugs get a bad rap.

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

Likewise, I also wrote the following in my post My Dr. now prescribing Singulair for allergies:

"I can understand how allergies can get so bad sometimes, that you might rather be dead. There were times when I was a kid, and even as recently as last summer, where the allergies were just unbearable. (Not that I would ever kill myself, I'm just saying that allergies can cause severe misery). Singulair is a great medicine. It has worked a miracle for this RT. I think all asthmatics should at least try it if nothing else works, it beats the alternative of being miserable all the time."

I'm just saying here folks. I'm saying that every patient taking any medication should take it with a grain of salt. If you suspect some side effect to the drug, then you should stop it immediately and call your doctor.

But lets not panic every time an assumption comes out about a drug, especially one that has been so good for so long for so many people like Singulair.

My Dr. now prescribing Singulair for allergies

My Internist and I had a neat little conversation about medical fallacies yesterday. He assured me that it isn't just RTs who get irritated with people getting all excited over "one" study.

I wrote here last December how I was hospitalized with a bleeding ulcer. My Internist wasn't the one who took care of me then, and he asked me if the surgeon who managed my care ever determined the etiology of my ulcer.

"Well," I said, "At first he said there was a 90% chance it was caused by H. Pylori, then he said the test came back negative. But I think I had H. Pylori, because I could have sworn when I looked at my chart the test was positive."

"I guess it really doesn't matter," he said.

"Why do you say that?"

"I think the H. Pylori thing causing ulcers is over hyped." Then he rattled of some facts so fast they rolled right over my head.

"How do you think I got the ulcer then?"

"Nobody really knows for sure. It's just since many people have H. Pylori, some people say that is what causes ulcers. The truth is, they really don't know. So the pharmacy company has us doctors treating the H. Pylori, and all it does is run up the medical bill."

I wanted to say, "Kind of like Ventolin." But I held my tongue.

Later I told him how miserable I was last spring with allergies. "I decided I can't suffer like that again," I said. "This year, since you started me on Singulair, it's almost amazing the difference. It's almost like I don't have asthma."

You must note here that when I mentioned to him last Jan. that I should try Singulari, he told me he thought that drug was over hyped. In May I told him how wonderful the medicine was working for me.

He said, "I just started a new person on Singulair today based on your testimony last time you were here."

"Cool," I said, "I have heard some bad things about it, though."

"Really, like what."

"Well, one kid was having suicidal thoughts, so now they blame it on Sinulair. Like you say though, I think it's all overblown."

"Yeah, I've heard that too now that you mention it."

"So now you have a lot of moms taking their kids off Singulair based on the this, and it's very unfortunate. My childhood sucked because I had allergies so bad, and my doctor wouldn't even let me have anithystamines because on the box it said not to take it if you have asthma. Now they have this new drug that will allow these kids to live normal lives, and parents and doctors won't let their kids take it based on a fallacy. It's a shame."

"I agree."

"So, anyway, my allergies are basically non-existent right now, and I give Singulair credit. Of course it could be a coincidence, so I'm still open minded. But it seems to be working great."

"Cool."

"I kind of joke about it though. I tell everybody that since I started on Singulair I don't have allergy problems anymore, but I have suicide thought."

"Yeah," he laughed, "If your allergies come back you'll kill yourself."

There's some truth to that, too. I can understand how allergies can get so bad sometimes, that you might rather be dead. There were times when I was a kid, and even as recently as last summer, where the allergies were just unbearable. (Not that I would ever kill myself, I'm just saying that allergies can cause severe misery).

Singulair is a great medicine. It has worked a miracle for this RT. I think all asthmatics should at least try it if nothing else works, it beats the alternative of being miserable all the time.

Another bad thing about Singulari is it is expensive because it is still under patent.

Related articles: Some drugs get a bad rap, and Singulair: Another asthma miracle drug.

Some good asthma/COPD drugs get a bad rap

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Singulair: Another asthma miracle drug

This is my weekly focus on patient education, where I will discuss everything you need to know about (fill in blank).

The theory here is that, as a patient, I think it's good to go to your doctor armed with as much knowledge as possible. I call these posts patient wisdom, and you can refer to them at your convenience by clicking on the patient wisdom link near the top of this blog.

Today's focus is on allergies, asthma and Singulair.

I talked to one of the doctors I respect very much a few months back while I was working, and somehow the topic of discussion changed to me, and how much I love spring, but hate how miserable my allergies are at that time of year.

He said, "I think that every asthmatic should be on Singulair. I prescribe it for all my asthma patients."

So, when I went to my doctor, I said, "So, what would you recommend for allergies?"

My doctor said, "Well, did you try over the counter stuff, like Drixorol, Claratin, benadryl and that type of stuff?"

"Yeah, I've tried it all over the past 25 years, I even had allergy shots as a kid. None of it seemed to work. I was just wondering if you knew of anything stronger I might try, not that I really want more medicine to take or anything."

"Well, there is Singulair."

"Ah, that's what I was leading at. I didn't want to say Singulair just in case you had a better idea."

"Yeah, I suppose we could try that."

There, I got what I wanted. "Since spring is right around the corner, I will know right away if it works."

So, how do you know if Singulair is right for you?

Pretty much, based on my research, Singulair has proven effective for anyone with Allergic Rhinitis (hay fever) and asthma/allergies. For the most part, these two tend to go hand in hand.

Thus, if doctors could somehow prevent allergies, they could control asthma.

Finally, in 1998, after spending millions of dollars and 63 years studying leukotrines and working on a way to block their release, Singulair was approved for use by the FDA.

Singulair has an active ingredient in it called Montelukast sodium, which blocks the action of leukotrien, thus preventing allergies, and preventing bronchospasm caused by allergies, and, in turn, preventing asthma.

So lets back up a bit. What the heck are Leukotrienes? Better yet, what causes allergies in the first place?

When our bodies sense a foreign substance that might cause harm has entered the body, such as a bacteria or virus, it releases chemicals to attack the foreign substance. This is the bodies normal immunologic response to prevent and fight diseases. This is a good response by our immune system.

However, in some people, those of us who are prone to allergies, our immune system responds to harmful things, but also things that are relatively harmless, and generally cause no reaction in people who do not have allergies. In essence, with allergies, our body is fighting itself, and this is bad.

These harmless things that cause allergies are called allergens. Some common allergens are pollens released from trees, mold, hay, grass, dander, and food.

For the most part, if something causes us to have an allergic response, or asthma, we try to identify our triggers, in this case allergens, and avoid them. If you only have one allergen it might be easy to avoid, but for us asthmatics who are allergic to a ton of things, the only way to avoid all of them is to live in a bubble.

Now we all know that's not possible, or at least extremely difficult.

To give you an idea of the allergy process, I'll provide here a pithy example.

Say you are prone to allergies and breathe in a molecule of pollen. Your body fails to recognize it as harmless, and releases a chemical called pollen IgE antibody that binds to mast cells.

Now, at this point, nothing really happens, but the next time you are exposed to pollen, the IgE primed mast cell releases chemical mediators which attach to specific cells in the body causing inflammation.

Leukotreins are one type of chemical mediator which is responsible for inflammation, and are the culprits responsible for causing bronchoconstriction (tightening of the muscles around the airways) and swelling of the airways.

Thus, if we could find a way to block the release of these leukotriens, we could stop, or greatly diminish, an allergy attack, and thus an asthma attack.

And that's where Singulair comes into play. It blocks the release of leukotreins.

It has been proven effective for the management of allergies in asthma, and allergic rhinitis. It usually takes 3-7 days to start working, so, unlike antihistamines, it does not have an immediate effect, and must be taken on a regular basis (every day) to be effective.

In other words, even if you have no symptoms, you should never stop taking this medicine, unless otherwise prescribed by your doctor.

Singulair has not been proven effective as treatment of itchy eyes, itchy nose, sneezing and runny nose. If these symptoms continue to be problems for you, you might want to try an antihistamine, which can be purchased over the counter.

There is one other use for Singulair, and that is for people who have excercise induced asthma.

According to Health Library at CNN.com, "Because exercise-induced asthma has the same symptoms and results from the same airway reaction involved in regular asthma, standard asthma medications can control it."

Patients who experience excercise induced asthma but don't necessarily have a problem with allergins, and do not already take the medicine on a daily basis can take the medicine two hours prior to excersising, but not again for 24 hours thereafter.

Some patients have managed to control their asthma, excersise induced asthma and/or allergic rhinitis with the use of Singulair alone. However, some asthmatics may need other prophylactic therapies, such as Chromolyn or Advair and an occasional use of a rescue medicine such as an Albuterol inhaler.

So there, in a nutshell, is everything you need to know about asthma related allergies and singulair.

For more information, check out this link. Also check out this, the official website of singulair

That concludes today's class.