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Medical Forum / Diseases and Disorders / Asthma / October 2003Tree huggers took my asthma medicine away !
http://www.carefirst.com/pharmacy/newsflash/NewsFlashDetail_07012003a.html Can you believe this? Inhaled powders are a step backwards in the treatment of asthma. Yet the greenie goons have managed to convince the government that aerosol inhalers are a threat to the world. Did someone forget to inform them that we INHALE the medicine and don't blast it in to the air ? This is truly pathetic. > http://www.carefirst.com/pharmacy/newsflash/NewsFlashDetail_07012003a.html > [quoted text clipped - 6 lines] > > This is truly pathetic. Turbohalers don't require aerosol and provide more effective delivery. Have you tried a dry powdered inhaler? For most people, most of the time they are equivalent or more effective, with less hassle. If you review use studies on the proper use of MDI's the VAST MAJORITY (including medical professionals) use them improperly or poorly. I've been teaching proper use of them for 15 years and only seen about a half dozen people show me correct technique with coaching. The Montreal ban is not the domain of tree huggers. CFC's emitted from all of these kind of devices (leaking air conditioners, fridges, etc.) are extremely stable and a tiny amount can destroy a significant amount of ozone. They are contributory. The ban was inacted in 1987 and MDI's have been exempt from this until proven replacements could be found. They have. I've got lots of kids taking DPI's now doing much better than they did with MDI's. Give it a try. Actually the MDI's MOSTLY "blast it into the air". Amount of medicine retained from an MDI inhalation is < 20% for an excellent inhalation, much worse for a poor one. ALL the CFC is lost to the atmosphere.  SignatureFM Respiratory Care Practitioner Asthma and Allergy Foundation of America-WA Branch > Inhaled powders are a step backwards in the treatment of asthma. Yet > the greenie goons have managed to convince the government that [quoted text clipped - 3 lines] > > This is truly pathetic. >Have you tried a dry powdered inhaler? Yes, many years ago. They were more irritating to my airways than any propellent based inhalers. >For most people, most of the time >they are equivalent or more effective, with less hassle. Less hassle? How can anything be less hassle than my old reliable serevent ? >I've got lots of kids taking DPI's now doing much better than they did with >MDI's. Give it a try. I don't have a choice other than to give it a try. We'll see in a week or so when I need a refill. > >Have you tried a dry powdered inhaler? > > Yes, many years ago. They were more irritating to my airways than any > propellent based inhalers. You should try them again now. They are very different from the powdered inhalers of 20 years ago (which I am told could be quite uncomfortable to use). When I took my first dose of Advair (powdered) from the diskus, I didn't even think anything had happened. I couldn't actually *feel* the powder. So, no discomfort whatsoever. And my asthma control is better now that at any other time in my life. > >For most people, most of the time > >they are equivalent or more effective, with less hassle. > > Less hassle? How can anything be less hassle than my old reliable serevent ? The powdered version is likely to work *better* for you than the propellent version. > >I've got lots of kids taking DPI's now doing much better than they did with > >MDI's. Give it a try. > > I don't have a choice other than to give it a try. We'll see in a week or so > when I need a refill. I hope you are pleasantly surprised. SignatureBe well, Barbara (Julian [6], Aurora [4], and Vernon's [18mo] mom) See us at http://photos.yahoo.com/guavaln This week's special at the English Language Butcher Shop: "No parking passed this sign" -- hotel parking lot sign All opinions expressed in this post are well-reasoned and insightful. Needless to say, they are not those of my Internet Service Provider, its other subscribers or lackeys. Anyone who says otherwise is itchin' for a fight. -- with apologies to Michael Feldman I tried Advair for about a month (I have cough variant asthma-mostly need steroids, usually use Qvar+spacer). I was amazed that I could hardly tell anything was coming out. If you open one up and look at the amount of medicine being delivered it is a pretty tiny amount. Same with Turbuhalers. I get to do this because I'm "in the biz" of instruction on delivery devices. I suppose people could be bothered by them but it's actually hard to see how. Early DPI's did not have the stability or small consistent particulate size that is available now. If you've used older products you may be pleasantly surprised. Realistically the biggest gripe I've had with them is not effectiveness but significant increase in price over the MDI formulation. I have lots of patients on limited incomes. OTOH, these things had to go through SIGNIFICANT testing and review to make sure they actually worked correctly. SignatureFM Respiratory Care Practitioner Asthma and Allergy Foundation of America-WA Branch > You should try them again now. They are very different from the > powdered inhalers of 20 years ago (which I am told could be quite > uncomfortable to use). When I took my first dose of Advair (powdered) > from the diskus, I didn't even think anything had happened. I > couldn't actually *feel* the powder. So, no discomfort whatsoever. > And my asthma control is better now that at any other time in my life. Dry powder inhalers can be a nice thing...but for those of us who have problems with them. When I finally got fed up and started doing my own peak flow monitoring, the results suprosed both my physician and me. The first thing we tried was a Pulmicourt turbuhaler. The turbuhalers are a wonderful device, unless you are somewhat sensitive to inhalation resistance. In my case, though it did improve my asthma a bit, the fighting a big coughing fit after inhaling the medication from the turbuhaler was too much. After all, the idea is to let the medicine deposit in the lungs, not to cough it right back out. In my case, the HFA propellant "puffer" seems to work best...but everyone is unique. When it comes to MDI's, I too have seen the studies on delivery without a spacer and I have seen first hand the problems people can have trying to coordinate the use of an MDI. As a fiirst aid volunteer, I've seen it ever further worsened during the panic of an asthmatic episode. Personal choice here is an MDI and spacer. I'd say give the dry powder inhaler a go, but be aware that as nice as they are, there are a few people for whom they don't work well. Michael H If you are having problems with the powdered inhalers, check to see if you are allergic to cow's milk. Flovent, servent, advair and foradil powdered inhalers use lactose with milk proteins. No intolerance here to dairy of any type, though it is a good point to raise. In my case, it is just a sensitivity to the inhalation effort...the increased drag started a stutter breath, which triggered a coughing fit as a result. Perhaps a rare occurrance, but one that cropped up for me... regardless of whether it was Pulmicourt or symbicort. Keep trying and find what works for you is the advice I give. ;) Cheers, Michael Halliwell -- > If you are having problems with the powdered inhalers, check to see if you are > allergic to cow's milk. Flovent, servent, advair and foradil powdered inhalers > use lactose with milk proteins. If you have trouble coughing from powdered inhalents you might try "priming" your lungs with a puff or two of Atrovent (ipratropium) ten minutes or so prior to the powder. Atrovent sometimes good to quell my dry unproductive cough as well. Pulmicort (Astra) Turbuhaler is pure budesonide powder. > > >Have you tried a dry powdered inhaler? > > [quoted text clipped - 7 lines] > powder. So, no discomfort whatsoever. And my asthma control is better now > that at any other time in my life. Severent and Advair actually add something to the inhaler so that you can feel/taste it. My experience with Pulmicort explains why. I have had people stop using it because they didn't think they were getting any medicine! -- CBI, MD If a minority of users prefer MDIs why can't MDIs continue to be available to that minority? Chloro-Floro is not the only possible propellant. Anything from compressed Helium to compressed Oxygen to who knows what could be made to work. (If I'm incorrect on this I'll sure-as-hell hear from someone on this NG) Democracy is not so much about rule by the majority as it is about protecting the minority. Business is about one size fits all: the cheapest. (That's why you pay more for a larger seat on the airplane. Even if you don't need one. Children and little people get to dangle their feet) >If a minority of users prefer MDIs why can't MDIs continue to be >available to that minority? [quoted text clipped - 3 lines] >to work. (If I'm incorrect on this I'll sure-as-hell hear from someone >on this NG) The issue with propellants for CFCs is the requirement that every dose be identical. The CFCs remain as a liquid and only enough 'boils off' to keep the gas pressure in the MDI the same from the first dose to the last. As a result you get the same amount of medication in the 200th dose as in the first one. There are only a limited number of chemicals that meet this requirement. And even fewer that are known to have _no_ effect on humans when inhaled. (CFCs have no effect on the body, they are not broken down by the body and they are not stored by the body and are discarded in the urine). -- We make war so we may live in peace. Aristotle I'm sure that almost anything and everthing has been tried :o) A couple of years ago a Pal of mine was visiting "sub-Saharan" Africa. He bought me back some OTC generic salutamol/albuterol. The drug worked fine - but the propelent tasted like S*^T! I'm sure it was 90 % gasoline!!!! Oh well: "you buy cheap - you buy twice" :o) Pete > >If a minority of users prefer MDIs why can't MDIs continue to be > >available to that minority? [quoted text clipped - 19 lines] > We make war so we may live in peace. > Aristotle Thanks, Colin.---Jack >If a minority of users prefer MDIs why can't MDIs continue to be >available to that minority? Good question, especially since MDIs with HFA propellant are available in Canda, England, Australia. Let's see to market these drugs in the US, a drug company must apply and the FDA must approve. That sure narrows the suspects down for the answer to your question. >Have you tried a dry powdered inhaler? I was using the aerosol Serevent, and had a case of thrush at least once a month. When I was switched to the powdered version, I had no problems at all, and can actually inhale it better. Cindi CFC-free MDI's have been on the market for some years now. I've used albuterol and steroid inhalers that both use HFA propellant, not CFC. The HFA causes very little ozone damage compared to CFC. Powder inhalers seem good where the volume of powder inhaled is small, eg Astra turbohaler, although not sure how the particle size distribution compares with an MDI/spacer combination or the relative delivery efficiencies. You want lots of very small particles so that the steroid is delivered to the small diameter airways to get the greatest anti-inflammatory effect. The speed of breath intake also affects delivery, so I've been told. MDI's are supposed to be very inefficient when used directly (no spacer), most of the drug ends up in the stomach, according to the studies I've read. I always use a spacer with steroid inhalers, but not practical to carry one for albuterol. Tried a small mini-sized one once but seemed little different from direct use. I've tried albuterol diskhaler but the amount of powder was large and I got significant irritation - much worse than an MDI; that was back around 10 years ago, before the HFA propellant MDI's came out. I'd like to try albuterol/fluticasone/seretide in turbohaler form, but those drugs don't seem to be available as turbohalers last time I looked, particularly the fluticasone. Anyone know if it's available? -- gumbo |
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