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Medical Forum / Diseases and Disorders / Asthma / September 2004Advair 500 + Serevent vs. Advair 250 x 2
Has anyone ever done a study on the effectiveness of Advair 500/50 taken once per day along with Serevent taken 12 hours later - this in comparison to Advair 250/50 taken twice per day at the same interval? And even if a study hasn't been done, if anyone would like to offer their opinion on this, please do. I've tried 500/50 + Serevent a few times instead of 250 x 2 and haven't noticed much of a difference but I haven't done it enough to have formed an opinion one way or the other. Thanks. -S- > Has anyone ever done a study on the effectiveness of Advair 500/50 > taken once per day along with Serevent taken 12 hours later - this in > comparison to Advair 250/50 taken twice per day at the same interval? > And even if a study hasn't been done, if anyone would like to offer > their opinion on this, please do. I've tried 500/50 + Serevent a few > times instead of 250 x 2 and haven't noticed much of a difference but > I haven't done it enough to have formed an opinion one way or the > other. Oral steroids are usually once daily unless being divided to make high doses more tolerable (things are a bit different in kids) so I have never understood why inhaled steroids couldn't also be given that way. Personally, I currently take my Pulmicort once daily and increase it to twice daily if I start to have some wheezing. I suspect that if the two were compared in a well designed trial that was suffufuciently large that it would be found that half the dose twice as often is probably a little more effective. However, I am also sure that many people could get away with once daily dosing. I do have to wonder why you ask. It seems to me that having to use two different inhalers and still dosing yourself twice daily lacks any advantage to just using the same one twice daily.  SignatureCBI, MD > > Has anyone ever done a study on the effectiveness of > Advair 500/50 [quoted text clipped - 30 lines] > twice daily lacks any advantage to just using the same one > twice daily. Thanks for your considered response. My reason for asking, other than just plain curiosity, is money. I happen to have several Serevent inhalers my doctor gave me - samples he received. Because my asthma is so connected to my allergies, I do much better once I'm back in the hepa-filtered air of my home for the evening and have gotten into the habit of taking less medicine in the evenings. My current standard is Advair 250/50 in the morning and Advair 100/50 at night. (And, like you, more when I feel the need.) Since I have to take medicine twice a day, anyway - Allegra - I'd like to see if I can make good use of the Serevent inhalers I have in the interest of saving me and my insurance company both a few dollars. I have found that Allegra only once per day does _not_ work well for me so, even though that medicine is available in a once-a-day dose, that's not a viable option. I also take Ginko Biloba, on the recommendation of my ENT, for persistent Vertigo twice a day, another reason that once daily dosing isn't an option for me, anyway. I should also note that I have tried not taking Serevent in any form in the evenings but this does _not_ work for me - I consistently feel tightness in my chest unless I get Serevent twice per day. Thanks again. -S- http://www.kbnj.com What is the idea of the ginko for vertigo? << (snip) I also take Ginko Biloba, on the recommendation of my ENT, for persistent Vertigo twice a day, another reason that once daily dosing isn't an option for me, anyway. (snip) Thanks again. -S- http://www.kbnj.com >><BR><BR> Sue M. > What is the idea of the ginko for vertigo? My ENT recommended it. Ginkgo Biloba helps many people with circulation in the head/brain area. It makes a noticeable, appreciable difference for me, and there are studies supporting Ginkgo for helping a pretty wide range of ailments, including the early stages of Alzheimers. Dosing of Ginkgo for medicinal purposes, if memory serves, is up to 360 mg of the standardized extract per day. I take 240 per day, 120 in the morning and another 120 in the evening. No side effects whatsoever that I'm aware of and, unlike some other herbs, you don't need to periodically cycle off of it. We ran out on Saturday and I was falling over trying to get out of my chair Monday afternoon - the stuff does make a difference for me. I couldn't figure out why I was having trouble with balance until I remembered it had been two or three days since I'd had any Ginkgo. Not so parenthetically, I recently started practicing headstands and those have also helped tremendously. I'm already, in all modesty, quite strong so it was a skill/coordination issue, not one of strength. Holding a headstand for several minutes once or more times per day really helps me. My ENT said the tests they did on me indicated that I might have some sort of fluid leakage or imbalance in my inner ears, basically some fluid where there ought to be none or something like that. (I responded very well to intravenous Lasix, a diuretic - I peed out 2 kgs (4-5 lbs.) of water within a couple of hours and did much better on the balance tests after that) Again, and I think this is relevant, I also cut down on my consumption of carbohydrates just to have a little less water running around in my system - I stay very well hydrated but eat a minimum now of bread, pasta, etc. I don't Atkins or otherwise low-carb, I just keep the quantity of carbs to what feels like the minimum most of the time. I have noticed that if I have something like pizza for dinner, which is both high carb and high salt, the extra water makes my balance a little worse for a couple of days - it's not bad enough that I avoid pizza altogether but I don't have it very often now. And besides, I now can have headstand contests with elementary school aged girls - the siblings of my first grade son's teammates seem to practice headstand, handstands, cartwheels, and the like at their games. So far, I've yet to be beaten. :) Now I just have to learn to cartwheel... Perhaps more than you asked for but, hey, I was on a roll. :) -S- http://www.kbnj.com > << (snip) I also take Ginko Biloba, on the recommendation of my ENT, for > persistent Vertigo twice a day, another reason that once daily dosing [quoted text clipped - 7 lines] > > Sue M. Steve, do I recall you are in Germany. I can't think of a doc in the USA who would prescribe Ginko. << My ENT recommended it. Ginkgo Biloba helps many people with circulation in the head/brain area. It makes a noticeable, appreciable difference for me, and there are studies supporting Ginkgo for helping a pretty wide range of ailments, including the early stages of Alzheimers. Dosing of Ginkgo for medicinal purposes, if memory serves, is up to 360 mg of the standardized extract per day. I take 240 per day, 120 in the morning and another 120 in the evening. No side effects whatsoever that I'm aware of and, unlike some other herbs, you don't need to periodically cycle off of it. We ran out on Saturday and I was falling over trying to get out of my chair Monday afternoon - the stuff does make a difference for me. I couldn't figure out why I was having trouble with balance until I remembered it had been two or three days since I'd had any Ginkgo. Not so parenthetically, I recently started practicing headstands and those have also helped tremendously. I'm already, in all modesty, quite strong so it was a skill/coordination issue, not one of strength. Holding a headstand for several minutes once or more times per day really helps me. My ENT said the tests they did on me indicated that I might have some sort of fluid leakage or imbalance in my inner ears, basically some fluid where there ought to be none or something like that. (I responded very well to intravenous Lasix, a diuretic - I peed out 2 kgs (4-5 lbs.) of water within a couple of hours and did much better on the balance tests after that) Again, and I think this is relevant, I also cut down on my consumption of carbohydrates just to have a little less water running around in my system - I stay very well hydrated but eat a minimum now of bread, pasta, etc. I don't Atkins or otherwise low-carb, I just keep the quantity of carbs to what feels like the minimum most of the time. I have noticed that if I have something like pizza for dinner, which is both high carb and high salt, the extra water makes my balance a little worse for a couple of days - it's not bad enough that I avoid pizza altogether but I don't have it very often now. And besides, I now can have headstand contests with elementary school aged girls - the siblings of my first grade son's teammates seem to practice headstand, handstands, cartwheels, and the like at their games. So far, I've yet to be beaten. :) Now I just have to learn to cartwheel... Perhaps more than you asked for but, hey, I was on a roll. :) -S- http://www.kbnj.com >><BR><BR> Sue M. > Steve, do I recall you are in Germany. I can't think of a doc in the USA who > would prescribe Ginko. Nope, I'm in the good, old, US of A, in northern NJ, right outside of NYC. The doctor didn't "prescribe" Ginkgo. The exact sequence of events in my case was that he prescribed Lasix, I filled the prescription but never took any, and started researching various herbal remedies on the Internet. When I found Ginkgo, I tried it, liked how it worked for me, and called the doctor to tell him what I'd done. He told me that he routinely suggested Ginkgo for his patients and that, based on the results of my tests, he hadn't thought of it as the first choice for me but that he had no problem at all with me taking it and, if it was giving me the amount of relief I need without requiring the Lasix, he was fine with it. The practice is called Northern New Jersey Ear, Nose and Throat or something like that and is located in Midland Park, NJ, a town or two from where I live. The practice has individual specialists and my guy was/is an ear guy. -S- http://www.kbnj.com > << My ENT recommended it. Ginkgo Biloba helps many people with circulation > in the head/brain area. It makes a noticeable, appreciable difference [quoted text clipped - 44 lines] > > Sue M. Cool! The only thing is that he forgot to mention it and gave you the lasix first, that is not a benign drug. It sort of proves my point that we have to do our own research and request treatment even tho' we are not the "experts", and they already know the answer. In my case, docs not willing to take the time to thoroughly explore treatments, a lot of time and procedures and $ wasted. Rather discouraging for me. << Nope, I'm in the good, old, US of A, in northern NJ, right outside of NYC. The doctor didn't "prescribe" Ginkgo. The exact sequence of events in my case was that he prescribed Lasix, I filled the prescription but never took any, and started researching various herbal remedies on the Internet. When I found Ginkgo, I tried it, liked how it worked for me, and called the doctor to tell him what I'd done. He told me that he routinely suggested Ginkgo for his patients and that, based on the results of my tests, he hadn't thought of it as the first choice for me but that he had no problem at all with me taking it and, if it was giving me the amount of relief I need without requiring the Lasix, he was fine with it. The practice is called Northern New Jersey Ear, Nose and Throat or something like that and is located in Midland Park, NJ, a town or two from where I live. The practice has individual specialists and my guy was/is an ear guy. -S- http://www.kbnj.com >><BR><BR> Sue M. > Cool! The only thing is that he forgot to mention it and gave you the lasix > first, that is not a benign drug. It sort of proves my point that we have to > do our own research and request treatment even tho' we are not the "experts", > and they already know the answer. In my case, docs not willing to take the > time to thoroughly explore treatments, a lot of time and procedures and $ > wasted. Rather discouraging for me. Discouraging? Only if you let it be that way. I have no problem with the idea that I'm an active participant in deciding my course of treatment. My doctor brings his training and experience to the table, and I bring other things; together we figure out a plan, and it's not necessarily to his discredit that I came up with a better idea for me this time. I far prefer a physician who doesn't know everything but is willing to listen to what I have to say to one who thinks he knows everything and couldn't care less about my opinion. -S- http://www.kbnj.com > << Nope, I'm in the good, old, US of A, in northern NJ, right outside of > NYC. The doctor didn't "prescribe" Ginkgo. The exact sequence of [quoted text clipped - 18 lines] > > Sue M. I have no problem with that concept either, but after 9 years of trying to figure it out and my doc building his practice on easier cases, there is not enuf time to listen and learn new ideas from patients now, even with factual material in my hand. I think this is the norm these days with less medical care time available for the patient. You're lucky you still have a willing participant. "Steve Freides" steve@fridayscomputer.com <<Discouraging? Only if you let it be that way. I have no problem with the idea that I'm an active participant in deciding my course of treatment. My doctor brings his training and experience to the table, and I bring other things; together we figure out a plan, and it's not necessarily to his discredit that I came up with a better idea for me this time. I far prefer a physician who doesn't know everything but is willing to listen to what I have to say to one who thinks he knows everything and couldn't care less about my opinion. -S- http://www.kbnj.com >><BR><BR> Sue M. > > I do have to wonder why you ask. It seems to me that having > > to use two different inhalers and still dosing yourself [quoted text clipped - 6 lines] > happen to have several Serevent inhalers my doctor gave me - samples he > received. I figured it was something like that. Since 500 once a day is actually a step up from 250+ 100 I suspect that you will probably do well on it. Only one way to find out. > I have found that > Allegra only once per day does _not_ work well for me so, even though > that medicine is available in a once-a-day dose, that's not a viable > option. Unlike most other once daily formulations of short acting meds - the once daily Allegra is just a higher dose rather than a sustained release pill. The dose of Allegra once daily is 180mg while the immediate release is 60mg so one could take two or three of the immediately release tablets and see if it lasts 24 hours without increased sedation. SignatureCBI, MD > > > I do have to wonder why you ask. It seems to me that having > > > to use two different inhalers and still dosing yourself [quoted text clipped - 22 lines] > immediately release tablets and see if it lasts 24 hours without > increased sedation. Interesting that you mentioned this. What I actually do, again in the interest of getting the amount of medicine that I need and not more, is split 180's in half and take 90mg in the morning and 60mg at night. When I was in the hospital with pneumonia about 18 months ago, the heat was working overtime, the windows were open, and I needed lots of Allegra so, for a few days, I took a 60mg every 5-6 hours. If the allergens are bad and I know I'm going to be out a lot, some days I'll take a 180 in the morning and a 60 again at night. Unfortunately, I can't take more than two 60's a day because then the prescription runs out and the insurance company won't pay for the refill if the proper amount of time hasn't passed, but by having a prescription for both 180 and 60, I seem to get by since I'm taking both only half as often as I'm allowed to most of the time. Again, thanks for you input. -S- http://www.kbnj.com >Because my asthma is so connected to my allergies, I do much better >once I'm back in the hepa-filtered air of my home for the evening and >have gotten into the habit of taking less medicine in the evenings. I'm curious what type of HEPA filter you have, how frequently you change filters and how much they cost. Thanks! As I've posted before, we have a Honeywell filter set up in our bedroom but have not arranged a whole-home filter. SignatureAlison Chaiken "From:" address above is valid. (650) 236-2231 [daytime] http://www.wsrcc.com/alison/ With how many things are we upon the brink of becoming acquainted, if cowardice or carelessness did not restrain our enquiries. -- Mary Shelley, _Frankenstein_ > >Because my asthma is so connected to my allergies, I do much better > >once I'm back in the hepa-filtered air of my home for the evening and > >have gotten into the habit of taking less medicine in the evenings. > > I'm curious what type of HEPA filter you have, how frequently you > change filters and how much they cost. Thanks! We're not brand loyalists - if it says it's a HEPA filter and rated for 700 square feet or so, it's been good enough to be placed in a hallway and deal with a floor of our house. We live in a small, older home where each floor is, give or take, that size, so there's one in the basement, one on the first floor, and one upstairs. We just followed the directions and/or the indicators on the machines themselves when it comes to changing the filters. Several models have a pre-filter you change or clean relatively often and a HEPA filter you change less often. The HEPA models vary from six months to eighteen months between changes, and the prefilters can be as often as every three months. I haven't tracked costs - I have no choice, really, so whatever we need in the way of filters, we get. > As I've posted before, we have a Honeywell filter set up in our > bedroom but have not arranged a whole-home filter. Your bedroom is certainly a good start. -S- I wonder if I got a request from my Dr. if the insurance would pay for it (minus) the co-pay. Has anyone tried this? |
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