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Medical Forum / Diseases and Disorders / Asthma / October 2003

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The best preventative asthma medication

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Steve - 08 Sep 2003 18:51 GMT
Hello,

I have used Flovent in the past, without too much success.  While using
Flovent, I still had to use my emergency inhaler (albuteral)  I currently
use my Albuteral 4-6 times a day and would like to ask my doctor about a new
preventative medication.

Are there any NEW preventative medications other than Flovent?

Thanks in advance
PENMART01 - 08 Sep 2003 19:48 GMT
>I have used Flovent in the past, without too much success.  While using
>Flovent, I still had to use my emergency inhaler (albuteral)  I currently
>use my Albuteral 4-6 times a day and would like to ask my doctor about a new
>preventative medication.
>
>Are there any NEW preventative medications other than Flovent?

Flovent is not an Asthma preventitive, it's a symptom mitigative... there are
no Asthma preventitives, unfortunately.

---= BOYCOTT FRENCH--GERMAN (belgium) =---
     ---= Move UNITED NATIONS To Paris =---
Sheldon          
````````````
"Life would be devoid of all meaning were it without tribulation."
     
Colin Campbell - 08 Sep 2003 19:57 GMT
>Hello,
>
[quoted text clipped - 4 lines]
>
>Are there any NEW preventative medications other than Flovent?

Have you tried Pulmicort?  Also, Flovent is available in different
strengths, how many micrograms (mcg) does you current prescription
deliver per dose?

--
"Iraq will not be defeated. Iraq has now already achieved
victory - apart from some technicalities."
Iraqi Ambassador Mohsen Khalil after the fall of Baghdad
gumbo - 08 Sep 2003 20:28 GMT
If you're only having to use albuterol 4-6 times a day, that's actually
within the manufacturer's recommended dose so you don't sound too badly
controlled to me; if you said you had to use albuterol 20-30 times a day and
you were also on high-dose (1000 mg/day fluticasone according to CBI)
inhaled steroids and also on leukotrine inhibitors and your peak flow
was 30% of normal, that would be rather more problematic.  If your albuterol
use goes up, I'd ask your doctor about increasing your inhaled steroid dose
as the most effective way of controlling your illness.

You could also ask about getting some allergy tests and explore allergen
avoidance in your home if they identify some allergic triggers.

For interest, I've listed a couple of newer treatments below although
I think you're already on the best treatment going so they probably
wouldn't apply to you.

Xolair (generic name: omalizumab - some vicious bean-counter  thought
that one up, try saying it fast) is a relatively recent genetically
engineered drug for which there have been some claims of success, based
on double-blind clinical trials.  The FDA have approved it but slapped a
cancer risk warning on it, although the manufacturers dispute whether
there is any increased risk.  Remember it's very new and there is little
long-term experience of it's use - I believe it's also very expensive.  
They give you one injection a month, if memory serves me.  Again, it's not
a true preventative, though; it aims to block the allergic reaction chain
to control the illness.  There have been some recommendations that it might
be useful for severe asthmatics whose symptoms are not controlled by
inhaled steroids (which probably rules you out).

There has been some recent research in the UK on an asthma 'vaccine'
for cat allergen (a hospital in london and I think imperial college,
I can try to dig out a reference if you want) which is basically a
desensitisation injection approach, the initial results were very good
but it's still experiemtal at this stage so not much point asking your
doc about it.  However this could arguably be called a preventative approach,
so I've included it for interest.

Another line of preventative approach may be some kind of genetic
therapy - there's been recent research that has identified some of the
genes implicated in asthma - however that's unlikely to be available for
years if not decades.

Please note I'm not medically qualified and you should not take my
post as medical advice, always ask your doctor before making any
changes to your treatment.

-- gumbo

> Hello,
>
[quoted text clipped - 6 lines]
>
> Thanks in advance
Colin Campbell - 08 Sep 2003 22:25 GMT
>If you're only having to use albuterol 4-6 times a day, that's actually
>within the manufacturer's recommended dose so you don't sound too badly
[quoted text clipped - 4 lines]
>use goes up, I'd ask your doctor about increasing your inhaled steroid dose
>as the most effective way of controlling your illness.

If somebody is having to use albuterol more than 2-3 times a _week_
then their asthma is not under control.

--
"Iraq will not be defeated. Iraq has now already achieved
victory - apart from some technicalities."
Iraqi Ambassador Mohsen Khalil after the fall of Baghdad
CBI - 09 Sep 2003 19:02 GMT
> >If you're only having to use albuterol 4-6 times a day, that's actually
> >within the manufacturer's recommended dose so you don't sound too badly
> >controlled to me;

> If somebody is having to use albuterol more than 2-3 times a _week_
> then their asthma is not under control.

I agree. The "manufacturers recommended dose" is a maximum safe dose
to take. i.e. you shouldn't see much in the way of immediate adverse
effects from the drug if you take it this way. This is not the same as
a saying that the asthma is well controlled.

--
CBI, MD
gumbo - 11 Sep 2003 12:52 GMT
I stand corrected.  What would be a reasonable definition of "well controlled
asthma?"  Is Colin's dose level of around 3 doses of albuterol a week
about right?  My specialist has told me that he sees no problem with taking
albuterol long-term at the recommended dose, clearly I was under the mistaken
impression that this implied that the asthma is "well controlled".

Is there any evidence that the new mono-isomer version of albuterol (the
standard drug is racemic) has any value?  I read in a press release from
the company that makes it that one of the isomers is considered actively
harmful, is there any objective evidence for this or is it marketing spin?

--gumbo
Colin Campbell - 11 Sep 2003 16:43 GMT
>I stand corrected.  What would be a reasonable definition of "well controlled
>asthma?"  Is Colin's dose level of around 3 doses of albuterol a week
>about right?  My specialist has told me that he sees no problem with taking
>albuterol long-term at the recommended dose, clearly I was under the mistaken
>impression that this implied that the asthma is "well controlled".

There is concern that albuterol may become less effective the more you
use it.

--
"Iraq will not be defeated. Iraq has now already achieved
victory - apart from some technicalities."
Iraqi Ambassador Mohsen Khalil after the fall of Baghdad
CBI - 11 Sep 2003 22:02 GMT
> I stand corrected.  What would be a reasonable definition of "well controlled
> asthma?"  Is Colin's dose level of around 3 doses of albuterol a week
> about right?  My specialist has told me that he sees no problem with taking
> albuterol long-term at the recommended dose, clearly I was under the mistaken
> impression that this implied that the asthma is "well controlled".

That is "the official" definition. Commonly used guidelines usually
also say something to the effect that you should not have more than 2
awakenings from wheezing per month.

If your specialist says it is OK to use the albuterol several times
per day it can mean one of several things:
1) You have something else besides asthma (like COPD/emphysema)
2) You have asthma and just asthma but it is so severe that he has
basically given up on normal standards of control.
3) He was referring to short term exacerbations and you misunderstood
him.
4) You need a second opinion.

I am NOT saying that you should stop the albuterol. If you need it
take it. What is usually done, rather than just telling the person to
stop it, is to increase the prevnetatives and eliminate triggers until
they no longer need it that often. What I would do is have a talk with
the specialist and try to see which one(s) of the 4 things above
apply.

> Is there any evidence that the new mono-isomer version of albuterol (the
> standard drug is racemic) has any value?  I read in a press release from
> the company that makes it that one of the isomers is considered actively
> harmful, is there any objective evidence for this or is it marketing spin?

The drup reps make the claim that the non-acive isomer contributes to
inflammation but I have never seen any evidence of this, even in drup
company literature. Some docs do think that the Xopenex causes less
palpitations and jitters but the literature on this is weak at best
and I have not been all that impressed in my personal experience with
it.

--
CBI, MD
Thomas F. Maguire - 12 Sep 2003 01:06 GMT
> That is "the official" definition. Commonly used guidelines usually
> also say something to the effect that you should not have more than 2
[quoted text clipped - 17 lines]
>
> CBI, MD

Shouldn't you add a bit something about exercise induced asthma? I use
albuterol before I run, but other than that my asthma is completely
controlled by Singulair and Advair.

Tom
--
www.DuendeDrama.org
Bringing Plays and Stories
to Our Schools and Communities
CBI - 12 Sep 2003 03:20 GMT
> Shouldn't you add a bit something about exercise induced asthma? I use
> albuterol before I run, but other than that my asthma is completely
> controlled by Singulair and Advair.

I almost did but left it out for the sake of brevity (read: to lazy to get
into it).

I think there is clear agreement that the dose of preventative medicine
taken before exercise does not count toward "the use limit" (i.e. does not
indicate poor control). I think you would find somewhat less agreement on
how to interpret wheezing in response to exercise (or cold). Some would just
say to take the med beforehand and totally cop out of the whole discussion.

The problem is that cold and exercise induced wheezing can be a sign of
suboptimal control. I frequently find that when you question "exercise
induced asthmatics" about their symptoms that they admit to symptoms at
other times. In these cases there is a clear indication to increase the
preventative meds. If they are clear that they have no other symptoms then I
think it is less well established what to do but most would lean towards
considering the asthma controlled.

A perhaps more reasonable approach is to recognize that EIA is a potential
indicator of uncontrolled inflammation, not proof of it, and to try to
clarify the matter through more in depth history, consideration of past
history (hospitalizations and ER visits/ other flares), and increased
monitoring with peak flows and spirometry.

--
CBI, MD
Thomas F. Maguire - 12 Sep 2003 18:13 GMT
> I think there is clear agreement that the dose of preventative medicine
> taken before exercise does not count toward "the use limit" (i.e. does not
[quoted text clipped - 18 lines]
> --
> CBI, MD

Thanks for the response. I appreciate the opportunity to learn about this
complex affliction with which I have only recently had to deal. Diagnosed
this year at age 61, I'm just starting to get a handle on just how empirical
this all is.

Tom
--
www.DuendeDrama.org
Bringing Plays and Stories
to Our Schools and Communities
j r - 13 Sep 2003 02:32 GMT
I was finally diagnosed with EIA, and after some research, realized that I
did have many other symptoms.  I am now on singular, and an planning to
start exercising again, without preventative albuteral, to see how I do.
"CBI" <00doc@mindspring.com> wrote in message news:L3a8b.496
<snip>
> A perhaps more reasonable approach is to recognize that EIA is a potential
> indicator of uncontrolled inflammation, not proof of it, and to try to
[quoted text clipped - 4 lines]
> --
> CBI, MD
CBI - 11 Sep 2003 22:15 GMT
> I stand corrected.  What would be a reasonable definition of "well controlled
> asthma?"  Is Colin's dose level of around 3 doses of albuterol a week
> about right?  My specialist has told me that he sees no problem with taking
> albuterol long-term at the recommended dose, clearly I was under the mistaken
> impression that this implied that the asthma is "well controlled".

http://www.3m.com/us/healthcare/pharma/maxair/AsthmaTreatmentGuidelines.pdf
http://www.clearbreathing.com/prevention/4_3_guidelines.asp
http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm
ARoberts - 09 Sep 2003 01:05 GMT
> Hello,
>
[quoted text clipped - 6 lines]
>
> Thanks in advance

Advair, which combines fluticasone (Flovent) and Salmeterol (bronchodilator)
and is available in several strengths.

QVar, a new formulation of Beclamethasone (smaller particle size for better
penetration, theoretically).

The leukotriene inhibitors, Singulair & Accolate, which work very well in
some--not at all in others.

Xolair, a genetically engineered (and very expensive) new class of drug that
targets IgE, the antibody underlying allergic asthma.
julien mills - 09 Sep 2003 14:34 GMT
> I have used Flovent in the past, without too much success.  While using
> Flovent, I still had to use my emergency inhaler (albuteral)  I currently
> use my Albuteral 4-6 times a day and would like to ask my doctor about a new
> preventative medication.
>
> Are there any NEW preventative medications other than Flovent?

As some others have said, why don't you ask your doctor to
give you Advair.  It is flovent/serevent combined, you will
only need one puff, morning and evening.

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Amoroso's Baking Company          |
Philadelphia, PA                  |

thebigmacs - 09 Sep 2003 19:43 GMT
You may want to reconsider approaching ADVAIR gung ho...there is a
continuous discussion on this message board that began on 8/14/03 that
discusses why ADVAIR (Fluticasone and Serevent) are getting a black label,
b/c of a significant amount of deaths that have occurred due to the use of
this product. Just a word of advice. ADVAIR can be a great drug, but should
not be used as a cure all, or first line of defense. Something such as QVAR
would be a better choice to start off with and if needed, titrate the
dosages upward. (Most doctors use this STEP-WISE approach).

> > I have used Flovent in the past, without too much success.  While using
> > Flovent, I still had to use my emergency inhaler (albuteral)  I currently
[quoted text clipped - 11 lines]
> Amoroso's Baking Company          |
> Philadelphia, PA                  |
Michael Halliwell - 10 Sep 2003 02:49 GMT
Yes,

My doctor used a step wise approach, however I does depend a lot on the
individual.  In my case, QVAR didn't do me any good and in fact we were
wondering if it was in fact making things worse.
After Pulmicourt (I don't do well with the Turbuhalers) I tried Qvar, then
we went to Flovent...after flovent, we stepped up one more to Advair.  It
works quite well, but I would almost prefer to try a neb version of
Pulmicourt and a long acting B2 antagonist MDI to avoid some of the problems
I've heard about Advair...

Michael Halliwell

Signature

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***************************************

> You may want to reconsider approaching ADVAIR gung ho...there is a
> continuous discussion on this message board that began on 8/14/03 that
[quoted text clipped - 4 lines]
> would be a better choice to start off with and if needed, titrate the
> dosages upward. (Most doctors use this STEP-WISE approach).
jackmallory@webtv.net - 11 Sep 2003 15:39 GMT
Yes there is something else: Pulmicort.  I used several others of this
type, not including Flovent, and found Pulmicort to be far better for
me.

Although the individual unit is expensive, it last longer.
chrissie - 11 Sep 2003 19:07 GMT
> Yes there is something else: Pulmicort.  I used several others of this
> type, not including Flovent, and found Pulmicort to be far better for
> me.
>
> Although the individual unit is expensive, it last longer.

It would be good to have a US/UK/other proprietary name translator.

I don't understand at all what Flovent is.  I've been on Flixotide for
the last 10  years.  Is that a product known in the US?

Chrissie
ARoberts - 12 Sep 2003 00:40 GMT
> > Yes there is something else: Pulmicort.  I used several others of this
> > type, not including Flovent, and found Pulmicort to be far better for
[quoted text clipped - 8 lines]
>
> Chrissie

Flixotide and Flovent are both formulations of Fluticasone Propionate, a
steroid.  To the best of my knowledge, the product is not sold under the
name "Flixotide" in the U.S.
Dave Oshinsky - 13 Sep 2003 23:07 GMT
The best preventative asthma treatment is to get rid of it entirely.
In my case, this was 15 weeks of azithromycin (Zithromax).  If this is
of interest to you, please see http://www.oshinsky.org/asthma.htm

Dave Oshinsky

>Hello,
>
[quoted text clipped - 6 lines]
>
>Thanks in advance
cindimobxnc@earthlink.net - 29 Oct 2003 04:10 GMT
>Hello,
>
[quoted text clipped - 6 lines]
>
>Thanks in advance

I use the Serevent Diskus inhaler, and have had to use my albuterol
inhaler MUCH less.  In fact, I have been able to tell a difference
when the stopped making the serevent aerosol and switched to the
diskus form.

Cindi in NC
 
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