Asthma Drug

Posted by kevvyg on Tuesday, March 24, 2015
Last week, we took a little time off from posting. As you may have noticed, Miele is completely renaming their entire line of HEPA vacuum cleaners, and it's been created a lot of new work for us. But it's Tuesday, and we're back. I wanted to start with a roundup of some of the recent stories touching on the world of asthma, allergies, and environmental control.

Reaching back the furthest is the announcement earlier this month that there was a proposed class action lawsuit filed against Lumber Liquidators. While traditional home improvement is necessarily something you'll see us writing about, this story was of particular note. Potential Problems with Cheap Laminate FlooringFor many with severe allergies or asthma, a recommendation your allergist or physician will often recommend is to replace your carpet with smooth flooring. This can be anything from linoleum or hardwoods, to tile or laminate. None of these will trap and retain allergens and irritants like carpet does. This story broke on 60 Minutes, and focused on laminate flooring and levels of formaldehyde in the product. As we've often mentioned, formaldehyde is common but powerful volatile organic compound (VOC) linked to a wide variety of conditions. Formaldehyde found in glues, adhesives, new furniture, and carpet can often aggravate respiratory conditions like allergies or asthma and severely impact those with chemical sensitivities. More generally, formaldehyde is a known carcinogen, and the result of long term exposure to any carcinogen is almost always the same - cancer.

Court Battles Ahead for Lumber LiquidatorsAt this point, there is plenty to be said on both sides. Some within the flooring industry attack the test or testing methods, which is performed by the California Air Resource Board (CARB), the same folks who test home air purifiers to ensure they do not produce ozone. Others have lambasted the company, Lumber Liquidators, as well as the manufacturers in China. While blame and claims fly, and a court battle is likely to drag on for years, there are a couple things to take from this story.

First, while all laminate does contain some level of this VOC, most have minimal levels that are within limits set by the CARB. CARB has some of the most rigorous testing in the world, with regard to emissions, ozone, and other potential indoor pollutants, and while some VOCs Are Common But Constant or Strong Exposure Can Create a Whole Host of Health Problemsmay take issue with how this particular test is performed, it's worth noting that the same testing of products sold by other home improvement stores revealed no issues with elevated levels of formaldehyde. Think of this like paint. Most interior paints contain some level of VOCs, but there are some that have lower levels than others.

Second, remember the source. While products of all types, made in a variety of countries, can and do have problems (think of the string of auto recalls in the last several years), in this instance it was only laminate made in China that so dismally failed CARB tests.

I'm not saying every product that comes out of China is bad or dangerous, but by this point, we should have had enough reason to be somewhat leery (drywall in 2001, toxic pet treats in 2007, melamine in milk in 2008, heavy metals found in toys' paint in 2011). Do a little extra research. The internet has a wealth of information, and in a short amount of time you can often double check a company's claim about its product. I'd also advise you to consider the source of your information. "Jimbo's Awesome Blog" might not necessarily be as credible as a piece found on a major news site or National Institute of Health page.

The second story I wanted to mention was likely missed by many, but it involves the drug Breo® Ellipta® by GlaxoKlineSmith. Commonly used to treat those with COPD, there has been scrutiny on the drug over its potential use by adolescents and children or for any condition other than COPD (which is comprised of emphysema and chronic bronchitis). Breo® Ellipta® - Adults with COPD OnlyAn FDA advisory panel overwhelmingly voted against the use of Breo® Ellipta® in children 12-17. For now, the drug will remain a COPD drug and NOT an asthma medication.

This isn't the first time an issue like this has arisen. Breo® is a two part drug which contains a corticosteroid as well as a long-acting beta-agonist (LABA). LABAs have and continue to be scrutinized for their links to increased risk of death in those who have asthma and use this class of medication. A quick glance at the official Breo® website should give you a pretty clear indicator of this as the warning that this drug is NOT to be used for asthma appears repeatedly on their site.

Air Pollution Continues to Plague to City of LightsLastly, today was not the day to be a Parisian resident with an even numbered license plate, particularly a joyride was on the daily to-do list. As has happened in Paris before, extremely high levels of air pollution has made the city the smoggiest on the planet, if only briefly dethroning Beijing and/or New Delhi. While a view of the skyline may appear rather miserable today, it likely won't last long.

As a final note, April is almost here, and in addition to the dogwoods being in full bloom this weekend, our most dreaded spring allergens are beginning to emerge from their winter slumber. Nicer weather shepherding in weeks of sneezing, congestion, and sinus pressure. Thanks nature!

To see the entire 60 Minutes piece about flooring.

Author: KevvyG

Posted by kevvyg on Thursday, February 19, 2015
Common Asthma Medications - CorticosteroidsThis week, we're going to take a look at medications, more specifically, the two classes of drugs most commonly prescribed for those coping with asthma. When it comes to asthma there is one basic, but large division, between treatment medications. Broadly, one type is considered a preventative while the other, a reliever. To help control asthma, a wide variety of anti-inflammatories can be prescribed. Each of which can reduce asthma attacks by reducing the swelling (inflammation) and mucus production in airways. This type of drug often makes airways less sensitive, thus less prone to asthmatic episodes. The second type of medication, bronchodilators, are often the reliever medications. Short acting forms of this class of drug can provide relief to asthma attack symptoms. While there are also long acting forms of bronchodilators than can also be used as a preventative, today we're going to focus on anti-inflammatories and more specifically, corticosteroids.

Corticosteroids are the most common preventative medications prescribed for asthma. This class of drugs mimics something that your body produces naturally, cortisol. In the body, cortisol helps to regulate, target, and limit inflammation. Inflammation is the body's natural response to a variety of intrusions from pathogens to allergens, but cortisol, and its synthetic counterpart (corticosteroids), suppress the immune response and desensitize airways. For asthmatics, this means airways that aren't as prone to react (or overreact) to asthma triggers, and remember, it is this overreaction (inflammation) that causes the difficulty breathing during an asthma attack.

Corticosteroids can be taken in a variety of ways, but the most common is inhaled. Highly effective, an inhaled corticosteroid is the most commonly prescribed class of drug for control and prevention of asthma attacks. Some examples of corticosteroids are beclomethsone, budesonide, flunisolide, fluticasone, and triamcinolone. These generic names are in many of the names you've likely used (if you or your child is asthmatic) or seen in ads.Latest Type of Corticosteroid - Dry Powder Inhalers (DPIs)
  • Azmacort®
  • Pulmicort®
  • Advair®
  • Flovent® HFA
This list is by no means exhaustive, but is mainly to introduce you to some of the brand names of the common corticosteroids. Often, this type of corticosteroid is taken via a metered dose inhaler (MDI), though in recent years, Dry Powder Inhalers (DPIs) have been developed and work without the use of a spacer. With either type, the medication is often taken once a day. The last method of delivery is via a nebulizer, but this applies to only budesonide.

In addition to inhaled corticosteroids, there are a few that are administered orally. While they often take several hours to begin working, oral corticosteroids, like prednisone, are generally used in conjunction with other medications to treat some of the most severe cases of asthma. Treatments can vary with oral medications like this from heavy, short doses, to more regular, lower doses.

With inhaled corticosteroids, there are a few side effects, and as with any medication, they can vary from person to person and by the dosage. Sore throat, hoarse voice, and thrush (yeast infection in mouth) are the most common side effects. The use of a spacer with these medications often reduces these, and rinsing after taking an inhaled corticosteroid seems to help many people. MDI - Metered Dose InhalerOral corticosteroids can often have a different set of side effects including acne, weight gain, and even mood changes.

This is only meant to be a quick primer to common asthma medications, what they are, and how they can help manage asthma. It is always a bit of a balancing act when it comes to getting the right dosage (side effects vs. adequate control of the condition), but often even small changes in dosage can make significant changes to both sides of this coin. And, with many asthmatics, dosage or even the medication itself can and likely should change with time. For many, it can be extremely beneficial to change medication or dosage, as the body often can try to normalize the effects of medication over time. So medication that used to properly manage your asthma may not work as well years down the road. As with any medication, for more information, please consult your doctor.

Author: K. Gilmore

Posted by kevvyg on Thursday, July 17, 2014
Back in 2012, I highlighted a study that was presented at the European Respiratory Society conference that focused on the link between the use of common asthma treatments and a child's height. In this study, researchers examined the use of budesonide, a corticosteroid that is the active ingredient in Pulmicort, a commonly prescribed asthma medication. This morning, two new studies were released that further the correlation between lower growth velocity and the use of corticosteroids.

Inhaled Corticosteroids - Dosage Effects Child GrowthCorticosteroids are commonly prescribed for persistent, moderate to severe asthma. Often inhaled, this type of drug is used to prevent asthma attacks. While the previous study focused on one particular corticosteroid, these latest studies expanded that to include six and five, respectively, different types of inhaled corticosteroid (ICS) drugs.

In the first study, six ICS and 25 trials involving nearly 8500 children were reviewed. Over the course of a year, there was about a .5 cm difference in growth between children who used ICS and those who used placebos or non-steroidal drugs. This review suggests much the same as the one mentioned in 2012, that though small, there is some reduction in growth velocity and overall height associated with the use of ICS. And again now, as then, the lead author of this most recent review suggests that the benefits of using ICS to control moderate to severe asthma outweighs this minimal, but significant, reduction in growth velocity.Inhaled Corticosteroids Effect Child's Height

In the second study, 22 trials were reviewed, with the main focus being the effect of low to medium doses on ICS on growth velocity. While the information collected was incomplete in the majority of the trails examined, a correlation between growth velocity and the amount of ICS administered was observed. Simply put, those with low dose ICS treatments experienced a smaller reduction in growth velocity than those who were treated with larger doses of ICS.

Overall, both studies highlight two points and further refine previous research. First, inhaled corticosteroids do have an impact on height/growth velocity. This is not limited to a particular type of corticosteroid and appears with many of the most common ones. Second, higher doses of ICS correlate with less growth. The smaller the dose, the less the effect on a child's height. Again though, it's worth repeating that they're not talking a major reduction in height, fractions of a centimeter annually. Most professionals who have either conducted these studies or have read them still agree that the benefits of ICS in controlling moderate to severe asthma outweigh this small reduction in height.

Studies like these are important for a few reasons. They highlight a potential side effect that has been previously not known or often discussed. It is also good to remember that these studies show results that effect more than just those who are coping with asthma. Some of the drugs used in the studies were beclomethasone dipropionate, budesonide, ciclesonide, flunisolide, fluticasone propionate and mometasone fumarate. These are the active ingredients used in common asthma AND allergy medications like
  • Symbicort
  • Pulmicort
  • Elocon
  • Flonase
  • Veramyst
  • Alvesco
  • Omnaris
  • Omnair
They also highlight the importance of what we do here at AchooAllergy. If blocking dust mites in your bedding or replacing carpet with hard flooring or using a high quality, HEPA air purifier reduces irritants in the home, the net benefit may likely be less reliance on medication and a lower risk of having to deal with the side effects. If your child has been diagnosed with moderate to severe asthma and inhaled corticosteroids are recommended, you should have a discussion with your doctor, and as is often the case with medication, the lowest dose that provides relief is the best dose.

To read more about the larger study of ICS on growth rates or the study of ICS doses and growth rates.

Author: Kevin Gilmore

Posted by kevvyg on Wednesday, February 26, 2014
Yesterday, a US Food and Drug Administration advisory panel voted not to recommend Primatene HFA for over-the-counter sale. This is the latest in the attempt to bring a bronchodilator back to the over-the-counter market. There were two additional votes on the drug, and the mixed results could be reason for hope in seeing a new bronchodilator on the market in the future.

Primatene Mist - OTC BronchodilatorMany of you may recall seeing Primatene Mist on drugstore and market shelves when you were younger. For me, it was a common occurrence as my cousin, who suffers from severe asthma, would often have this inhaler with him. After spending time in the backyard with my cousins and brothers playing football, he would pull out his inhaler, flip the top and use it if his asthma flared up.

In 2011 Primatene Mist was phased out and removed from store shelves. These pocket-sized inhalers used chlorofluorocarbons (CFCs) to propel the epinephrine out and into the lungs of the asthma sufferer. As part of an overall move away from CFC-based propellants, the axe finally fell on Primatene Mist in December of that year. Since then, the manufacturer, Armstrong Pharmaceuticals, has been attempting to gain OTC status for a replacement inhaler, the short-acting beta2-agonist (SABA) bronchodilator, Primatene HFA. Currently, the only forms of this type of drug available are prescribed. If you have asthma, you might be familiar with their names, albuterol and levalbuterol. However, there is some need for an OTC alternative, particularly in case of emergencies or when people run out of their prescription at inopportune times.

In addition to ultimately voting no to OTC use, the 25 member advisory panel also voted on the efficacy and safety of the new inhaler. While there is still another ongoing clinical trial, the panel discussed the results of two other clinical trials that showed significant results. On a vote over the efficacy, 14 yes votes won out.

Lastly, the panel discussed and voted on the safety of the proposed drug. Like most drugs, Primatene HFA did show some side effects, though even with the most severe side effect being tremors, all cases were mild. Other side effects were infrequent. A larger safety issue was likely found in the correct use of the inhaler. While the new inhaler uses an ozone-friendly propellant, the new formula is a suspension that can settle. Consequently, the inhaler must be primed four times before the first use and twice after two weeks of nonuse. It must also be washed and dried each day, and both of these present significant hurdles when it comes to ease-of-use and proper use. With regard to labeling, some members felt that patients may be led to believe that it is for daily use when only actually intended for intermittent use. All of these things resulted in 17 panel members voting no, in terms of safety.

The end result, for now, is that the new Primatene HFA will not be in pharmacy and store shelves any time soon, but the drug does show promise. It does work, and there is a need for it. Undoubtedly, Armstrong will revisit the inhaler and attempt to address issues of misuse or mishandling.

Author: K. Gilmore

Posted by kevvyg on Tuesday, September 04, 2012
Popular Asthma Drug Stunts GrowthIn a recent study presented at the European Respiratory Society conference in Vienna, researchers defined the link between the use of a common asthma treatment drug and a child's height. For years it has been believed that budesonide, the primary active drug in Pulmicort, temporarily slowed the growth of children but that as the children grew into adults, their height eventually "caught up." This most recent study finds that the long term effects on adult height, though minimal, are permanent.

When accounting for all factors across multiple age groups, researchers found that prepubescent children who took a twice daily dose of the inhaled glucocorticoid were an average of 1.2 cm (just under half an inch) shorter than those in the placebo group. As the children grew to be adults, the slowing in growth was not cumulative nor was it progressive.

Overall, this is likely a case of not wanting to throw the baby out with the bathwater. While height is minimally effected, particularly with higher doses and with younger children, the overall effect of fewer asthma attacks ultimately outweighs this potential side effect.

For doctors and parents, this study should prompt a discussion about the use budesonide and finding the minimal dose required to control asthma while limiting any potential growth issues.

To read the original articles published in the New England Journal of Medicine.

Author: Kevin Gilmore

Keep an eye out the next three days as this week is VIRUS WEEK!

Posted by Shifrah on Friday, July 29, 2011
My chronic cough turned out to be adult asthma tells the story of one woman who had a cough she just couldn't shake.

When ribs bruised from violent coughing landed her in the emergency room, 40-year-old Linda Finlayson of New Jersey learned that she had asthma, most likely triggered by a bout of pneumonia. Although she had never had asthma before, Linda developed the condition after her lung infection.

To prevent asthma attacks, Linda takes several medications, including corticosteroids, a bronchiodilator, and allergy medicines to prevent an allergic response and congestion, which could trigger asthma symptoms.

While these measures helped keep Linda's asthma from flaring up, she decided to do more to improve her lung function specifically, and her health in general. She signed up for a half marathon and began running. Her lung function has improved significantly, and while her doctors are not comfortable taking her off her medications, she rarely has asthma attacks now.

As with many asthma sufferers, Linda is quite affected by allergies, which can lead to asthma symptom flare-ups. Spring seasonal allergies are particularly challenging for her; she has to be very careful not to get congested because the mucus drips into her lungs and causes breathing difficulty. Cat dander and secondhand smoke are also potent allergens for Linda, and can lead to asthma attacks.

Posted by Shifrah on Monday, July 25, 2011
In Asthma Risk Lower In Breastfed Babies, Medical News Today reports on a Dutch study which found that babies who are exclusively breastfed up to the age of six months have a lower risk of developing asthma-related symptoms in early childhood.

The study was conducted by researchers at the Erasmus Medical Center in Rotterdam in The Netherlands and was published online in the European Respiratory Journal. The researchers emphasize that their findings support current recommendations that infants in industrialized countries should only receive breast milk up to the age of six month.

This study is part of a broader body of research called the Generation R Study, which is "following thousands of multi-ethnic urban children from before birth until early adulthood, to identify early environmental and genetic causes of normal and abnormal growth, development and health," according to Medical News Today.

While previous studies have linked breastfeeding and asthma risk, this study is the first to show a link between duration of breastfeeding and number of wheezing periods.

Researchers summed up their conclusion in the following statement: "Shorter duration and non-exclusivity of breastfeeding were associated with increased risks of asthma-related symptoms in preschool children. These associations seemed at least partly explained by infectious but not by atopic mechanisms."

Posted by Shifrah on Friday, July 15, 2011
We may take it for granted that frightening and serious conditions like asthma require medication. However, a study discussed in Time's article Study: For Asthma Patients, Placebos Feel Just as Good as the Drug calls this assumption into question – at least in terms of how medication makes patients feel.

Conducted by Harvard Medical School, the study demonstrated that placebos (treatments that aren't real but the patients don't know it) "can be as effective as standard medical therapy."

Researchers gave 39 chronic asthma patients one of four interventions: albuterol inhalers, placebo inhalers, sham acupuncture (in which the patients didn't actually receive acupuncture, but believed they were), and no treatment at all.

Over 12 medical visits that spanned up to four months, patients' symptoms were gauged objectively through measuring lung function and subjectively through asking patients if they felt better. Results indicated no statistical difference between real and sham treatments in how patients said they felt.

However, placebo treatments did not actually improve lung function, indicating that the placebo effect, while it doesn't actually make a physical difference in patients' symptoms, has a powerful effect on patients' perception of how they feel.

As study author Ted Kaptchuk, director of the program in placebo studies at Beth Israel Deaconess Medical Center puts it: "It's clear that for the patient, the ritual of treatment can be very powerful. This study suggests that in addition to active therapies for fixing diseases, the idea of receiving care is a critical component of what patients value in health care. In a climate of patient dissatisfaction, this may be an important lesson."

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