Atrovent hfa steroid

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This confusing situation happens often, even when the rescue and maintenance inhalers are of different color. The root problem is lack of standardization among inhalers, with unclear labeling to distinguish between rescue and maintenance inhalers. A contributing cause is lack of proper education for both the caregivers and their patients . All too often proper instructions were not given when the drug was first prescribed. And even when they are provided, patients sometimes don't really understand, or they forget. Either way, having similar inhalers for different purposes is an invitation to error. (This was less likely to be a problem when the drug was studied by the drug companies; see YELLOW BOX above, under 'DPI Type 2'.) The problem is compounded when patients are on multiple inhalers, eg, Proventil for rescue, Advair and Spiriva for maintenance. That's 3 separate devices with two different purposes -- easy for the patient to get confused. (Pills and capsules come in many colors and sizes, but they are all swallowed the same way.) What's needed is a universal delivery device for all inhalers, with perhaps just two colors: red for rescue drugs and green for maintenance drugs. Anyone with clinical interest in the inhaler problems discussed above (Errors 1 & 2) should definitely read Problems With Inhaler Use: A Call for Improved Clinician and Patient Education , by James B. Fink and Bruck K. Rubin (Respiratory Care, Sept 2005, Vol 50, No. 10, pages 1360-75). 3. Not checking some objective measurement of the patient's air flow obstruction. Every patient should have a breathing test to ascertain the degree of impairment caused by the asthma. The most frequently performed test is 'spirometry', which takes just a few minutes and requires the patient to exhale forcefully thru a testing device (shown below).
A patient performing the spirometry test


Graphs from a normal spirometry test; left panel, graph of flow vs. volume; right panel, graph of time vs. volume.

5. Thinking a written prescription for a COPD inhaler means the patient knows when to use it: The drug's purpose. For treatment purposes all inhalers for COPD & asthma fall into one of two broad categories:

a) to provide quick relief ('rescue inhalers') and
b) to improve chronic symptoms and prevent flareups ('maintenance inhalers'). Examples of rescue inhalers are albuterol (brand names Proventil HFA, ProAir HFA, Ventolin HFA) and ipratropium bromide (brand name Atrovent). Combivent contains a combination of albuterol and ipratropium bromide. Maintenance inhalers include any inhaled steroid (IS), either alone (brand names Azmacort, Qvar, Pulmicort, etc.) or in combination with a 'long acting bronchodilator' (LABD; brand names Symbicort, Advair). PROBLEM: The SAME type of delivery device (size, shape, mechanism of action) is commonly used for both rescue and maintenance inhalers. For example, as shown below, ProAir HFA (a rescue inhaler, on left) and Symbicort (a maintenance inhaler, on right) both come packaged as pressurized metered dose inhalers, and both are deep red in color. There is nothing intuitive about this. For a patient who may have both inhalers (quite common), and who becomes short of breath, it is all too easy to forget which is which.

SOURCES:
American Academy of Asthma, Allergy & Immunology: "Asthma" and "Allergy and Asthma Drug Guide."
National Jewish Medical and Research Center: "Inhaled Medication with a Metered Dose Inhaler (MDI)." 
Asthma Society of Canada: "How to Use Your Inhaler."
Science Daily: "New Asthma Inhaler Propellant Effective, but Costlier."
Children's Hospital Boston: "Allergy Treatment."
Boehringer Ingelheim: "US FDA Expands Approval of Tiotropium Respimat® for Maintenance Treatment of Asthma in Children."
FDA. Prescribing Information: Spiriva Respimat.

Atrovent hfa steroid

atrovent hfa steroid

SOURCES:
American Academy of Asthma, Allergy & Immunology: "Asthma" and "Allergy and Asthma Drug Guide."
National Jewish Medical and Research Center: "Inhaled Medication with a Metered Dose Inhaler (MDI)." 
Asthma Society of Canada: "How to Use Your Inhaler."
Science Daily: "New Asthma Inhaler Propellant Effective, but Costlier."
Children's Hospital Boston: "Allergy Treatment."
Boehringer Ingelheim: "US FDA Expands Approval of Tiotropium Respimat® for Maintenance Treatment of Asthma in Children."
FDA. Prescribing Information: Spiriva Respimat.

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