[Allergy & Asthma Corner]

 

Did you know a new asthma inhaler became available earlier this year?

The name of it is Alvesco and it is made by a company called Nycomed.

The inhaler is a new addition to the class of Inhaled Corticosteroids (ICS) which include such drugs as: Flovent, Pulmicort, Qvar, Asmanex, Aerobid and Azmacort.

Alvesco has some unique features to offer patients. It is a small particle inhaler (similar in size of particles to Qvar) which means the inhaled dose tends to land more in the lung where you want it, and less on the surface of the mouth and throat. Furthermore, the medicine is not activated as a steroid until it reaches the lung. What’s the big deal? Well, some people that suffer from the side effects of hoarseness or oral thrush (a yeast infection of the mouth) are less likely to experience these problems with Alvesco. A small percentage of people that are on ICS have these problems. Clinical trials of patients on Alvesco showed no greater oral thrush or hoarseness than placebo.

Alvesco is a once daily inhaler that may be effective without the use of a spacer. It may be prescribed for the treatment of asthma in patients that are 12 years or older.

How does this new inhaler stack up to others with regard to its effectiveness? A comparison study with Budesonide (Pulmicort) and Fluticasone (Flovent) showed comparable effectiveness when improvement in lung function was measured.

Are there any drawbacks? Your insurance company may charge you more for this new medication especially if it is non-formulary. Some pharmacies may not be as well stocked in this ICS because of the relatively small demand for it (most pharmacies should be able to get a shipment within a few days though). Children under 12 years are not approved for Alvesco.

I have, so far, only written a few prescriptions for Alvesco but I will be writing more over time.

Want to learn more about this relatively new drug ( the site also includes an instructional video)? Just click here!

Last week an FDA advisory committee convened with the FDA to address the ratio of benefit to risk of medications containing LABAs (Long Acting Beta Agonist, also referred to as Long Acting Bronchodilators) used for the treatment of asthma (not COPD).

LABAs have been under a microscope since getting Black Box warnings a couple of years ago. The above inhalers are LABA containing products which are widely used across America and around the world.

No new data or research on adverse effects of these inhalers was revealed. Several experts in asthma, allergy and healthcare expressed their opinions about the importance of these inhalers in the successful management of asthma.

I posted more details about this meeting along with some of my own comments on this site (click here).

For my patients on Advair or Symbicort: Nothing has changed my view on their use in treating asthma. A large majority of patients I treat, both children and adults, benefit from these inhalers and are spared the greater risks of having poorly controlled asthma (which may be life-threatening). Furthermore, well controlled asthma decreases the risk of needing an oral steroid regimen or infused (intra-venous steroid) as treatment for severe persistent asthma or severe asthma attack.

No studies on Advair or Symbicort have shown an increased risk of death or trend towards worsening asthma, as a result of the inhalant.

It appears the risk is in asthma patients taking Serevent or Foradil alone (with no inhaled steroid) on a regular basis. Asthma may seem well controlled for a while but subsequently worsen because of unchecked inflammation (this is unproven but a postulated explanation).

Final Words-

Always ask questions, and beware of misleading commentary on the internet, in the newspaper and from friends and relatives. Check with your doctor if you have concerns about your asthma medication. See an allergist or as pulmonary specialist if you have difficult to control asthma.

Have a question for me?

7 Tips to Get Through the Winter

Thanksgiving has come and gone. Cough, cold and flu season is well underway. Many doctor’s offices are tending to the walking wounded these days. For many of us it is only a matter of time before we fall victim to the variety of germs awaiting passage to our nasal sinuses, ears, throats and lungs. We know that balanced diet, exercise and adequate sleep help but how many of us can accomplish and maintain these tenets? There are some other things we can do that may get us through this high risk time of year.

 

•1) Avoid high risk activities such as kissing and hugging friends and relatives.

 

•2) Wash your hands before eating meals and snacks as well as after contacting other people or handling objects that are touched by others (utensils, handle of a cart, telephone, elevator buttons, escalator hand-rails doctor's office chairs, knobs and counter tops “uh oh!” etc.)

 

•3) Encourage friends and relatives that are sick from a cold or flu to stay home. Co-workers that come to work with a cold should have reduced contact with other staff and practice frequent hand-washing.

 

•4) Aggressively manage any active allergic rhinitis symptoms with medications that have been prescribed for treatment and control.

 

•5) See if your home is over or under humidified. The optimal humidity level is 40-50%. Levels that are 30% or below are much too dry for the nasal passages. Over 50% humidity fosters over-growth of mold and dust mites.

 

•6) Review environmental controls for indoor allergy triggers and make modifications that are warranted. (Is a live Christmas tree in your home? Check out this link)

Millions of mold spores lay dormant until they get inside your home.

 

 

•7) Finally, get your flu shot. Ask your doctor if you are a candidate for the pneumonia vaccine (over 65 years of age, history of chronic heart, lung, liver or kidney disease for those over age 2...)

There are no surefire ways to avoid getting sick over the winter but we might as well do the best we can to avoid it.

What do you think?