If you have asthma and/or allergy problems you probably want to ask Pres. Obama for your own stimulus package to pay for medications.

I’ve been in practice now, 19 years. I remember when generic drugs were just coming on the medical scene. Some people were very vocal about their fear of getting a drug that was less effective or impure. Some patients refused to have a generic substitute for their asthma, allergy or blood pressure treatment. Consumers didn’t trust these drugs, in the same way generic canned foods were sometimes regarded.

Well, what a difference a down economy makes. Now, not only insurance companies are requesting doctors to order generics but many patients and pharmacies are on the same bandwagon.

Why is this so?

It appears the fear of generic medications as a class has markedly faded for one. Generics can certainly save you several bucks which are welcomed these days. Pharmacists often make a little more money off generic brands because the AWP (average wholesale price) is less. Therefore the mark-up for retail may be higher without over-pricing the consumer (Get it?). Many generics have gone over the counter (OTC) and proven to the masses, their effectiveness. Albuterol inhaler is an example of a generic line of medication being withdrawn (in the U.S.) and causing a sizeable backlash.

Some asthma patients are convinced the generic albuterol was/is superior to the available brands of HFA albuterol (Ventolin HFA, Proventil HFA, ProAir HFA, Xopenex HFA). There are online petitions to bring back the CFC (chlorofluorocarbon) containing albuterol inhalers.

I take care of a lot of asthma patients and have only come across a few disgruntled patients that are not pleased about the new HFA albuterol inhalers. I have spent some extra time with these patients explaining to them the reason for the switch and the difference in the old and new inhalers. I stress the importance of priming and re-priming (when indicated) and periodic cleaning of the new HFA inhalers. I also reassure them of the dose they are getting, which is equivalent to the puffs of the older albuterol inhalers.

There have been reports of some patients getting sicker from asthma with the new HFA inhalers but they are rare, compared to the number of people that use them now. The old albuterol inhalers were also reported to cause more asthma symptoms in a very small number of patients (more common in African-Americans but not limited to this ethnic group.

Generic drugs are here to stay and probably represent one of the fastest growing markets (when you exclude albuterol inhalers). Our moribund economy has been a stimulus to the call for more generics.

I posted an article about the escalating cost of allergy and asthma medications on Health Central’s MyAsthmaCentral.com a few days ago.

Want to check it out? I gave several tips on how to save money on costly allergy and asthma meds.

Here is the link: (Click here for the Tips!)

Next Week’s Topic:

When should you suspect your cough is “habit cough”?

Some of you have already been introduced to a new nasal spray called Astepro. This medication represents a “makeover” of Astelin which has been available for treatment of allergic and non-allergic rhinitis for many years. Both nasal sprays contain the active drug azelastine.

Why the Makeover?

Astelin, although a very popular medication in the allergy domain, has a foul aftertaste. I have spent countless extra minutes warning patients about this imminent bitter taste that shortly follows the squirts up the nose. To this end, even more time has been spent in showing patients how to properly position the spray in the nostril in order to insure effectiveness and reduce the run-off down the back of the tongue.

Actually, I received very few complaints about Astelin’s taste but there were occasional patients that either stopped taking it or used it sparingly because of this unsavory sensation. Were you one of these patients?

The makers of Astelin (same as Astepro) decided to launch a nasal spray that had the same mechanism of action but with a better taste. They found that by using sorbitol based ingredient, they could reduce or mask the taste effect. Clinical trials proved they reached their goal. But the pharmaceutical company was happy to discover that patients in their clinical trial actually had better symptom reduction with the new Astepro when compared to Astelin (despite having the same active drug).

What does this mean to you?

Well, your allergist has another new agent to consider in patients that are not pleased with their allergy management or are presenting for the first time with allergic nasal problems.

What’s the downside you might ask?

Astepro is approved only for those who are 12 years of age or older (Astelin could be prescribed for seasonal allergic rhinitis treatment in children down to age 5; and was approved for non-allergic rhinitis for age 12 and older). Astepro is not approved for non-allergic rhinitis (nasal symptoms related to fumes, fragrances, tobacco ash, pollution etc.) in any age group. This appears to be a formality in that adequate data has not yet been submitted to the FDA by Meda for this indication.

Drowsiness and fatigue may be a side effect experienced by some, especially at the maximum dose of 2 sprays each nostril twice daily. I almost invariably recommend 1 spray each nostril up to twice daily for this reason. There was a very low incidence of drowsiness in the parallel studies (Astepro Vs Astelin) included in the package insert.

New medicines are always a double edged sword. They tend to be better than many older meds but are usually more expensive. But Meda pharmaceuticals addressed this issue in a very unique way (that, I think is fantastic!). In addition to providing plenty of sample starters, the company has an arrangement to cover the full cost of the first prescription order, and discount refills for the following 12 months such that patients will pay $20 or less for each refill. This will work for all insurance carriers when presented to the pharmacy after proper registering (I’ve been told).

Astelin or Astepro

I am excited at the prospect of having an improved nasal spray that actually tastes better. Both Astelin and Astepro have the flexibility of being able to be dosed twice daily as needed. The response to these nasal sprays does not take as long as most nasal steroid sprays. I instruct patients to use either one regularly during their active season or as needed (if this pattern of use works for them). Some patients with more severe rhinitis benefit from the use of nasal steroid sprays in addition to Astelin or Astepro.

Furthermore, these two nasal sprays (Astelin and Astepro) may relieve nasal congestion (stuffy nose) in minutes without having the potentially addictive characteristics of OTC (over the counter) topical nasal decongestants. This sets them apart from other prescribed nasal sprays which may take several hours to days to reduce congestion (topical nasal steroids).

If you are struggling with nasal congestion and drainage that, so far, haven’t responded to your current medications, ask me about Astepro at your next appointment. You will already be in the know.