Asthma Inhalers

In an effort to help kids better control their asthma, researchers found a new way for young asthma sufferers to go about their medication regimen. 

While most doctors give kids two inhalers -- one for on the spot treatment and one that works to prevent symptoms over the long term -- this new study suggests that taking both inhalers as symptoms arise could be a better alternative to persistent medication use. 

“We were pleased to find that as-needed treatment based on symptoms can deliver similar asthma control with less medication,” said researcher Dr. Kaharu Sumino. “Patients in the group that used both inhalers as needed used about one-fourth the steroid dose of the group that inhaled a prescribed daily amount. We also were pleased to see that the patients and families felt that they had more ownership over their asthma management when practicing as-needed treatment.” 

The case for as-needed medications

To see how taking asthma medications as needed affected kids differently than staying on the medication over the long-term, the researchers had over 200 African American children, who are disproportionately affected by asthma, participate in the study. 

The participants, all between the ages of 6 and 17, were divided into two groups: one that followed the more traditional course of treatment, which involved taking a prescribed dose of a steroid daily regardless of symptoms, in addition to a rescue inhaler as symptoms persist; and another group that took both the steroid and the rescue inhaler only when symptoms arose. 

While asthma symptoms and lung function were no better or worse for either group, the researchers did note one major takeaway from the study: the children taking their inhalers only as needed were using less medication over the long term. 

Steroids are beneficial in treating asthma symptoms, both on the spot and for prolonged treatment, but they do come with a number of side effects, which can be worrisome for parents. However, in taking the inhalers only as needed, the children were still able to control their asthma and dramatically reduce how much of the steroid they took on a regular basis -- which lowered the associated costs of the medication. 

“This as-needed steroid plus rescue albuterol strategy is now recommended in the Global Initiative for Asthma guidelines as one of the options for the treatment of mild asthma,” said Dr. Sumino. “Given the result of our study and others, primary care doctors may tell their patients with mild asthma that they have an alternative effective strategy other than taking the inhaled steroid every day, if they prefer not to do so.”

GlaxoSmithKline is recalling one lot of Ventolin Diskus inhalers that may not deliver the intended dose.

Ventolin Diskus is a prescription drug used in adults and children 4 years or older to relieve and prevent bronchospasm due to asthma, chronic bronchitis and other chronic lung disorders.

Bronchospasm is a sudden worsening of shortness of breath and wheezing.

Individuals who do not receive the intended dose may not be aware that the dose was not delivered. Their symptoms (cough, wheeze, breathlessness or tight chest) may get worse over time and they can suffer serious health consequences, including a potentially life-threatening asthma attack.

The following product, sold throughout Canada, is being recalled:

• Ventolin Diskus (200 mcg salbutamol per blister (60 Dose) (DIN 02243115)) Lot 786G, Expiry 05 2019

What to do

Customers who purchased the recalled product should return it to the pharmacy where purchased for a replacement.

Consumers with questions or concerns may contact GlaxoSmithKline (GSK) via Stericycle (which is managing the recall on GSK’s behalf) at 1-855-215-5956.

Previous studies have shown that obese children are more likely to develop asthma. Now, a new study suggests that kids with asthma are at a greater risk of obesity. The association was revealed following an analysis of the health records of nearly 2,200 elementary school students in California.

Investigators found that childhood asthma was linked to a 51% increased risk of obesity over the next decade. The researchers also found that the use of “rescue” inhalers reduced the risk of becoming obese by 43%.

“Asthma and obesity often occur together in children, but it is unclear whether children with asthma are at higher risk for onset of obesity or whether obese children develop asthma, or both,” said lead author Zhanghua Chen, a postdoctoral research associate of preventive medicine at the Keck School of Medicine at the University of Southern California.

“Our findings add to the literature that early-life asthma history may lead to increased risk of childhood obesity,” Chen said in a statement.

‘Vicious cycle’

While the new study did not prove a cause-and-effect relationship between asthma and obesity, the authors say it did suggest a connection worthy of further investigation.

The fact that rescue, but not controller, asthma medication appeared to reduce the risk of obesity was surprising, said senior author Dr. Frank Gilliland, a professor of preventive medicine at the University of Southern California's Keck School of Medicine in Los Angeles.

Overall, the findings highlighted the importance of early diagnosis and treatment of asthma, said Gilliland, who describes the relationship between asthma symptoms and obesity as a “vicious cycle.”

Reducing obesity risk

The link might exist, Gilliland suggested, because kids with asthma play outside less often when their symptoms flare up. Additionally, “sleep disturbances are common in asthma, and a large risk factor for obesity," he said.

To reduce the risk of obesity, the authors say children with asthma can use simple but effective strategies for improving their overall health. Strategies include eating a healthy diet and increasing physical activity, as well as knowing triggers and maintaining control of the chronic respiratory condition through medication.

The full study has been published in the American Journal of Respiratory and Critical Care Medicine.

If you use an aerosol inhaler to treat your asthma or chronic obstructive pulmonary disease (COPD) you're going to have to get a new one.

The last two inhalers used in the United States containing ozone-damaging chloroflurocarbons (CFCs) and are being pulled from the market by the end of this year.

If you use one of them, you'll have to talk with your doctor about a prescription for an alternative.

Most people who use inhalers have already made the switch to those that are CFC-free and the U.S Food and Drug Administration (FDA) says that -- in general -- the transition has gone smoothly. 

Inhaler problems

The transition may have gone smoothly for the FDA but it hasn't been trouble free for patients.

An asthma patient in Virginia voiced harsh concerns about the FDA's comments that patients remember to breathe deep with the new inhalers. The new, non-flurocarbon rescue inhalers require the patient to take a deep breath, whereas the older inhalers aggressively shot the medication into the airways. 

"This is absolutely total ignorance," says Roger M. of Glen Allen, Virginia, in a ConsumerAffairs post. "People having an asthma attack and in a panic state cannot breathe in deeply. People with COPD and limited lung function -- when in need of medication -- cannot breathe in deeply. Recent times have shown the (incompetence-plagued) FDA's inability to properly understand and evaluate these life altering decisions."

"I may die if I cannot have my CFC inhaler," says Paulette B. of Sacramento, California. "I cannot use hydrofluoroalkanes (HFA) albuterol inhalers as I am allergic to the propellants in all of them. I tried two different ones and they made me cough really badly, and my lungs burned awfully. They gave me an awful headache and caused nausea, too." 

The phase-out

But be that as it may, the final two inhalers on the market are going away. 

Combivent Inhalation Aerosol will no longer be available after July 2013. It contains two medicines -- ipratropium bromide and albuterol sulfate. A bronchodialator intended to open airways, it is approved for patients with COPD. An alternative inhaler -- Combivent Respimat -- contains the same two medicines but does not contain CFCs. It was approved by the FDA in 2011.

Maxair Autohaler will not be available after Dec. 31, 2013. This inhaler contains pirbuterol, which is also a bronchodilator and is used for the treatment of bronchial spasms in patients with asthma or COPD. Alternative inhalers are available that contain other bronchodilator medicines, such as albuterol or levalbuterol, but do not use CFCs as a propellant to move the medicine from the inhaler.

CFCs a problem

CFCs damage the ozone, a thin, outer layer in the stratosphere that acts as Earth's shield against the sun's radiation. The U.S. and most other countries signed the Montreal Protocol in the 1980s to phase out the worldwide production and use of CFCs. In this country, CFCs have been removed from such products as hairsprays, deodorants and air conditioning.

CFCs have also been used in medical devices, including as propellants to move medicine out of inhalers so that patients can breathe in the medicine. For more than two decades, FDA has coordinated the phase-out of CFCs in inhalers.

Most inhalers using CFCs have already been phased out. The most widely used -- albuterol CFC inhalers -- were phased out in 2008 and replaced with alternatives that use HFAs. The most recent phase-out was of over-the-counter epinephrine inhalers sold under the brand name Primatene Mist, which were phased out at the end of 2011.

FDA maintains a list of inhalers for asthma and COPD that do not use CFCs, and adds the names of new non-CFC inhalers as they become available.

Used by millions

Millions of people who suffer from asthma, allergies and COPD use inhalers. In the U.S., more than 25 million people suffer from asthma, a disease that affects the airways in the lungs and can cause coughing, trouble breathing, wheezing and tightness or pain in the chest. Attacks can be mild, moderate, severe and even life-threatening.

Another 15 million U.S residents have been diagnosed with COPD, a serious lung disease that usually causes breathing to get worse over time. It can limit airflow, and may include chronic bronchitis, emphysema or both.

While all FDA-approved inhalers currently on the market have been shown to be effective, there are some differences between the products. For example, products propelled by HFA may taste and feel different than the spray from CFC-propelled inhalers.

Although some consumers note that the spray from an HFA inhaler feels less forceful, this does not mean that the medicine is not working. Other alternative medications may use no propellant at all. Your doctor may be able to find the product right for you.