Prescription ASTHMA INHALERS

Chances are that you know someone with asthma. In fact, if there are just 15 people in your family or extended family, then it is probable that you are related to someone with asthma. Asthma effects about 20 million Americans, 5 million of which are below the age of 18. Asthma is the number 1 cause of missed school days for children. Asthma is responsible for over 4,000 deaths per year.

What is asthma? The word "asthma" comes from the Greek word for breath, and it simply means "noisy breathing, panting, or wheezing." A patient with asthma has difficulty breathing because the airways through which we breathe become constricted (tighter) or inflammed. Have you ever tried to breathe air through a very tiny straw like the ones used for stirring coffee? That is what asthma feels like.

This article is a brief overview of the prescription inhalers (some people call them 'puffers') available to treat asthma. If you have just been diagnosed with asthma, or are currently being treated for asthma, the number of inhalers available may seem overwhelming. Do they all do the same thing? How does my inhaler work? Asthma inhalers can all basically be grouped into 1 of 2 categories (some inhalers, called 'combination inhalers', combine TWO categories together).

Group 1: Beta Agonists: These inhalers cause your airway to expand

Group 2: Steroids: These inhalers reduce swelling in your airway

Virtually all commercially available prescription inhalers for asthma fall into 1 of these 2 categories (or some combination of them).

A note about COPD: Another common breathing disorder is known as COPD (Congestive Obstructive Pulminary Disease). This is different than asthma, although both can result in difficulty breathing. Some inhalers are intended just for COPD (like Atrovent HFA or Spiriva). I will not be discussing those inhalers here. This article is only about asthma inhalers.

Beta Agonist inhalers cause the airways to expand and relax so that you can breathe more easily. They accomplish this amazing feat by stimulation of some very tiny receptors known as "Beta 2 receptors." Think of the "beta 2 receptor" as a miniature doorbell in your lungs. These inhalers "ring" the little doorbells that cause the airway "door" to open wider. That may be a bit over-simplified...but you get the basic idea.

Beta Agonist inhalers can be divided into those which are:

(A) FAST/SHORT acting inhalers. These inhalers are also sometimes known as "rescue" inhalers as they may be used to bring immediate relief to wheezing and shortness of breath (SOB). These include:

• MAXAIR (pirbuterol) inhaler: Approved for ages 12 and older, Maxair is the ONLY fast acting inhaler that is "breath activated." That means the patient only needs to breath in on the mouthpiece to receive a dose. No shaking or pressing a canister is required. Visit the Maxair website by CLICKING HERE for more information. Maxair is a product of Graceway Pharmaceuticals of Tennessee.
• Proair HFA (albuterol) inhaler: The Proair HFA inhaler is 1 of several "albuterol" containing inhalers available on the market. This one, marketed by Teva Pharmaceuticals, claims the advantage of a "warmer" puff and improved canister technology such that it doesn't need to be primed again and has a long (2 year) expiration date. For more information on Proair HFA you can CLICK HERE.
• Proventil HFA (albuterol) inhaler: Proventil is the Merck albuterol inhaler, and is indicated for children and adults ages 4 and over. As with all inhalers, correct technique is important. For more information on Proventil and on using Proventil HFA inhaler CLICK HERE.
• Ventolin HFA (albuterol) inhaler: Ventolin is the Glaxo albuterol inhaler. It is the only albuterol inhaler with a built in "counter" so that you know how many puffs you have left. A pretty cool feature in my opinion. For more information, CLICK HERE.
• Xopenex HFA (levalbuterol) inhaler: Finally, Sepracor Pharmaceuticals offers us their Beta Agonist inhaler, called Xopenex. For a video on how to use Xopenex, or to sign up for a Free case to carry your inhaler, go to their website by CLICKING HERE.

For your information, the letters "HFA" refer to the propellant used to expel the medication from the canister. The "long" name is "hydrofluoroalkanes." As you can see, "HFA" is much easier to say.

Another note: In a special deal with Glaxo, WalMart Pharmacy has arranged for an exclusive line of Ventlin HFA inhalers which they will sell under the name "Relion Ventolin HFA" for just $9.00 each! A great deal for those without insurance to cover the cost of these.

(B) LONG acting inhalers are intended for regular daily use. They are NOT effective at stopping an asthma attack or treating immediate shortness of breath. These inhalers are used to PREVENT an asthma attack only. NOTE: The latest medical information from the FDA advises doctors NOT to prescribe these inhalers for asthma, unless other treatments are currently being followed and are ineffective. They must be used in combination with steroid inhaler therapy (see below).

Foradil (formoterol) inhaler: Both Foradil (by Merck) and the other long acting Beta Agonist, Serevent, are actually "powders" which are inhaled into the lungs by means of an aerolizer (device) which breaks open the powder capsule and allows the patient to breathe in the powder into the lungs. For this reason, these inhalers do not use propellants like the HFA inhalers previously mentioned. For more info on Fordail, visit their website by CLICKING HERE.

Serevent (salmeterol) Diskus inhaler: This is a uniquely designed inhaler, called a "diskus" by Glaxo and is dosed twice daily to help prevent asthma attacks (bronchospasms). The ingredient in Servent works in precisely the same way as the "short" acting Beta Agonist inhalers, but happens to have a slower onset (starts to work in 30-45 minutes) longer "life" in the body...thus it can be dosed just twice daily.

Steroid inhalers for asthma work differently than Beta Agonists. Inhaled steroids help REDUCE inflammation within the airways. This is important. Many asthma sufferers have not been told that airway "constriction" is only part of the problem. Inflammation is just as important, and it cannot be treated by Beta Agonists. Steroid inhalers, therefore, are an important part of asthma treatment and prevention. Steroid inhalers do NOT stop an immediate asthma attack. For this you must use a short-acting Beta Agonist inhaler. As a general rule, you should always rinse out your mouth after using a steroid inhaler to prevent possible fungal infections.

Aerobid (flunisolide) inhaler: Aerobid is marketed by Forest Pharmaceuticals. This product has suffered from back order problems from time to time. Also available in a "mint" flavored spray known as Aerobid-M! Prescribing information can be found by CLICKING HERE.

Alvesco (ciclesonide) inhaler:Alvesco is a steroid inhaler provided by Sepracor (now known as Sunovion) Pharmaceuticals, which also handles other respiratory prescription medications like Xopenenx HFA (see above), Brovana and Omnaris (a nasal steroid inhaler). Alvesco is dosed just once daily, and is approved for ages 12 and up. CLICK HERE for more info.

Asmanex (mometasone) inhaler: Asmanex is marked by Schering-Plough Corporation (AKA Merck Pharmaceuticals now). It can be used by patients ages 4 and up. It has a unique "twist" design which releases the powder dose for the patient to inhale. Asmanex, once opened from the foil pouch, must be used within 45 days. For more info on Asmanex inhaler, CLICK HERE.

Flovent (fluticasone) inhaler: This product comes as an inhaled powder version, called "Flovent Diskus" or as the traditional propellant based inhaler called "Flovent HFA." Prescribing information on both forms can be found HERE.

Pulmicort (budesonide) inhaler: Approved for ages 6 and up, Pulmicort is the product of AstraZeneca Pharmaceuticals. Pulmicort comes in 2 strengths: 90mcg and 180mcg. It is an inhaled powder product. For more info, CLICK HERE.

Qvar (beclomethasone) inhaler: Finally, Qvar inhaler is available from Teva Pharmaceuticals for adults and children ages 5 and up. Qvar releases medication in the traditional "propellant" form with a canister that you press down to release the dose. The manufacturers of Qvar claim that the particle size released into the lungs is especially small...thereby allowing the medication to penetrate deeper. For more on Qvar, CLICK HERE.

NOTICE: Each of the above steroid inhalers uses a slightly different active ingredient(listed next to the brand name). One is not necessarily "better" than any other. Some may be more potent, deliver a smaller particle, or use a different canister. But in the end, the choice will depend on what works and what your insurance (if you have insurance) covers. Assuming your insurance covers more than 1...it may be worth your time to compare the costs when considering treatment.

What happened to Azmacort? Some of you may remember a steroid inhaler called Azmacort. What happened to it? Well...frankly...the government killed it. Along with other products which contained a CFC propellant, Azmacort could no longer be sold. The manufacturer, Abbott, decided not to reformulate it, and thus they buried it. Good bye Azmacort! We miss you.

Why not use both? Many asthma patients use BOTH a steroid and a Beta Agonist inhaler to treat their asthma. Some prescription inhalers are now available that combine both a steroid and a long acting beta agonist for better control. These include:

• Advair Diskus and Advair HFA (fluticasone/salmeterol) For info: CLICK HERE
• Dulera (mometasone/formoterol) For more information, CLICK HERE
• Symbicort (budesonide/formoterol) For information, CLICK HERE

Note: The combination of a long-acting beta agonist ( LABA) with a steroid for the treatment of asthma is currently considered more appropriate than the use of a LABA alone.