Too Many Asthma Medications?
Folks with asthma are often taking 2 or 3 asthma medications every day, even when they have been in the green zone of good control for many months. Most of the time, they can work with their doctor to successfully discontinue one or two of those expensive medications and remain in good control.
Brooke, a 12 year old girl with mild asthma since age 5 gets a cold in February which "goes to her chest," causing coughing spasms followed by wheezing and shortness of breath, relieved by her albuterol rescue inhaler. During the next 3 days her asthma does not improve and she requires albuterol every 4-6 hours. So her mom takes her to the pediatrician in their Dallas suburb. She hears wheezing, measures a peak flow of 60% of predicted, and agrees that Brooke's asthma is worse (into the yellow zone of poor control) and prescribes a new inhaler (Advair) to take twice every day, and a once-a-day pill (Singulair). Brooke's asthma improves over the next few weeks, so that she no longer needs to take the albuterol inhaler, except during soccer practice. Brooke's mom realizes that the new asthma medications are working great, so she encourages Brooke to take them faithfully every day, and it becomes part of her daily routine. Three months later, when Brooke returns to the pediatrician for an ear ache and leg cramps, no wheezing is heard and her peak flow is 120% of the predicted value.
Ever since her asthma exacerbation, probably due to a rhinovirus, Brooke has been taking 3 different types of asthma controller medications: fluticasone (an inhaled corticosteroid), salmeterol (a long-acting bronchodilator), and montelukast (a leukotriene inhibitor). The Advair inhaler contains the fluticasone (at one of 3 different doses, depending on which was prescribed) and the salmeterol. What Brooke, her mom, and the pediatrician don't realize is that Brooke's leg cramps are almost certainly due to a side-effect of the salmeterol. Furthermore, she probably no longer needs the salmeterol (which is also causing insomnia, but nobody asked Brooke about her sleep). She probably also no longer needs the Singulair, and may not even need a moderate daily dose of fluticasone (which was causing a mild sore throat due to thrush, but the pediatrician was too busy to look behind her tongue to see the white fur at the back of her throat).
Patients are naturally more likely to go to a doctor when their asthma becomes bothersome, and their doctor is naturally likely to respond to the asthma exacerbation with drugs that are highly likely to work well for the majority of patients. This "step-up" in therapy is recommended by widely accepted clinical practice guidelines (published by the NAEPP). However, these guidelines also recommend a step-down in asthma therapy after the asthma is well controlled for 2-3 months. Unless the patient just decides to stop one or more of the asthma medications by themselves (without consulting a doctor), those with good medical insurance will usually just keep taking the medications. Since the patient no longer has asthma complaints, the doctor may follow the old adage, "If it ain't broke, don't fix it."
The problem is, the Advair inhaler costs $120 per month and the Singulair pills cost 3 dollars each ($90 per month). Even if insurance covers all but the copay for these drugs, this unnecessary cost is borne by someone or "everyone." In addition, the patient suffers from side-effects which are unmentioned or unrecognized (the leg cramps, insomnia, and thrush, for example). Asthma medications should be tailored for each patient, and used only for as long as the benefits outweigh the costs and side-effects. A good written asthma action plan will take these factors into consideration, allowing the patient to step-up and step-down their therapy as guided by their symptom frequency and lung function, but sadly, only a fraction of patients with asthma have been given one. I recommend that you print one from WebMD and take it to your next visit to the doctor. Ask her to complete it for you or your child with asthma. Also ask her if it's really necessary to take all of those asthma medications during the next 3 months, if you continue to stay in the green zone.
Related Topics: Asthma Complexities, Asthma and Allergies
Brooke, a 12 year old girl with mild asthma since age 5 gets a cold in February which "goes to her chest," causing coughing spasms followed by wheezing and shortness of breath, relieved by her albuterol rescue inhaler. During the next 3 days her asthma does not improve and she requires albuterol every 4-6 hours. So her mom takes her to the pediatrician in their Dallas suburb. She hears wheezing, measures a peak flow of 60% of predicted, and agrees that Brooke's asthma is worse (into the yellow zone of poor control) and prescribes a new inhaler (Advair) to take twice every day, and a once-a-day pill (Singulair). Brooke's asthma improves over the next few weeks, so that she no longer needs to take the albuterol inhaler, except during soccer practice. Brooke's mom realizes that the new asthma medications are working great, so she encourages Brooke to take them faithfully every day, and it becomes part of her daily routine. Three months later, when Brooke returns to the pediatrician for an ear ache and leg cramps, no wheezing is heard and her peak flow is 120% of the predicted value.
Ever since her asthma exacerbation, probably due to a rhinovirus, Brooke has been taking 3 different types of asthma controller medications: fluticasone (an inhaled corticosteroid), salmeterol (a long-acting bronchodilator), and montelukast (a leukotriene inhibitor). The Advair inhaler contains the fluticasone (at one of 3 different doses, depending on which was prescribed) and the salmeterol. What Brooke, her mom, and the pediatrician don't realize is that Brooke's leg cramps are almost certainly due to a side-effect of the salmeterol. Furthermore, she probably no longer needs the salmeterol (which is also causing insomnia, but nobody asked Brooke about her sleep). She probably also no longer needs the Singulair, and may not even need a moderate daily dose of fluticasone (which was causing a mild sore throat due to thrush, but the pediatrician was too busy to look behind her tongue to see the white fur at the back of her throat).
Patients are naturally more likely to go to a doctor when their asthma becomes bothersome, and their doctor is naturally likely to respond to the asthma exacerbation with drugs that are highly likely to work well for the majority of patients. This "step-up" in therapy is recommended by widely accepted clinical practice guidelines (published by the NAEPP). However, these guidelines also recommend a step-down in asthma therapy after the asthma is well controlled for 2-3 months. Unless the patient just decides to stop one or more of the asthma medications by themselves (without consulting a doctor), those with good medical insurance will usually just keep taking the medications. Since the patient no longer has asthma complaints, the doctor may follow the old adage, "If it ain't broke, don't fix it."
The problem is, the Advair inhaler costs $120 per month and the Singulair pills cost 3 dollars each ($90 per month). Even if insurance covers all but the copay for these drugs, this unnecessary cost is borne by someone or "everyone." In addition, the patient suffers from side-effects which are unmentioned or unrecognized (the leg cramps, insomnia, and thrush, for example). Asthma medications should be tailored for each patient, and used only for as long as the benefits outweigh the costs and side-effects. A good written asthma action plan will take these factors into consideration, allowing the patient to step-up and step-down their therapy as guided by their symptom frequency and lung function, but sadly, only a fraction of patients with asthma have been given one. I recommend that you print one from WebMD and take it to your next visit to the doctor. Ask her to complete it for you or your child with asthma. Also ask her if it's really necessary to take all of those asthma medications during the next 3 months, if you continue to stay in the green zone.
Related Topics: Asthma Complexities, Asthma and Allergies
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8 Comments:
I have a 7 year old that's on rhinocort aqua 1 spray in each nostil every monrning, advair 250/50 1 puff twice daily, maxair, but now I cant get it so they recently put her on albuterol HFA 8.5mg inhaler every 4 to 6 hours as needed, brovex-d in the am 1/2 rsp, brovex-ct 1/2 tablet in the pm, singular 5mg at bedtime and when her cough is bad delsym or robittusin. Yes, this all has helped her severe allergy induced asthma, but the side affects continue to be a problem. They include thrush, ear infection, sinus infection and upper respitory infections. We didn't have all this years ago and people got treated naturally. Isn't there so natural way to help my child without pumping her full of drugs that cause her to have more medical problems than what she started out with.
Thank You, Diane
I am presently usin alegra and nasonex for alergies and for the last month I have noticed a foul smell when I breath in. Is this a normal condition or does it indicate perhaps a sinus infection? have anyone experienced this before? I would appreciate your comments. Max
Hello My Brother called me from California this morning and told me that we are not to use anesthesia called Succinylcholine. That his Doctor called him and said that it is a paralizing drug for when the tube is needed and to notify all his immediate family members . Can you PLEASE email me and tell me about this. Thank you for your time and consideration.
Does acid reflex cause shortness of breath and chest pain?
I have been using the natural remedies given in the site www.asthmainformationguide.com, it has been quite beneficial for me. I have been having it along with the medicines prescribed by the doc.
My daughter has never been diagnosed with Asthma, but she was just diagnosed with "post infection bronchial spasm". She has had coughing fits -- some at night, some induced by simple things like laughter -- for a few months. Overall, this has been an annoyance for her, more than anything.
Our doctor prescribed Advair 100/50 and Singulair 10mg. As far as I can tell, this is an off-label use for these drugs, and the warnings for salmeterol in Advair seem rather dire, to put it mildly. We have not given her any of the medicine yet, and I am inclined to return it to the pharmacy. Should I be so concerned??
(p.s. I tend to believe the reports about the cozy relationships between doctors and drug companies, so I suspect an ulterior motive here.)
Thanks!
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I have a 9 year-old son that takes singular faithfully every night. He has no longer needed any other other meds except for a nebulizer treatment once in a blue moon. He used to be hospitalized at least once a year and on oral steroids. This hasn't happened for 4 years. I feel he is either out growing his asthma or the singular has helped tremendously.
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