I've just had my first appointment with the local Asthma Education Clinic. I'm effectively non-asthmatic here in my apartment, but when I visit my family (really important to me around Christmastime!) I have severe asthma attacks because my folks are heavy smokers, have cats and dogs (I'm allergic to both).
Basically the Clinic is recommending that I go on a combination anti-inflamitory/long-term bronchodialator (they suggested Advair). I've been trying to do extra reading online, and it seems to me that Symbicort would be the better medication because of it's fast relief time. Has anyone ever tested the two "head to head"? I guess I'm looking for wrin here, I've seen most of the Symbicort posts from wrin.
Also, what's the deal with all the different delivery systems? Is there an advantage to the classic puffer with spacer (this is what I use now for my Flovent and Salbutamol)? The Advair diskus looks 'neat' and Symbicort is only available in the turbohaler... Since my attacks are so severe, should I ask my Dr. for Advair so that I can get the medication even if my inspiratory flow is poor?
Thanks for any advice you can give... obviously I'm going to go with whatever my Dr. recommends, but I'm trying to inform myself as much as possible! I just want to make it through Christmas with no attacks, but still be able to visit my family! Thanks!
Hi, I can't help you with the different drugs, (I'm from england and they have different names over here) but the use of a spacer improves the amount of medication you get into your lungs. It also makes it easier for you if you don't have much puff!! The problem with breath activated inhalors is that is if you're short of breath then they may be difficult to activate. I'm only speaking from my experiences tho, it may be right for you. Make sure you discuss all the options with you doctor. Good luck x x
Thanks for the tip... I know it shouldn't make a difference to me but the idea of fancy turbohalers and diskuses sounded exciting! But it sounds like the basic puffer is really the best delivery system.
Actually, the turbohaler and the diskus...both are DPIs or dry-powder inhalers. I've read that if you can inhale, you can use them, just like MDIs.
I can't tell you about symbicort vs Advair, though because in the States, only Advair is approved...I have no clue why symbicort isn't yet though because both of its components are approved seperately...weird, huh?
For people saying Advair is only a DPI -- in Canada, all the drugs from GlaxoWellcome are available in DPI or MDI -- including Advair and its different strengths.
That said, just because it's an MDI doesn't mean that you should be using a spacer either -- the HFA inhalers don't work very well with the spacers because the spray comes out slower.
I am on Symbicort because I had a weird reaction to Flovent, and was put on Pulmicort thereafter. Since Flovent seems to be working fine for you now, I would be hesitant to switch you to another inhaled anti-inflammatory, partially because you'd have to not only get used to a different delivery system but also a different steroid.
The long-acting bronchodilator does act quicker in Symbicort but the difference is really a matter of minutes -- like 10 or 15 minutes difference, so it's pretty negligible.
The turbuhaler dpi does take a stronger inspiratory flow even than the diskus. I find as my inhaler gets older throughout the month, it gets harder and harder to inhale through it, like it's getting gummed up. I don't think the Advair MDI would do this.
If you really wanted to, I don't think it'll matter which one you pick. If you're really having trouble with your inspiratory flow, take a hit of ventolin before you take your controller puffer, and that should help.
Thank you... I think I will ask for Advair, I'm really hoping it'll ease my symptoms at home for the holidays.
I wasn't aware that there was a problem with a spacer and the new HFA inhalers. I didn't see anything in the info papers at least, but I know they aren't comprehensive. I thought that using the spacer with the anti-inflamatory (Flovent) was good; the asthma clinic said that it would help reduce the chance of thrush etc?
For Orion: Yes, that was the originally touted main reason for taking Flovent with a spacer -- that it was better for thrush etc etc. Honestly I'm not so sure it makes that big of a difference and I'm not sure that the HFA are that compatible with the spacers (I mean, maybe some of the smaller ones, I've seen like 20 different kinds of spacers and maybe SOME of them would work ok) because the whole premise behind the spacers was that it let the aerosol particles spread out more ... 'twas why you were supposed to hold your inhaler out from your mouth before puffing -- but you're not supposed to do THAT anymore, either.
Mostly I think they just can't agree. Rinsing your mouth has always been and will be the best defense against thrush. Using a spacer doesn't mean you don't have to do that anymore. I'm not sure it'll hurt either, if you use the aerochamber style spacer that's got the valve that tells you when you're inhaling too fast. There's some bigger ones that I don't think would be such a good idea.
It's the Aerochamber spacer that I have, so I'll stick with it. I read earlier that we're supposed to breathe in somewhat slowly from taking a puff (I think I always go too fast if I don't use the Aerochamber).
The Asthma clinic that I was at warned me, however, that if I was not using a spacer, that I should "take care to avoid spraying the steroid into my eyes." I laughed at first but they claimed it happens more than you'd think!
Also, I guess I've always thought of the USA as having the latest in medical research and medications, but the Advair MDI and Symbicort here make me feel like Canada is a bit more progressive in the asthma medications at least! I'll count my blessings.
From what I've heard, the USA is quite behind the times as far as progressive treatment goes -- I mean, they just started getting into this preventer treatment thing like four or five years ago!
A lot of the differences (that I can see, anyway) are also having to do with how the hospitals are run -- it's very physician oriented down there, doctor says, staff does, that kind of thing, whereas up here, a respiratory therapist or a nurse or an OT or PT or lab tech has an equal opportunity to argue their piece -- it sure seems like the docs up here recognize that they're not necessarily experts on everything.
With regards to the spacer delivery system, it does make a difference to how much of the steroid gets into your lungs. It stops the particles from hitting the back of your throat and allows them to be inhaled. That also helps prevent thrush although i agree that you should still rinse out your mouth.