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Is anyone else confused about all those inhalers?
Is Anyone Else Confused by all the inhalers prescribed for our lungs?
After a lengthy visit with my pulmonologist yesterday, I came away with a new set of medications and a whole lot of confusion!
This morning, I sat down and made list of all the drugs I use/have used, all the drugs we talked about yesterday, and several that have been suggested or mentioned here on Connect. Then I got busy and figured out what they are and why we use them.
Here is a summary…incomplete for sure, listing the classes of drugs with a short explanation of each class, and individual drug names (not the Brand Name or Combo name).
“Rescue” drugs – may be inhalers, or in some cases nebulizer solutions
Short Acting Beta Agonist (SABA) Opens airways quickly, relaxes airways, but doesn’t last long
• Albuterol (Common Brand Names: ProAir, Ventolin, Proventil)
• Levalbuterol (Xopenex)
• Salbutamol
Short Acting Muscarinic Agonist (SAMA) Like SABA, opens airways, or prevents bronchospasm. Less often used than SABA
• Irpatropium Bromide (Atrovent)
• Tiotropium Bromide (Spiriva)
Long Term or Daily Use Medications
Inhaled Steroids Direct dosage to lungs compared to oral steroids which are systemic. Reduces inflammation which helps keep airways open.
Inhaled Corticosteroid (ICS)
• Budosenide (Pulmicort, Entocort, Rhinocort)
• Mometasone (only in combinations)
Inhaled Glucosteroid (IGS)
• Fluticasone Propionate (Flovent, Allerflo)
Long Acting Beta Agonist (LABA) Acts to keep airways open – usually used in combination with an inhaled steroid
• Formoterol Fumarate (Foradil)
• Salmeterol Xinafoate (Serevent)
• Vilanterol (only in combinations)
Long Acting Muscarinic Agents (LAMA) Relaxes muscles around airways for 12-24 hours to reduce asthma attacks
• Tiotropium bromide (Spiriva)
• Umeclidinium bromide (Incruse)
Here is a summary of the most commonly prescribed Name Brand medications and what drugs are in each one.
Advair - Fluticasone propionate (IGS), Salmeterol (LABA)
AirDuo - Fluticasone propionate (IGS), Salmeterol (LABA)
Anoro- Umeclidineum (LAMA), Vilanterol (LABA)
Breo - Fluticasone Furoate(ICS), Vilanterol (LABA)
Combivent - Irpatropium Bromide (SAMA), Albuterol (SABA)
Dulera - Mometasone (ICS), Formoterol (LABA)
DuoNeb - Irpatropium Bromide (SAMA), Albuterol (SABA)
Nebulizer Solution
Symbicort - Budosenide (ICS), Formoterol (LABA)
Trelegy - Fluticasone (IGS), Umeclidinium (LAMA), Vilanterol
(LABA) Explanation
This is not a list of inhalers you should use, just a list of those that are often used for Asthma, Bronchiectasis & COPD - some of us have only one of these diseases, some of us have several.
I have attached a PDF file if you would like to print this list.
Sue
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@sueinmn This is on my list to do this week - sort through the types of inhalers to see if I can get some improvement in keeping my airways open longer. Saw a commercial on television for Airsupra that I am going to investigate. I'm sure Medicare won't want to pay for it, but worth a try if it appears that it would work better. Airsupra is a rescue inhaler that has albuterol and budesonide. Thanks, Sue! @lindam272
Interesting question.
I have had (stable) glaucoma for over 10 years, pressure maintained at 14-15 with eyedrops. For several years while battling asthma & bronchitis I was on prednisone and/or budosenide frequently - it seemed to have no effect on my glaucoma.
Then I was diagnosed with MAC & bronchiectasis and took antibiotics for nearly 2 years.
Recently I have been using Symbicort (budosenide plus formoterol) for over 2 years with no changes.
Both my ophthalmologist and my pulmonologist are aware of all my diagnoses and medications. The pulmonologist was specific in using budosenide - perhaps due to the glaucoma? - she never said that directly. I have visual field and retina scans, pressure checks and physical eye exams every 6 months, all showing very little progression in the glaucoma.
So apparently, not every steroid poses the same risk.
Sue
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2 ReactionsWhile I have not been diagnosed with glaucoma, I'm aware that this is one of the side effects of a steroid inhaler. My ophthalmologist said that people usually know very soon after starting the inhaler if they have a sensitivity as it starts to cause glaucoma, within a year or 2. That's the way I understood it. What does your ophthalmologist say?
From what I've read budesonide steroid in an inhaler is a bit safer than fluticasone. Less likely to cause pneumonia in a variety of studies.
Has anyone had an issue with steroid induced glaucoma? Recently diagnosed with very early stages of glaucoma. One of the side effects of Breo Elliptor (have been using it for 8 years) is glaucoma, which I was unaware. Any feedback appreciated.
Medicare Part B will pay for albuterol or levalbuterol in vials for the nebulizer. I've never had an issue with their paying for them. On the other hand, I still have not learned how to get them to pay for the saline vials, but thankfully they're affordable with GoodRx. Donna
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3 ReactionsAlbuterol in vials for a nebulizer is $27 for 120 vials w/goodrx. About the same price as my part d copay
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1 ReactionI have been using Atrovent and Breyna. I have decided to drop the Breyna because it is a steroid med. Will see how it goes on Atrovent alone. I am 74 and have moderate BE. I also take Azi 3 days a week.
I started treatment with Ventolin. Had annoying very scratchy throat. Was switched to Albuterol. No side effects. Medicare does not want to pay for Albuterol. Any ideas?
Thank you Sue!
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1 Reactionhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8629914/
"Fluticasone propionate is associated with an increased risk of pneumonia compared to budesonide in patients with COPD. In addition, the risk of pneumonia increased at higher ICS doses. Therefore, the types of ICSs and ICS doses need to be carefully considered in the treatment of COPD with ICS."
Even though this is a COPD study, having bronchiectasis we share symptoms with COPD.
Essentially, if one has asthma better to be on a budesonide inhaler vs. a fluticasone inhaler. Important to work with doctor to find the minimum effective dose.