Sunday, March 29, 2015

New Medications for Asthma

It feels as though there has been a paucity of new medications released for the treatment of asthma. The first of the leukotriene modifiers was made available in 1996; and the anti-IgE monoclonal antibody (omalizumab) came on the market in 2003. There is a short list to mention of newly-released medications since that time, and even then we’ll have to borrow some from the therapeutics of COPD.

New inhaled steroids: Some of you may remember the inhaled steroid, flunisolide, marketed as Aerobid. For some people, it had an unpleasant taste, leading to development of a menthol-flavored version, Aerobid-M. Both brands disappeared with the banning of sale of metered-dose inhalers with chlorofluorocarbon (CFC) propellants, but flunisolide has recently re-appeared in a metered-dose inhaler formulation with hydrofluoroalkane (HFA) propellant, called Aerospan. Unlike other inhaled steroids currently on the market, it is available in only one dosage: 80 mcg/puff. The dose is notably less than its predecessor, Aerobid, which was 250 mcg/puff. The unique feature of the new Aerospan inhaler is a built-in, small-volume spacer, reminiscent of the old triamcinolone inhaler with built-in spacer, Azmacort, that was very widely popular in the 1980s and 1990s (before it too succumbed to the ban on CFCs). Aerospan is approved for children age 6 years and older.

A second newly-released inhaled steroid is fluticasone furoate (Arnuity). A variant of the widely used fluticasone propionate (Flovent), it has been approved for once-daily dosing. The only other inhaled steroid approved by the FDA for use once daily is mometasone (Asmanex), although in truth many patients with mild asthma seem to maintain adequate asthma control when taking their inhaled steroid (regardless of which agent) once a day. Fluticasone furoate is available at two doses (100 and 200 mcg/puff), thereby providing a relatively low daily dose. It has been made available in the novel dry-powder device called Ellipta, which seems exceedingly easy to use. The device is fully prepared when the cover is rotated 90 degrees to expose the mouthpiece. The medication is then inhaled with one deep breath … once a day … and the cover rotated back to close the device. There is a built-in dose counter on the Ellipta which displays the number of remaining puffs with large, easily viewed numbers. This medication has been approved for use in children as young as 12 years of age.

Coming soon? And that’s it for new, approved asthma medications. But let me mention in addition two medications currently approved only for the treatment of chronic bronchitis and emphysema (COPD) that may find their way into asthma care in the near future. One is the anticholinergic bronchodilator, tiotropium (Spiriva). We have previously written in this blog about the observation that this once-daily, long-acting bronchodilator can be used in place of or in addition to the long-acting beta-agonist bronchodilators, salmeterol and formoterol, as add-on therapy to an inhaled steroid in patients with difficult-to-control asthma or among those intolerant of the long-acting beta-agonists. Although not an FDA-approved indication for tiotropium, its use in asthma together with an inhaled steroid represents an alternative to the inhaled steroid/long-acting beta-agonist combinations that are Advair, Dulera, and Symbicort. What’s new here is that tiotropium has recently been made available as a soft-mist inhaler rather than the single-dose, dry-powder inhaler using individual capsules of medication loaded into a device (Handihaler) with each use. The soft-mist inhaler (called “Respimat”) has been used to deliver the combination medication, albuterol plus ipratropium (Combivent), and is now available as an alternative to the dry-powder device for delivery of tiotropium. Two inhalations from the soft-mist inhaler are equivalent to one capsule of the dry-powder preparation. Its major advantage is that each canister of the soft-mist inhaler contains 60 doses or a one-month’s supply. Each day’s dose does not need to be prepared separately. Tiotropium’s safety has not been tested or documented in children.

Finally, the once-daily inhaled corticosteroid mentioned above, fluticasone furoate, has been combined with an ultra-long acting inhaled beta-agonist bronchodilator, vilanterol, into a combination called Breo. These medications are delivered from the same multi-dose, dry-powder inhaler used with fluticasone furoate alone, the Ellipta. The once-daily inhaled steroid/long-acting beta agonist combination (Breo) has been approved for use in COPD; its package insert specifically indicates “not for use in asthma.” However, clinical trials in asthma sponsored by its manufacturer (GlaxoSmithKline) have documented the safety and efficacy of Breo in asthma; and an FDA Advisory Panel has recently voted in favor of giving approval to Breo for treatment of asthma.

If approved, Breo will be, in a sense, a once-daily Advair; that is, an inhaled steroid/long-acting beta-agonist combination delivered from a multi-dose, dry-powder inhaler. Although dosing is still to be determined, studies have explored two steroid concentrations: 100 and 200 mcg of fluticasone furoate combined with 25 mcg of vilanterol. Children as young as 12 years of age have been enrolled in these clinical trials.

And stay tuned: clinical trials are underway using a combination once-daily anticholinergic bronchodilator (umeclidium) combined with fluticasone furoate in a multi-dose, dry-powder inhaler in the treatment of asthma. It is a reasonable assumption that persons with asthma will be more faithful to daily medication use if their medications need to be taken only once a day ... as long as they are effective and have few side effects.

23 comments:

  1. Nice information on asthma medicines. Every asthma patients and doctors must know about new medications as they come with the new more effective formula.

    ReplyDelete
    Replies
    1. After having a persistent cough for over a year, I was diagnosed with COPD in March 2015. In 2016 my COPD got worse to the point where not only do I have trouble sleeping at night, I also struggle to get air into my lungs. I read in a health forum of a herbal centre (Traditional Herbal Healing Centre) who have successful treatment to COPD/Emphysema, i immediately contacted the herbal centre via their website and purchased the COPD herbal remedy, I used the remedy for 2 weeks, all my symptoms were reversed, i did another test for confirmation, i was declared COPD free. Visit (www.traditionalherbalhealingcentre.webs. com) or email (traditionalherbalhealingcentre@gmail.com) or Call/WhatsApp (+2348110857969)if you want to conform more about it whatsApp me at +1(856)402-1198.....

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  2. The timely revolution in asthma medications would prove a lot. The variants of sufficiently prescribed inhaled steroids act. Appreciate detailed medications!!

    ReplyDelete
  3. I'm confused about the difference between these medications and what I'm currently on. Should I change medications? Right now I buy generic advair online, because I get a half off code (50%off). When can I expect these medications to show up online?? This is what I take now. http://canadapharmacyrx.com/generic-advair-diskus.html

    ReplyDelete
  4. Nice information about asthma and it's new medicines.
    Foracort Rotacaps 400

    ReplyDelete
  5. I am from USA, I was diagnosed of Emphysema (COPD) in 2015 and I have tried all possible means to get cured, i even visited pulmonologist but all to no avail, until i saw a post in a health forum about a herbal doctor from Africa who prepare herbal medicine to cure all kind of diseases including Emphysema, at first i doubted if it was real but decided to give it a try, when i contacted this herbal doctor via his email he sent me the Emphysema herbal medicine through courier service, when i received this herbal medicine, he gave me step by instructions on how to apply it, when i applied it as instructed i was totally cured of this deadly disease within 12-14 days of usage, if you are suffering of this diseases you can as well Contact this great herbal doctor via his email drlusandaherbal@gmail.com

    ReplyDelete
  6. Emphysema Treatment ought to include, obviously, eliminating exposure to emphysema-bringing about poisons. This includes more than the evasion of tobacco smoke. You ought to look at your everyday life and check for different wellsprings of poisons.

    ReplyDelete
  7. Herbs play an important role in this natural healing strategy. Here are a portion of the best Emphysema Herbal Treatment that are endorsed as a solution for emphysema.

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  8. Thanks for sharing this extremely informative article on best inhaler for asthma. I recently read about some inhaler on website called breathefree.com. I found it extremely helpful.

    ReplyDelete
  9. After having a persistent cough for over a year, I was diagnosed with COPD in March 2015. In 2016 my COPD got worse to the point where not only do I have trouble sleeping at night, I also struggle to get air into my lungs. I read in a health forum of a herbal clinic (NewLife Herbal Clinic) who have successful treatment to COPD/Emphysema, i immediately contacted the herbal clinic via their website and purchased the COPD herbal remedy, I used the remedy for 7 weeks, all my symptoms were reversed, i did another test for confirmation, i was declared COPD free. Visit (www. newlifeherbalclinic. weebly. com) or email (newlifeherbalclinic @ gmail. com)

    ReplyDelete
  10. Nice information on asthma medicines! Every asthma patients and doctors must know about new medications as they come with the new more effective formula.
    asthma treatment

    ReplyDelete
  11. (EMPHYSEMA/COPD SUCCESS TREATMENT: My story)
    I'm from Nebraska USA, I was diagnosed with Emphysema in July of 2009. I may have had it for 6 months to 1 year prior to diagnosis. It started with a dry cough, shortness of breath, and fatigue. A chest x-ray confirmed it and I was placed on corticosteroids. As the disease progressed all medication stopped working, i was introduced to NewLife herbal clinic who have successful herbal treatment to Emphysema and other lungs related diseases. I spoke to few people who used the treatment here in USA and they all gave positive responses, so i immediately purchased the emphysema herbal remedy and commenced usage, i used the herbal supplement for only 7 weeks, all symptoms were reversed, herbs are truly gift from God. contact this herbal clinic via their email (newlifeherbalclinic @ gmail. com or visit www. newlifeherbalclinic. weebly. com)

    ReplyDelete
  12. I am 50 years old and I was told I had COPD 10 years ago. I immediately quit smoking, but as the years pass by my situation gets worse, and I started having attacks once a year, then every six months, and later every 3 to 4 months I was in the hospital. I used to be able to exercise, but it was so hard because i was out of breath. I see people say exercise, but understand this, you can`t exercise if you`re out of breath. I live off steroids and became type 2 diabetic from the steroids, but they`were the only medicine that kept me going. No one knows how you really feel unless they have been through your situation, not even some doctors. When the steroids no longer helps, i was introduced to Health herbal clinic in Johannesburg who have successful herbal treatment to COPD and other lungs diseases. I spoke to few people who used the treatment here in USA and they all gave a positive response, so i immediately purchased the Pulmonary fibrosis herbal remedy and commenced usage, i used the herbal supplement for only 9 weeks, all symptoms gradually faded away, herbs are truly gift from God. contact this herbal clinic via their email healthherbalclinic@gmail.com or visit www.healthherbalclinic.weebly.com

    ReplyDelete
  13. After having a persistent cough for over a year, I was diagnosed with COPD in March 2015. In 2016 my COPD got worse to the point where not only do I have trouble sleeping at night, I also struggle to get air into my lungs. I read in a health forum of a herbal centre (Traditional Herbal Healing Centre) who have successful treatment to COPD/Emphysema, i immediately contacted the herbal centre via their website and purchased the COPD herbal remedy, I used the remedy for 2 weeks, all my symptoms were reversed, i did another test for confirmation, i was declared COPD free. Visit (www.traditionalherbalhealingcentre.webs. com) or email (traditionalherbalhealingcentre@gmail.com) or Call/WhatsApp (+2348110857969)if you want to conform more about it whatsApp me at +1(856)402-1198.....

    ReplyDelete
  14. For the past few years I have had difficulty working out in yard, then in 2015 it got harder and harder to breathe. After many tests, it was a CT scan that showed COPD, emphysema and scarring in my lungs. I quit smoking 8 years ago but the damage has been done. I got to a point I couldn't catch my breath and was coughing so hard I thought the top of my head would blow off, nothing was really working to help my condition. Finally i started on COPD herbal formula i purchased from NewLife Herbal Clinic, i read alot of positive reviews from other patients who used the COPD herbal treatment. I used the herbal remedy for 7 weeks, its effects on COPD is amazing, all my symptoms gradually faded away, i breath very more freely now! (Visit www.newlifeherbalclinic.com ) I recommend this COPD herbal formula for all COPD/Emphysema sufferers

    Megan Flores
    New Jersey, USA.

    ReplyDelete
  15. Am from Canada, I was diagnosed of Emphysema (COPD) in 2013 and I have tried all possible means to get cured, i even visited pulmonologist but all to no avail, until i saw a post in a health forum about a herbal doctor from south Africa who prepare herbal medicine to cure all kind of diseases including Emphysema, at first i doubted if it was real but decided to give it a try, when i contacted this herbal doctor via website which i got an email from him, he sent me the Emphysema herbal medicine through courier service, when i received this herbal medicine, he gave me step by instructions on how to apply it, when i applied it as instructed i was totally cured of this deadly disease within 12-14 days of usage, if you are suffering of this diseases also he cure 1. Diarrheal Diseases,2. HERPES 1/2,3. CANCER,4. ALS (Lou Gehrig’s disease),5. Herpatitis B,6.chronic pancreatitis,7.Emphysema,8.COPD (Chronic Obstructive Pulmonary Disease),9.asthma,10.Acute angle-closure Glaucoma,11.CHRONIC PANCREATITIS.you can as well Contact this great herbal doctor via his
    email abumereherbalcentre@gmail.com
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  16. My father has COPD and ALS,diagnosed 2 years ago,His speech is bad not able to talk and experience shortness of breath,i spent a lot of money on his medication till a point i was so frustrated,My friend David ossy told me about Perfecthealthherbalmedicinehome, who cured his parents of Hepatitis b,Herpes,Copd and Als. I contacted this herbal home and purchase the herbal medicine, then they sent me the herbal medicine through courier service, when i received it my father applied it for 8 weeks as prescribed and was totally cured of COPD and ALS within 8 Weeks of usage. Contact Perfecthealthherbalmedicinehome via:
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    ReplyDelete
  17. I am 50 years old and I was told I had COPD 10 years ago. I immediately quit smoking, but as the years pass by my situation gets worse, and I started having attacks once a year, then every six months, and later every 3 to 4 months I was in the hospital. I used to be able to exercise, but it was so hard because i was out of breath. I see people say exercise, but understand this, you can`t exercise if you`re out of breath. I live off steroids and became type 2 diabetic from the steroids, but they`were the only medicine that kept me going. No one knows how you really feel unless they have been through your situation, not even some doctors. When the steroids no longer helps, i was introduced to Health herbal clinic in Johannesburg who have successful herbal treatment to COPD and other lungs diseases. I spoke to few people who used the treatment here in USA and they all gave a positive response, so i immediately purchased the COPD herbal remedy and commenced usage, i used the herbal supplement for only 7 weeks, all symptoms gradually faded away, herbs are truly gift from God. contact this herbal clinic via their email healthherbalclinic @ gmail. com or visit www. healthherbalclinic. weebly. com

    ReplyDelete
  18. I had Chronic Obstructive Pulmonary Disease (COPD) for 7 years, My first symptoms were dry cough, chest tightness and shortness of breath. This was ongoing for 3 years, my first chest x-ray only showed bronchitis. Finally I went to a pulmonologist and was diagnosed with COPD, I was immediately placed on Seebri Breezhaler, it's an inhalation powder, I take it once a day in the morning. Finally, i started on COPD Herbal Formula i ordered from NewLife Herbal Clinic, the herbal formula worked 10x better than all the medications my pulmonologist had prescribed. I have had a total decline of symptoms since i started on this herbal formula, visit ww w .newlifeherbalclinic .com

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  19. This comment has been removed by the author.

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  20. I was told I had emphysema in 1987 when I was 45 years old. I smoked for 30 years, but quit smoking as soon as I was told that I had COPD. Quitting smoking was the hardest thing I ever did. But I knew I would die if I didn't. My health was getting so bad that I needed oxygen 24/7 and was down to 92lbs. Thankfully, in 1999 I got lung volume reduction surgery. It saved my life. I no longer needed oxygen and was able to climb stairs, dance, and travel the world. That good fortune lasted for almost 13 years. I am now back on oxygen 24/7 and can't climb stairs, dance or travel the world. i searched for alternative treatment Online i was introduced to Health herbal clinic by a friend here in the United states she told me they have successful herbal treatment to Emphysema and other lungs diseases. I spoke to few people who used the treatment here in USA and they all gave a positive response, so i immediately purchased the COPD herbal formula and commenced usage, its totally unexplainable how all the symptoms totally dissapeared, my cough was gone and i no longer experience shortness of breath(dyspnea), contact this herbal clinic via their email Info@ healthherbalclinic. net Or website www. healthherbalclinic. net Herbs are truely gift from God

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  21. After having a persistent cough for over a year, I was diagnosed with COPD in March 2015. In 2016 my COPD got worse to the point where not only do I have trouble sleeping at night, I also struggle to get air into my lungs. I read in a health forum of a herbal clinic in march 19th 2017 about (General Herbal Health Center) who have successful treatment to COPD/Emphysema, i immediately contacted the herbal clinic via their website and purchased the COPD herbal remedy, I used the remedy for 6 weeks, all my symptoms were reversed, i did another test for confirmation, i was declared COPD free.Contact via:
    email:(generalhealthcenter1@gmail.com)

    Website for more info: http://generalhealthherbalcental.simplesite.com

    Phone number: +27719591654

    ReplyDelete