FORADIL (formoterol) The FDA ruled against this drug and others which are similarly advertised as stand alone, long acting bronchodilators. The FDA says they will have to amend labeling to reflect the unsafe nature of this regime. All patients requiring LABA also require inhaled steroid coverage. More combo drugs will follow this ruling.
SALMETEROL (Serevent) Approved by the FDA in 1994. No tachyphylaxis after years of use (Larsson,1991) (Booth, 1993)
PIRBUTEROL (Maxair) has a small additional benefit in improving cardiac ejection (Awan, 1981) (SHARMA, 1981) (Dawson, 1981) (Clolucci, 1981) However, if the patient is taking MAO inhibitors extreme headaches are not uncommon. Hypertensive crisis is improbable, but not unheard of. For these reasons, this drug is not administered frequently.
FLUTICASONE (Flowvent) Twice the affinity for targeted sites over beclomethasone. Significantly less effect on long bone growth over beclomethasone.
TILADE (nedocromyl) 25% improvement over Intal but the taste is so horrible and long lasting that it has fallen out of favor.
THEODUR (theophylline) a xanthine with similar effects to coffee. In slow release formulas it is better tolerated, improving diaphragmic muscular ability from 15 – 20% (Hendles, 1995) Further, a blood level range of 5-15 instead of 20 has a majority effect with minority side effects. Be advised. Levels can be increased with calcium channel blockers, steroids, and E-mycin.
MUCOMYST (acetylcystine) Used for Tylenol OD, of course, but it also has cellular protective mechanisms. A POWERFUL free radical scavenger, it improves the production of human glutathione which slows aging. (Henderson-Hayes, 1994) (Bakker, 1994) (Dinarello, 1993) (Greech,1993) (Ferrari, 1990) Also, there is evidence that it can prevent renal damage due to cardiac cath dyes. Further, this med is often given pre and post op in heart surgeries.
AURANOFIN a gold preparation lessens steroid dependance-interferening with leaukotriene mediation. (Nierop, 1992) found 6mg a day reduced somewhat steroid requirments in 32 patients.
ISUPREL (isoproterenol) catacholamine. Sledge hammer bronchodilator. Instant. Its cardiac effects have similar prowess. Interest for clinicians to note, it causes a shunt. Increases pulmonary flow flow far more than it increases bronchodilitation. This effect is not marginal.
These factoids are of moderate practical clinical use in and of themselves, though LUNGLORD has carrried them for decades with only rare places to use them in the ICU or ER.
Tilade use in the youngster is waste of money. In LUNGLORD’S view, it is more likely to get a child to put several old pennies in their mouth and suck on them for twenty minutes daily than to get a compliant use of Tilade. Product should be dispensed with a Binaca co-spray, like that two part, foaming action Drano. Maybe Drano’s brand name could be used on a new mucolytic?
As for chugging a forty cc oral dose of Mucomyst for cellular protection–this is the rough equivalent of drinking a glass of raw, rotten eggs with a big splash of vodka stirred in.
Isuprel (isoproterenol) is an old drug. In the 1960’s, the Ben Casey outcomes were two: extreme tachycarida and SVT if you did treat their asthma and vaporlock if you didn’t. The big “I” was replaced by a much safer little “i” isoetharine. Marketed by Breon as Bronkosol, it was already in therapeutic dose decay by the time one started charting at the end of the therapy. It was the first dual drug combo with 1% phenylephrine in it, a vasopressor, which combated asthma mediatated airway edema. In this regard it was very effective. Lunglord rues the day this drug approach was discarded for acute treatment and still uses it, with MD approval, for status asthmaticus, provided their heart rate is not already excessive. Bronkosol was replaced by Alupent, which lasted 3 hours, woohoo, but was not the answer and was replaced by even longer lasting albuterol giving 4-6 hours of duration- in the mid 1980’s. It is now undergoing obsolescence because of levoalbuterol, an eight hour duration drug.
LUNGLORD regrets to inform his dear readers, he is this old.
With Isuprel, heart rates had to be monitored more closely than a top fuel dragster’s rpms, with similar rates of acceleration. Some people however, liked the buzz with a Valium chaser. The “synovial shakes” coined by LUNGLORD in his youth was evidence of the presence of an adequate dose, akin to blue gingiva (pre CPO) giving clinical evidence of hypoxia. LUNGLORD actually took a 1.0cc dose with 3.0cc NS (a double dose) via IPPB PR-2 full nebulizer spray. This cowboy action was to self medicate a severe bout of bronchitis in 1975.
LUNGLORD could actually feel his aortic arch flex and deform its shape with each beat at peak, riding in fright the pulsatile wave, this while amphetamine like panic rushes overwhelmed and vibrated his world for twenty minutes. Muscular twitches. HR increased from 72 to 120 in perhaps three minutes. Think ten cups of coffee. This drug is the equivalent of starter fluid sprayed in the carburetor. It may work, but sooner or later some vital portion of the valvetrain— probably a bicuspid—is going to be ejected through the chest wall.. er… hood of the vehicle. This is LUNGLORD’s last experience with this drug and when he sees it hanging at a patient’s bedside he always discusses its shunt effect with the nurse. However, this is now rarely used.
If the reader likes this content/format/perspective/style they may be well entertained by LUNGLORD’s first of six novels available on this site starting NOVEMBER 1st, 2011. The reading is less concentrated than this–made for both the clinician and for the non medical reader. But, these ideas are examples of the small moons circling planets that travel in orbit around the central plot.