ABC Health Insider

As an asthmatic since my late 30's, I used a rescue inhaler composed of albuterol sulfate. Then, as our air quality degenerated badly, I use 3 nebulizer delivered treatments daily of albuterol sulfate/ipratropium bromide, supplemented with one AM and one PM "puff" of an Advair discus. I do well. However, twice, I would have lost the battle without my rescue inhaler. My cousin, age 29, did not find hers in time. It had fallen from her pocket earlier. I hear the pharmacies are not going to file Medicare claims for inhaler use patients in 2009? Is this true? Truthfully, we all think Social security disablity, Medicare, and the Drug Giants who really rule the FDA and the doctors WANT to kill off all the COPD patients they can.

After being prescribed Advair for a year, and after repeated bouts of pneumonia and bronchitis, I very gradually weaned myself off of it. -- I stopped the yo-yo games with lung infections, and have finally been feeling much better for the past two years. -- A young doctor recently told me that he might want me to start on the Advair again. -- He got angry with me when I said NO. -- I am beginning to wonder if our medical people really have our best interests at heart. -- Perhaps our medical paradigm needs revamping, entirely! -- Retain your MEDICAL RIGHTS, folks. -- Careful, because there are people trying to take them away from you. -- There is real danger here.

We are talking about a couple different types of medication here, folks. Serevent and Foradil are both long-acting bronchodilators (LABAs); they improve lung function for several hours instead of providing immediate or "rescue" relief. This type of drug is the 3rd line of defense in the war against asthma. Your rescue medication (albuterol or levalbuterol) is first line and if you need that more than once a week your doctor SHOULD be going to an inhaled steroid as the second line of defense. Inhaled steroids can be low, medium, or high dose and their job is to keep your upper respiratory system from overreacting to any and every stimulus. *Note-steroids do supress immune response (that's how they help you). If you are suffering from infections, make sure you have tried the lowest dose available before you quit completely. I have been on Advair and I couldn't handle the shakes and needing to eat 6x/day, so I wasn't on it long enough to have any other complications, but that is an example of combination steroid and LABA therapy.* If you are still overusing your rescue inhaler (uncontrolled) with an inhaled steroid, NAEPP guidelines recommend the addition of a long-acting bronchodilator. Many doctors skip the second step and go straight to this third-line combination therapy. That is why so many doctors and drug companies are emphasizing that these drugs are safe and even life-saving "when used appropriately." There is no need to be on a long-acting bronchodilator if your asthma is controlled with an inhaled steroid.
Ipratropium bromide works differently from both the above drug classes. Think of it as a slower bronchodilator that relaxes those muscles that contract when you panic. It should definitely be considered as an alternative for those whose immune systems are too weak for steroids, but does not work better or necessarily as well.
I believe what you're hearing about Medicare not covering rescue inhaler claims has to do with the changeover from CFC propellant inhalers to HFA propellant inhalers. Don't worry. Your rescue inhaler will still be covered. It will just be one of the "branded" HFA ones, like Xopenex HFA or Proventil HFA, instead of your generic albuterol CFC.

I was diagnosed with activity induced asthma at the age of 13. My meds for that really stopped working by the time I was 16, but since I was otherwise healthy, I never complained. It wasn't until college, when I began having frequent, unprovoked asthma attacks that I sought to rework my medical plan for caring for my asthma. I was put on an inhaled LABA and pill steriods. This combo never worked for me- my rescue inhaler wasnt even working well enough. I finally reached the point where I was spending whole days in a low grade asthma attack. It was impossible for me to draw a deep breath. That was when my doctors chose to try Symbicort. I use one puff, twice daily, and it has given me my life back. I breathe well for the first time in years. I haven't had an attack now in 4 months. I am glad to see the FDA did not recommend the removal of Symbicort for asthma sufferers. It is only one of numerous helth issues I have, and changing one of my meds can have an effect on how they all work.

nice article