Posted on 05/27/2024 6:43:38 PM PDT by ConservativeMind
Only 14.5% of adult patients with moderate or severe asthma are prescribed the recommended SMART combination inhaler regimen and over 40% of academic pulmonary and allergy clinicians have not adopted this optimal therapy, according to research.
By 2021, both the National Asthma Education and Prevention Program and Global Initiative for Asthma had updated their guidelines to recommend the use of a single combination corticosteroid (ICS) and formoterol (a long acting beta agonist) inhaler for both Maintenance And Relief Therapy for moderate to severe asthma, or SMART.
In the United States, ICS-formoterol inhalers include Symbicort (budesonide-formoterol) and Dulera (mometasone-formoterol). Under the SMART guidelines, these inhalers are used as both maintenance, twice every day, and rescue inhalers, used during asthma attacks.
SMART has been shown to significantly reduce asthma exacerbations. Previous guidelines recommended the use of maintenance inhalers such as those that combine ICS and a long-acting beta agonist (LABA), generally used twice a day, in addition to short-acting rescue inhalers (bronchodilators such as albuterol).
"Our findings suggest current asthma management guidelines are not being routinely implemented or adopted by clinicians," added Sandra Zaeh, MD MS.
The team reviewed these charts to ensure patients met eligibility criteria. SMART prescription was also examined by looking at provider documentation. Statistical techniques were used to analyze the relationship between patient characteristics and SMART prescriptions.
A total of 2,016 patients were included in the final updated analysis; 87% of patients prescribed SMART were also prescribed a rescue inhaler such as albuterol, even though inhalers used for SMART are intended to be used for rescue therapy.
(Excerpt) Read more at medicalxpress.com ...
That’s what I use now.
I could probably use it, if it were not powder. I have never had any success with any of the powder inhalers.
I have seen drastic price reductions in the "list" price for Fluticasone-Salmeterol and Albuterol formulations. And with some of those pharmacy discount cards these medications can be quite inexpensive. They are also quite effective.
Montelukast is somewhat effective as a preventative measure, for those who can tolerate the side-effects. The tablets are inexpensive.
And Primatine tablets or inhalers are still available OTC for a low-end solution. They can actually be more expensive than the Albuterol inhalers and are not well-suited to patients with high blood pressure. They are reasonably effective.
All of the prescription medications can be obtained at more reasonable prices from "Canadian" (Indian) pharmacies.
I’d pay cash money for a good old-fashioned CFC infused inhaler that doesn’t clog up when I need it. Thanks Obama.
Lots of things said in this article, but bottom line, it appears they’re just telling us asthmatics to take Symbicort and nothing else? Looks like they want it to be used as a matter of treatment, as well as a rescue inhaler.
(I have tried taking myself off of different asthma medications at times, while continuing on with Symbicort. In my case, I definitely need theophyllene, zafirlukast and even Nucala injections.).
GoodRX shows me 120 doses of Symbacort for $118.
I don't really understand pharmacy pricing. I have purchased Albuterol inhalers at prices from $70 per unit to as low as $8 per unit from the same local pharmacy. The price is never the same on a subsequent refill.
I ask for 90-to-120-day supplies on such medications. Sometimes the pharmacy fills that qty. Other times they are "out of stock" and can only fill a 60-day qty. There seems to be an allocation system and intermittent shortages of asthma medications.
When using the discount cards, it seems to be important to ask for the discount. I had a prescription for an antibiotic that was quoted at $1,200 for the qty. I thought that could not be right, as I had purchased that medication some time previously. When I asked for a price check, the quote went to $75 for the qty - which is what I had paid the last time.
"Oops!", they said. "Some kind of computer problem".
So, no albuterol or iprat?
My son has mild to moderate asthma, and when he got Covid in 2020 it was scary bad. He got Covid a second time and that time started the regime of vitamins and Ivermectin. I don’t know it that helped or he just had a milder strain. He did seem to think that the protocol helped with his asthma. IIRC I did a bit of research where studies showed that Ivermectin may be effective against asthma.
My doctor brought it up recently as I have allergy driven asthma and pollen season in Atlanta is apocalyptic. But I don’t want to go on a 2 drug inhaler. Most of the time the Arnuity Ellipse inhaler works fine with albuterol rescue inhaler as a backup. I agreed to go back on Montelukast for a few months. It works well as long as you don’t mind walking around with anxiety and you can’t remember your sister’s name. 😆
I found the psychological effects of Montelukast wore off after about two weeks of usage, and I was somewhat resistant to them anyway. But they are quite real. I had colleagues who absolutely could not tolerate the side effects.
I was astonished to find that my doctors were unaware of any such adverse reactions.
For those who are not affected by the side effects, this drug is a pretty good anti-allergy remedy and does reduce the number and severity of asthma incidents. And it is inexpensive. It is not suitable for everybody.
I was recently diagnosed with asthma, again, due to the aforementioned Covid/Long Covid, and my regular doctor prescribed me with a Budesonide and Formoterol Fumarate Dihydrate inhaler, twice daily, then also with a Albuterol Sulfate inhaler in case I need more help during the day. My pulmonologist also gave me prescriptions for Prednizone and Doxycycline as a "just in case" measure for times when the asthma really flares up.
So I got all kinds of drugs now. Yay me!
You can still get such items from an India pharmacy. The problem is that you will lose about 50% of your orders due to customs impoundments.
And the India pharmacies all want direct access to your bank account to collect payments.
No need to thank Obama for this. The pharmaceutical companies arranged the newer formulations so they could patent them and keep the prices higher. It was all part of protecting us from "Climate Change"(tm) or something.
I’m the first to say that Monthly last really works great. But the first time I took it about 2 months in I started having anxiety for no apparent reason and then I couldn’t think of words. So finally I got the idea to look up the side effects of Monthly last and then I quit taking it.
This time around I’m only taking half a dose and no anxiety but the cognitive stuff started up right away. The other day I could not think of the words misdemeanor and felony. I’m only staying on it another month or so.
Looks like a pretty decent collection. Did you stock up on all of the items?
Yes and No. My primary physician ordered the inhalers, 5 of each, then the pulmonologist ordered the Doxycycline and Prednisone, as well as extra inhalers. So I got enough of each to last me for a while, but I didn’t overtly stock up, they just gave them to me!
I was put on “Spiriva” the damn powder, some assembly required.
The one time I paid full price was US$397.xx at Walmart.
I now get my Symbicort (budesonide-formoterol) from InHousePharmacy.vu (Vanatu is kinda near Australia)
Same contents but branded as Foracort.
Symbicort(and Foracort) comes “pre-assembled” no messing with powder!
I spend about US$1.10 per day (US$0.27 per puff).
I pay by check via bill pay at my bank.
4-6 weeks after they get funds package arrives.
The reason I am waxing Filo about that vendor is that you can try it before you change over and have some extra.
Most important IT_WORKS_FOR_ME_!!! :-)
My perscription does not allow for any extra puffs for rescue.
The doc,insurers, etc. squeeze more $$$ for a phone call when you run short.
It’s easier than going to the pharmacy but it does take planning ahead and clicking on your bank website to pay.
YMMV
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