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From the Editor: The ongoing issue of asthma

August 1, 2009


After an article I wrote in December, on the FDA advisory panel’s recommendation to recall popular asthma drugs Serevent and Foradil,

Photo by Vitaly Nikolaev

Photo by Vitaly Nikolaev

asthma and concerns about inhalers have become one of the most frequently used search terms that bring web surfers to The Talking Twenties.  This made me think that the issue of asthma, which affects more and more children each year in the U.S. (and plenty of adults like me), deserved another look, especially at this transitional moment.

Now that Fall and back-to-school time is approaching, asthma patients have a lot of concerns coming their way.  Seriously, we’re getting a raw deal here.  Not only is the dreaded season of autumn coming (it’s no fun for allergies with all those molding leaves and the like), but the news has been running report after report on the potential return of a strengthened swine flu once school starts and how we don’t need to be overly concerned—except for people with underlying respiratory conditions such as asthma.

“Mostly what you’ve read is about hype and fear,” says a reassuring Daniel More, M.D., on  “Swine flu, just like the ‘standard’ flu, can significantly worsen asthma symptoms in people with asthma.”

H1N1 requires the same level of concern the “standard” flu does, which includes getting vaccinated.  In fact, MSNBC recently announced on the Nightly News that the CDC has determined respiratory patients, along with pregnant women and healthcare workers, should be on the list of who will get the limited number of swine flu vaccines this Fall (should the vaccines prove effective and safe, of course).

Still worried?  The American Academy of Allergy, Asthma and Immunology, according to, says the following:

“While people with asthma or other chronic lung conditions are at a higher risk for developing complications from influenza, it is important to be attentive to the presence of symptoms but not to panic. Catching the symptoms early is key because the antiviral drugs used to combat swine flu are most effective if started as soon as possible, and might not work if administered more than 48 hours after becoming ill.”  Tamiflu, remember, still works on the H1N1 strain we’ve dealt with so far.

Well, phew, that’s (mostly) out of the way.  But what about standard asthma woes?  Some searches that have brought visitors to The Talking Twenties Blogzine include phrases like “can’t tolerate Symbicort.”  If I could add my own to that, it would be “can’t tolerate albuterol.”

Albuterol, a common component of (especially fast-acting, or “emergency”) inhalers, is famous for giving users the shakes.  Or, like the one I tried in junior high (amazing!  I ran across an entire school gym and back and wasn’t out of breath!), they can turn your limbs into mush (I also collapsed onto the floor every time I stopped running and lost the ability to concentrate.  Not so amazing).

When it comes to the fast-acting category, what does work for me, and a lot of other asthma and COPD patients, is Xopenex, a nebulizer drug that became available as an inhaler only within the last few years.  Too bad CVS Caremark announced that the expensive inhaler was taken off their Performance Drug List on July 1st!

Even my pulmonologist’s office has been forced to stop ordering Xopenex in nebulizer form because of cost, and the plight of poor, pricey Xopenex is sad news for respiratory patients across the board.  A member of’s COPD & Emphysema Support Group (full of people with similar complaints about albuterol) wrote in April that “I’m on Medicare, and found that none of the suppliers in my city are supplying Xopenex any more. Hope you get to try it. I did notice a difference.”

As I said in my previous article on inhaler recalls, it really is more of the same.  If it’s not an issue of safety with pharmaceutical companies and the FDA, it’s about pharmaceutical and insurance companies keeping their bottom line green.  It’s just a shame that their green line has to trip up so many respiratory patients in the process.

I’ll be following up this article with an “Advice on…” regarding managing asthma later this month.  Till then, enjoy the humid days of summer, and stay healthy!

— keito, The Editor
August 1, 2009


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