Steroid inhalers pregnancy

SOURCES:
American Academy of Asthma, Allergy & Immunology: "Asthma" and "Allergy and Asthma Drug Guide."
National Jewish Medical and Research Center: "Inhaled Medication with a Metered Dose Inhaler (MDI)." 
Asthma Society of Canada: "How to Use Your Inhaler."
Science Daily: "New Asthma Inhaler Propellant Effective, but Costlier."
Children's Hospital Boston: "Allergy Treatment."
Boehringer Ingelheim: "US FDA Expands Approval of Tiotropium Respimat® for Maintenance Treatment of Asthma in Children."
FDA. Prescribing Information: Spiriva Respimat.

There is inadequate evidence of safety in human pregnancy. Administration of corticosteroids to pregnant animals can cause abnormalities of foetal development including cleft palate and intra-uterine growth retardation. There may therefore, be a risk of such effects in the human foetus. It should be noted, however, that the foetal changes in animals occur after relatively high systemic exposure. Beclometasone dipropionate is delivered directly to the lungs by the inhaled route and so avoids the high level of exposure that occurs when corticosteroids are given by systemic routes.

5. Thinking a written prescription for a COPD inhaler means the patient knows when to use it: The drug's purpose. For treatment purposes all inhalers for COPD & asthma fall into one of two broad categories:

a) to provide quick relief ('rescue inhalers') and
b) to improve chronic symptoms and prevent flareups ('maintenance inhalers'). Examples of rescue inhalers are albuterol (brand names Proventil HFA, ProAir HFA, Ventolin HFA) and ipratropium bromide (brand name Atrovent). Combivent contains a combination of albuterol and ipratropium bromide. Maintenance inhalers include any inhaled steroid (IS), either alone (brand names Azmacort, Qvar, Pulmicort, etc.) or in combination with a 'long acting bronchodilator' (LABD; brand names Symbicort, Advair). PROBLEM: The SAME type of delivery device (size, shape, mechanism of action) is commonly used for both rescue and maintenance inhalers. For example, as shown below, ProAir HFA (a rescue inhaler, on left) and Symbicort (a maintenance inhaler, on right) both come packaged as pressurized metered dose inhalers, and both are deep red in color. There is nothing intuitive about this. For a patient who may have both inhalers (quite common), and who becomes short of breath, it is all too easy to forget which is which.

A neb treatment has 2500 mcg of Albuterol, while two puffs of an MDI is 200 mcg of the same medicine. The increase in heart rate often noted with the neb reflects the higher dose. So how do we explain the often reported similar subjective and lung response in patients regardless of delivery method ? I’m not sure, but I wonder if the neb dose could be lowered without sacrificing response for those instances where the MDI is effective. Or approach nebs like we do with an MDI: start with 500 – 1000 mcg, and if desired take a second treatment.

Steroid inhalers pregnancy

steroid inhalers pregnancy

A neb treatment has 2500 mcg of Albuterol, while two puffs of an MDI is 200 mcg of the same medicine. The increase in heart rate often noted with the neb reflects the higher dose. So how do we explain the often reported similar subjective and lung response in patients regardless of delivery method ? I’m not sure, but I wonder if the neb dose could be lowered without sacrificing response for those instances where the MDI is effective. Or approach nebs like we do with an MDI: start with 500 – 1000 mcg, and if desired take a second treatment.

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