Forest Pays Almirall $75M Up Front as Part of Second Respiratory Therapies Agreement

Forest Laboratories is paying Almirall $75 million up front as part of a U.S. development, marketing, and distribution agreement for the latter’s once-daily, long-acting beta2 agonist, LAS10097. The deal covers development of LAS100977 in combination with an undisclosed corticosteroid for the treatment of both asthma and chronic obstructive pulmonary disease (COPD), using Almirall’s Genuair® inhaler. LAS10097 has already completed Phase IIa trials in asthma patients.

Under terms of the deal, Forest will be responsible for U.S. regulatory approval and commercialization of the LAS100977-based therapy. Almirall will receive milestone payments and sales-based royalties on top of the up-front fee.

The deal represents the second major respiratory therapies collaboration between the companies. In April 2006 Almirall and Forest signed a $60 million up front deal to develop, market, and distribute Almirall’s inhaled, long-acting muscarinic antagonist, aclidinium bromide, in the U.S. The drug is an anticholinergic bronchodilator, selective M3 muscarinic antagonist for the treatment of COPD.

The companies had originally anticipated filing an NDA in the fourth quarter of 2009 or the first quarter of 2010. However, in March 2009 the companies announced that after consultation with FDA, additional clinical studies with aclidinium bromide will need to be conducted to provide further support for the selected regimens, including higher and/or more frequent doses. EU filing of aclidinium bromide by Almirall is currently projected for 2011.

Commenting on the deal, Howard Solomon, chairman and CEO at Forest, said, “with the addition of LAS100977, Forest rounds out a broad COPD pipeline that was recently augmented with Daxas® (roflumilast) and will also gain access to the larger asthma market with a once-daily inhaled corticosteroid/LABA combination.”

P.S. Boost your natural immunity against Asthma by eating Vitamin C and Vitamin D rich foods and fruits.

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Treatment of childhood asthma

MBBS(Ceylon), DCH(Ceylon), DCH(England), MD(Paediatrics), FRCP(Edinburgh), FRCP(London), FRCPCH(United Kingdom), FSLCPaed, FCCP, FCGP(Sri Lanka) Consultant Paediatrician

Asthma is an inflammatory disorder of the airways characterised by narrowing of the air tubes brought on by swelling of the lining of the airway, contraction of the muscles of the airways and increased secretion of mucus or "phlegm". In the case of children, asthma is such a variable disorder that there are many considerations that need to be gauged when one looks at the treatment options that could be used. There is a very wide spectrum of clinical presentation of asthma ranging from mild infrequent attacks through moderately severe and frequent episodes to acute severe life-threatening events. Careful assessment is essential before tangible decisions are made regarding further management and the use of certain medications.

One component of treatment is the management of an acute attack. There are several drugs which are so very useful in controlling an acute episode but judicious decisions have to be made regarding their use. Initial assessment of the severity of the attack is the determining factor for the selection of drugs. This initial evaluation is used to classify the episode as a mild attack, a moderately severe attack or an acute severe attack. The last could be so severe that the presence of certain features would further categorise it as a life-threatening attack. This is a harbinger of death and urgent intensive treatment is absolutely essential to save life. All these assessments need to be done by an experienced doctor using features of the history of the illness, its progression, past history and the findings on clinical examination.

The first requirement for a moderately severe or an acute severe attack is the provision of added oxygen through either a mask or through nasal prongs. The airway narrowing leads to marked interference with ventilation of the lungs that the necessary amounts of life-giving oxygen are not allowed to be provided to the blood and thereby to the tissues of the body. The only initial solution to this problem, at least till one could take steps to correct the narrowing of the airways is to provide an additional increased amount of oxygen into the lungs. Parents often get frightened by medical staff starting a child on oxygen but it is more or less a precautionary measure. Most people believe that added oxygen is given only to a dying patient. This is not true and there are several other instances where added oxygen may be used. Steps must be taken to explain this to the parents or care-givers, allay their anxiety and provide reassurance.

Then there are the drugs that are so useful to treat the acute episode and relieve the airway narrowing. Their action is centred around dilatation of the narrowed airways. These drugs are therefore known by the collective term "relievers". There are several different groups of medications that fall into this category. Some of them need to be given by inhalation, either by using a nebuliser or via a spacer device attached to a metered dose inhaler which is commonly known by the name of "puffer". The advantage of these methods is that only tiny doses need to be used as the drug is directly provided to the lung where its primary effect is required. Some of these drugs could also be given by mouth but then much larger doses need to be used. The oral use is generally employed only for very mild attacks. Many people also believe that these children who are once nebulised will always need nebulisation. This too is not true and there is no scientific basis for this belief. Nebulisation and other forms of inhalation therapy is used for the moderately severe and severe attacks as it is so very effective and the observable clinical effect comes on within minutes. The other advantage is that inhalation therapy could be repeated at very frequent intervals as and when necessary. The general side effects that are seen when the same drug is given by mouth are generally not seen as frequently with inhalation therapy. Inhaled therapy is quite safe in the acute phase of the attack and this is so even when the procedure has to be repeated at frequent intervals. It certainly has no adverse effects on the heart.

There are other reliever drugs that are used through the intravenous route. These are generally used when inhaled therapy fails to control the acute attack. Some of these drugs, just like those used for inhalation therapy, act quite quickly but prolonged treatment in the form of intravenous infusions may be necessary to maintain the achieved dilatation of the airways. There are several drugs that fall into this category and some newer drugs are being increasingly used. All these drugs work by different mechanisms of action, the effects are generally complementary when more than one drug needs to be used and the end results are quite good. It is however imperative that proper doses are used to obtain the best effect.

In markedly severe cases, drugs belonging to the corticosteroid group may need to be used. However, it must be remembered that these medicines take about 4 to 6 hours to produce optimal effect. They could be given orally or through the intravenous route. In severe cases, the latter route of administration is preferred. They act by suppressing the inflammatory response of the airways and this process necessarily takes time. Steroids may need to be continued for up to a week in certain instances. Such short courses of steroids are safe and do not have long-lasting undesirable side effects on the child.

In most acute episodes, ancillary treatment measures are also quite important. If the child is hospitalised, good nursing, attention to good quality nutrition and adequate hydration are essential. The latter is of marked significance as rapid breathing induced by the attack leads to a loss of water from the body via exhaled breath. If it is not possible for the child to drink because of the severity of the episode of asthma, replenishment of the fluid losses should be by the intravenous route. In the case of suspected bacterial infections precipitating the acute attack of asthma, it may be necessary to use antibiotics but it must be stressed that this is perhaps uncommon and the use of antibiotics is certainly not a panacea for all ills in asthma.

Once the acute episode has been brought under control, it is time to assess the need for further long-term treatment. There are several drugs available today which, when used prudently, help to prevent recurrences of asthma. These drugs are therefore known as "preventers". However, these decisions are not to be made lightly as preventive treatment is a protracted form of therapy and needs to be continued for quite some time. There are certain features that suggest that the child may benefit from these forms of treatment. Children with what is known as persistent asthma with some degree of airway narrowing virtually every day, those who get very frequent attacks that interfere with normal life, children with acquired chest deformities as a result of asthma, those with marked exercise induced asthma, those who have growth retardation as a result of asthma, those who have significant disturbance of schooling as a result of asthma, those who are prone to get acute severe episodes of asthma and those who suffer from troublesome nocturnal asthma and persistent night cough that interferes with sleep are the ones in whom preventive therapy may be considered. In addition, those who have poor access to medical care, especially at night too, may be considered for primarily social reasons. The rationale for this is that severe attacks at night may cause a lot of problems and perhaps may even cause death.

There are some oral drugs that may be used for preventive therapy but these are effective only in some cases and are not quite useful in severe forms of the disease. However, some of them may be quite useful in combinations with other forms of preventive therapy, especially in severe and difficult to control cases. In today’s context, the "gold standard" for preventive therapy is the use of inhaled corticosteroids. Only very small doses of these steroids need to be used as the drug is delivered directly to the lungs and as such general effects on the rest of the body are not of any significant consequence. In the recommended doses, even long-term treatment with inhaled corticosteroids is safe. The effectiveness of these drugs depends on their anti-inflammatory action as it counteracts the very basic disturbance in childhood asthma which is inflammation of the airways. All preventive medications have to be given even when the child is quite well as they work purely for prevention and most of them are not useful during acute attacks.

There are several different formulations of inhaled corticosteroids and different inhaler devises that could be used in children. There are some dry powder inhalers that could be usefully employed in older children. The child has to inhale the very fine powder into the lungs. However, the most useful form if inhaler in children is the metered dose inhaler or "puffer". When each dose is actuated, a jet of gas containing the effective dose of the drug is ejected. The only problem is that the speed of ejection is very high, around 70 miles per hour and most children, and for that matter, even adults, find it impossible to synchronise their intake of the breath with the actuation of the device to ensure that the drug is inhaled properly. To get over this problem a holding chamber or "spacer" needs to be used. This device is connected to the puffd the child breathes in and out normally at the other end of the spacer after the puffer is actuated and the dose of medicine is put into the spacer. One-way valve systems ensure that the breaths that are put out do not get into the spacer. In the case of children, they need to be trained under direct medical supervision on the proper technique of the use of all these devices. The parents too must observe and learn all necessary details of these forms of treatment. All inhalers have a finite number of doses and it is useful to write down the date of starting a fresh inhaler on the inhaler device label itself so that a new inhaler could be purchased when all the contained doses have been used up. Many parents wait till the inhaler device completely finishes and is no longer able to eject, before purchasing a new one. This is a mistake as, beyond the total number of doses that are specified in the device, there is only the propellant gas that is emitted. The active drug is available only for the total specified number of ejections.

Whatever the device, it is best to rinse the mouth with water and throw out this water each time inhaled steroids are used. This is to ensure that some of the drug that is deposited in the mouth is not swallowed. All spacer devices need cleaning from time to time and there are special ways in which these need to be cleaned. Vigorous rubbing of the inside of the spacers should be avoided as this interferes with the normal working of the device. Proper advice regarding the use of all inhaler devices should be given by the prescribing doctor and time taken to explain the different aspects of inhalation therapy is time well spent to guarantee proper utilisation of the drug and ensuring optimal effectiveness of these forms of treatment.

Preventive therapy has to be carried out under medical supervision. These children need regular assessment by the prescribing doctors from time to time. The dosage may be reduced by the doctor once control of the disease has been obtained and the child remains well for a reasonable period of time. The dosages may also need to be increased to deal with special situations and when the disease appears to be getting out of control. These are not drugs that could be continued by the parents without regular medical direction. Haphazard changes in dosage, keeping off doses from time to time and abrupt stoppage of treatment should be scrupulously avoided. It must be remembered that the disease is being kept under control by these drugs and the child may develop an unprotected acute severe attack if the drugs are suddenly withdrawn. There is no truth whatsoever in the commonly held belief that patients tend to get addicted to these inhalers. These drugs are used simply because the asthmatic state is of considerable concern which requires their use and there is no risk of addiction to them.

P.S. Boost your immunity against asthma by eating Vitamin C and Vitamin D rich foods and fruits.

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Smoke a testing time for asthmatics

THE National Asthma Council Australia is urging people with asthma in bush fire zones, or those planning summer holidays in the country, to ensure they have considered their asthma as part of their total summer survival plan.

“People with asthma are at particular risk from bush fire smoke, especially the very young and older people,” National Asthma Council Australia Director,Associate Professor Peter Wark.

“The best protection, where possible, is avoiding exposure to high levels of smoke and ensuring your asthma is well controlled from day-to-day.

“This means seeing your doctor to make sure you have an appropriate written asthma action plan to help you manage your asthma over summer as well as making sure you regularly take your preventer puffer,” Professor Wark said.

“If you live in a high risk fire zone, you should also ask for a prescription for a second emergency inhaler, which you should have ready to take with you if you evacuate.

“Keep your back-up medication with your most precious papers or photographs to ensure it goes with you if you decide to leave.”

The National Asthma Council Australia also stressed the need to follow the manufacturer’s storage recommendations for medications during the hotter summer months.

“Keeping a back up inhaler in your glove box may seem like a good idea, but the extreme heat may render your medication ineffective, or worse still, some medication canisters could explode under the intense heat conditions that will occur in cars this summer.”

People who live in built up areas also need to plan for days of smoke haze as winds can move bush fire smoke and harmful airborne particles over great distances.

Bushfire smoke contains particles of different sizes, water vapour and gases, including carbon monoxide, carbon dioxide and nitrogen oxides, which can trigger asthma symptoms, such as wheezing, coughing or chest tightness

Larger sized air-borne particles, containing burning debris, contribute to the visible haze when a fire is burning.

They are generally too large to be breathed into the lungs, but they can cause irritation to the lungs, throat and nose.

Finer particles and gases, however, are small enough to be breathed into the lungs.

“This is why we are cautioning people with asthma across Australia to be vigilant about their health as the 2009/10 bushfire season unfolds and Australia heats up.”

P.S. Boost your immunity against asthma by eating Vitamin C and Vitamin D rich foods and fruits.

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Just breathe - Buteyko Method

"When a person gets short of breath, intuitively the right thing to do seems to be to inhale deeply," says Margalit Noam. "But amazingly, if asthma patients are asked whether a deep breath helped them during an attack, the answer is unequivocally no. This is because people with breathing problems do not suffer from a lack of air, but from too much ventilation. They inhale too much air and the body has a hard time coping with that."

To anyone who's ever witnessed an asthmatic struggling to get air into his lung, this approach sounds contrary to logic. However Noam, a therapist who treats asthma using the Buteyko method, explains, "When you inhale too much, the concentration of carbon dioxide in the body dwindles and not enough oxygen reaches the tissues. Inhaling more air in order to provide more oxygen to the tissues not only does not help, it actually worsens the situation."


Professor Konstantin Buteyko, a Ukrainian doctor, derived this understanding from the findings of the physiologist Christian Bohr in the early 20th century. Bohr found that a decline in carbon dioxide levels in the body reduces the blood's ability to release oxygen to tissues and vice versa. Based on this phenomenon, known as the Bohr effect, Buteyko concluded that while in a state of shortness of breath, the body will benefit more from a reduction in the volume of air that enters the body. In the mid-20th century, Buteyko developed a unique method for treating patients suffering from asthma and other breathing passage problems, and patients of this method learn to slow the pace of their breathing.


Restoring balance

A shortage of oxygen is not the only problem related to over-breathing. "When there is too much air, the acidity level of the body drops [the PH level increases] and the body is not balanced," adds Noam. "In order to restore its acidity level, the body begins to secrete more lactic acid. This does not improve the situation and only causes fatigue. The breathing system enables the balancing of the acidity level in the body much more quickly than the body's other systems."

"For the sake of comparison," he continues, "the metabolism, the digestive system and kidney tract require several hours and sometimes even several days to restore the body's acidity levels to normal levels, whereas the breathing system can do so in minutes. Slowing the pace of breathing and sometimes even a brief halt in breathing reverses the process, and with a normal breathing pace the body returns to its desired acidity levels."

The treatment is sought primarily by asthmatics, but also helps people with allergies, anoxia, snoring, chronic runny noses, stuffed noses and sinusitis. The treatment is also sought by those with a tendency to suffer from anxiety and unease, high blood pressure and migraines. The direct connection between breathing and the improved conditions is explained by the following: after the breathing is relaxed, oxygen is released to the tissues, the blood vessels expand, pressure from them decreases and pain is reduced.


Learning to relax

Noam's patients attend six two-hour sessions, during which they improve their awareness of breathing difficulties, learn to identify situations where they over-breathe and learn how to relax the pace of breathing.

The Buteyko method is one of the most effective ways of treating asthma patients. In studies conducted in Canada and Australia, patients report a substantial reduction in the use of extenders, inhalers and inhalation machines (up to 96 percent after just 12 weeks) and in asthma prevention medications (49 percent). The reduction in the use of inhalers and medications is of greater significance for asthmatics who have become used to living alongside the inhaler and in many cases become anxious if they can't remember where they put it. Noam also reports improvements for those suffering from sleep disturbances such as apnea or snoring.

In Russia, the method is widespread and has been studied for over 50 years. In the West it is also starting to gain institutional recognition. In Australia, medical insurance covers some of the expenses of attending a Buteyko workshop, given the knowledge that it will save on other insurance costs. In England, a family doctor is authorized to recommend the method for treating breathing problems.

Dr. Avner Goren, a pediatrician and allergy, clinical immunology and asthma expert, as well as the director of the Maccabi health maintenance organization branch in Ramat Hasharon, says he frequently recommends the treatment, based on "the research results that indicate a substantial reduction in the use of medications and also because of the fact that I know for certain that they do not interfere in any stage of the patient's drug treatment."


P.S. Boost your asthma immunity by eating Vitamin C and Vitamin D foods and fruits.



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Smart Inhalers Help Fight Asthma

Developing and deploying smarter wireless medical devices to manage chronic conditions is a high growth area, and with good reason.

According to the CDC, 70 percent of deaths among Americans are due to a chronic illness. One of the keys to controlling chronic disease is adhering to proper medication dosage and schedules. Yet many patients seem to have difficulty following their doctor’s recommendations. We recently came across a couple of smart, connected medical devices designed to help asthma patients be more compliant and achieve better control over their disease – which may in turn help them lead longer lives.

Asthma is a widespread chronic disease that often strikes in childhood, making it a prime area for smarter treatment solutions that help patients to manage their symptoms. One avenue for such devices is to deliver medication through inhalers. Computer controlled inhalers with embedded intelligence can precisely measure the amount of the drug that gets to the patient. Increasingly, doctors are moving from pills to inhalers as a way to administer drugs, but it can be difficult determining how much actually was inhaled into the lungs. This is the challenge that smart inhalers help to solve.

One such smart inhaler system prototype is being developed by Clement Kleinstreuer, a mechanical engineering professor at North Carolina State University in Raleigh, in collaboration with a departmental colleague, Dr. Stefan Seelecke.


According to Kleinstreuer, the inhaler system (pictured left) “modulates the patient’s inhalation waveform and then releases a controlled drug-air stream which targets specific lung sites.” This stream could also be targeted at sites like a tumor or some other predetermined lung area, giving the smart device even wider applicability. Kleinstreuer adds that this “optimal targeting methodology” has been successfully tested in both virtual reality and in the lab, and components of a smart inhaler system prototype are now being built and tested.

“Clearly,” he says, “clinical trials will be necessary to convincingly document the amazing capabilities and wide-range applicability of the invention.”

In the long run, medical devices that use embedded intelligence to deliver precise amounts of medication to patients will help not only asthma patients, but also address other chronic and acute diseases that need targeted and specific medications.

Asthma patients can look for more immediate relief from a smart inhaler that is already available in New Zealand. This device comes from Nexus6, Ltd, a New Zealand company. New Zealand has one of the highest incidences of asthma in the world so it’s not surprising that they are leading the efforts in this area. According to COO Garth Sutherland, “New Zealand has the second-highest per capital incidence of asthma in the world; over a half a million of the 4 million people have the disease. Fortunately, we have a good public health care system so there is a good chance that asthma will be diagnosed and treated.”

Sutherland started the company in order to help chronic asthma patients better manage their own care. The Nexus6 Smartinhaler device (pictured right) helpspatients adhere to the prescribed amount and frequency of medicine. It connects to the patient’s computer via a docking station and the data is uploaded and sent to their email system. The patient can then print a report to provide to their doctor and health care team. A wireless version, which has a cell phone chip imbedded in the device, is currently in clinical trials. Also in trials is a ringtone reminder that is designed with kids in mind. Preventing asthma attacks is important, and keeping to the prescribed routine is crucial in those prevention efforts. “Kids really like the ring tones and it keep them on a schedule.”

The need for smarter management of asthma treatment is certainly not unique to New Zealand. In the United States, it’s estimated that more than 34 million Americans suffer from asthma. Smart inhalers are one example of how connected health technology can help those with chronic illness get the most benefit from prescription drugs and give them tools to better manage their own care.


P.S. boost your asthma immunity by eating Vitamin C and Vitamin D rich foods and fruits.



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Beckham tips for asthma sufferers

David Beckham hopes the revelation that he has suffered from asthma since he was a boy will help others with the condition.

The England midfielder said he had not tried to hide the fact he had asthma - it became apparent when he was seen using an inhaler after playing for Los Angeles Galaxy in the MLS Cup final in Seattle.

Beckham said: "It's out there now. Sometimes I have good days and bad days. I've never hidden it but it's something I've had for a good few years now."

He added: "I hope it turns into a positive because I've been able to play for many years with the condition. I know there are many other players who have overcome it such as Paul Scholes."

The 34-year-old also dismissed a report that he smokes cigars.

"I've always prided myself on the way I look after myself," he said. "On special occasions, like winning the European Cup, I might have had a puff. But I don't sneak into the garden - I think my boys would kill me if I did."

Beckham is recovering from an ankle injury and had three painkilling injections in Seattle but said it should be mended by the time he joins AC Milan after Christmas.

He added: "In the last few days it has felt a bit better. Bone bruising takes time to go away and obviously the injections I had during the game in Seattle didn't help.

"But it should be fine by the time I get to Milan. There's not much you can do with bone bruising apart from resting it and icing it. I just need a couple of weeks off, which I'm having."

P.S. boost your asthma immunity by eating Vitamin C and Vitamin D rich foods and fruits.

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What is Chronic Obstructive Pulmonary Disease

COPD (Chronic Obstructive Pulmonary Disease) is a chronic disease of the lung that covers several conditions including Chronic Bronchitis or Emphysema.

Chronic Bronchitis results from an inflammation of the airways of the lung. The term chronic refers to the fact that the condition is present for a long time and bronchitis means inflammation of the bronchi or air passages of the lung. You can find the anatomy of the lung on any well-researched website, but I will give a brief summary here.

The air passages begin with the trachea in the neck which branches into the left and right main stem bronchi. These bronchi continue to branch into smaller bronchi or bronchioles until they end up in the microscopic air sacs or alveoli. It is the alveoli that oxygen and carbon dioxide are exchanged with a rich network of small blood vessels or capillaries. The bronchioles and bronchi are responsible for delivering the oxygen to the alveoli and for carrying the carbon dioxide from the alveoli to the outside. These air passages are more than just tubes — the linings are composed of cells and structures that serve many functions for lubricating the airways and removing debris from the airways. These cells can be damaged by infections or toxins like inhaled poisons or smoking. When these cells are irritated by various stimuli, they form mucus which can plug up the airways and make air movement difficult. In addition, the airways have muscles in the walls and these muscles will contract or dilate the airway depending on what kind of pressure is placed on them.

When we breathe in, our diaphragmas act like an accordion and pull air into the airways. When we breathe out, we squeeze our chests and the airways by pushing our diaphragms up to force the air out. This pressure to force the air out causes the bronchi to become narrow and slows down the speed of the air escaping from the lungs. If the airways are already partially blocked by mucus, or if the muscles are contracting due to irritation, the air cannot escape from the lungs as well, and we feel short of breath or you will hear a wheezing sound as the air tries to escape through narrow tubes.

Emphysema, on the other hand is a disease of the alveoli or air sacs, where the lining of the sacs become destroyed by specific enzymes or infections, and the small air sacs become larger and larger as the walls or membranes between them become destroyed. They tend to lose their elasticity and are unable to squeeze the air out of them as effectively. In addition, the walls or membranes contain the capillaries or small blood vessels that carry the oxygen to the tissues and remove the carbon dioxide from the tissues, so air exchange becomes compromised and we feel short of breath, because not enough oxygen is being delivered to our tissues. In severe cases we can actually see our fingernails turn blue from lack of sufficient oxygen. When there is not enough oxygen in the blood, the blood becomes dark or blue, like in our veins. When there is enough oxygen in the blood the blood becomes a bright red, like in the arteries.

Chronic Obstructive Pulmonary Disease or COPD is a combination of Chronic Bronchitis and Emphysema. The treatment is therefore three fold.

* Remove the toxins from the lungs. This is done by avoiding irritants like smoke, perfumes, dust, or allergens from the environment. In addition, direct toxins like cigarette, cigar or pipe tobacco smoke should be immediately discontinued.

* Treat the constriction of the airways with medicines that can open up the airways. These are called bronchodilators and are usually in inhalers or nebulizers, but can also be in cough medicine, or pills.

* Treat the inflammation of the airways with inhaled anti-inflammatory medications, or by pills or injections. These medications are derivatives of cortisone. Frequently in severe episodes you will be treated with doses of Prednisone tablets for short period of time, or injections of cortisone.

The treatment of COPD is therefore a combination of bronchodilators and cortisone as well as discontinuing smoking, treating any infections and avoiding an environment of smoke.

The prognosis varies depending on the severity of the condition, and this can be determined by doing pulmonary function tests to see how well you can breathe. A simple test that can be done in the office is the PEFR (Peak Expiratory Flow Rate). This is a simple flow meter that patients with COPD can obtain from the pharmacy to test the amount of airway restriction that is present. A more detailed test can be done by a pulmonary specialist, which we do have here in Nassau.

If caught early enough, like any other disease, the prognosis is excellent. I have seen patients with severe COPD who require oxygen all the time, still smoke even with the oxygen being administered. Those are extreme cases but, as you can see, the prognosis can vary widely depending on the severity of the disease and the compliance of the patient with prescribed treatment.

P.S. boost your asthma immunity by eating Vitamin C and Vitamin D rich foods and fruits.

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H1N1, asthma can be a dire combination in children

The day before Halloween, T.J. Berndsen had what his parents believed was a little asthma flare-up. By Halloween night, he felt lousy enough to cut trick-or-treating short.

A week later, the 9-year-old was straining to breathe in the emergency room at Cincinnati Children's Hospital Medical Center because of complications from an H1N1 influenza infection.

"By Sunday, Nov. 8, his cough turned into a croupy bark, and he started running a fever. It got to 102.9. I knew it had gotten to be more than we could handle at home," says his mother, Jennifer Berndsen. She had suspected flu but wasn't sure. His school had had significant numbers of children out, but his classroom hadn't seemed to be hit hard, she says.

While H1N1's effects in a healthy child can range anywhere from mild congestion and sore throat to serious respiratory illness, and even death, the 7 million American kids who have asthma are at a higher risk for complications and death if they contract the novel flu virus, says Tom Skinner of the Centers for Disease Control and Prevention.

"We're seeing underlying health problems, including asthma, in about two-thirds of the estimated 540 children who have died from H1N1 complications," he says.

But the CDC and pediatric asthma experts say there are steps you can take to prevent H1N1, or swine flu, as well as seasonal flu, and ways to treat it if an infection does occur.

Prevention is best

"In children with asthma, the key issue is anticipation rather than reacting," says Erwin Gelfand, chair of pediatrics at National Jewish Health in Denver, a hospital that specializes in treating children with respiratory conditions.

Gelfand says a parent can ensure two things: vaccination and making sure a child's asthma is in control.

The advice goes even for children who get asthma only intermittently, says Tyra Bryant-Stephens, medical director of the Community Asthma Prevention Program at Children's Hospital of Philadelphia.

"Children who only get asthma during exercise, with a cold, or during allergy season can also have serious complications from flu," Bryant-Stephens says.

T.J.'s parents gave him what asthma experts call "maintenance medications" every day: an oral Zyrtec (cetirizine) for allergies and the inhaled corticosteroid Flovent (fluticasone), which reduces inflammation in the lungs. They knew he needed the H1N1 vaccine, says T.J.'s mom, but it hadn't become available in their area yet.

Unlike T.J., many asthmatic children do not take medications as prescribed, sometimes because of cost or parental concerns about side effects, Gelfand says.

"I'd say to any parent, this is not a time to relax compliance. The drugs we have for asthma are as a rule not effective if taken on an intermittent basis, except in possibly the mildest of cases," Gelfand says.

As for vaccines, the CDC recommends that children with breathing issues get the shot form of the vaccine – two doses spread out by a month in those under age 9 – instead of the nasal mist.

If a child does get flulike symptoms, there are steps caregivers should take, says Carolyn Kercsmar, director of the Asthma Center at Cincinnati Children's.

She says if a child develops a fever, is feeling poorly, has chest pain, a bad cough or extreme fatigue, see a doctor right away.

Rough night, quick comeback

T.J.'s parents took the correct steps, Kercsmar says. After additional home albuterol treatments didn't budge his symptoms, they scooted fast to the pediatrician, who sent him on to the ER. There, Jennifer Berndsen says, "they did three back-to-back albuterol treatments – continuous for about an hour. He was so sick by then, poor thing."

He then received a cornucopia of drugs: Motrin to help reduce fever, antibiotics for atypical pneumonia that a chest X-ray revealed, and an intravenous line of magnesium sulfate to help further open up his airways. They dosed him with the steroid prednisone to simmer down inflammation, and he received pure oxygen through a nose mask, Berndsen says.

After he was moved to a room well after midnight and an H1N1 swab came up positive, he was given Tamiflu (oseltamivir).

"These are the children who can benefit from starting Tamiflu right away. It can turn a very nasty disease into one that's tolerable," says Kercsmar, who adds that it works best started within 48 hours, but even within 72 hours can help.

Berndsen reports that though her son's night in the hospital was rough, the turnaround was fast.

"By noon the next day, Tuesday, Nov. 10, T.J. was feeling well enough to eat a chili dog and a pretzel with cheese," she says. He went home that night.


P.S. Boost your immune system by eating Vitamin C and Vitamin D rich foods and fruits.



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Users Complain About New Asthma Inhalers

A year ago the government ordered a big change in asthma inhalers.

The propellant used to force the medication out of the inhaler was changed to a more environmentally safe chemical.

The old albuterol inhalers used chlorofluorocarbon (CFC), but it’s believed the CFC damages the ozone.

As of the first of the year, CFC inhalers were banned and hydroflouroalkane (HFA) was used as a propellant instead.

While the HFA may be better for the environment, some patients and doctors say the inhalers may be dangerous for patients.

Katie Mitchell of Pittsburgh suffers from severe asthma.

She described what an asthma attack feels like. “My chest gets tight, feels like an elephant on my chest, then your airways constrict and you kind of gasp for air.”

Mitchell, a junior at Slippery Rock University, relies on an albuterol inhaler to control her symptoms. Like all asthma patients, her inhaler now contains the environmentally friendly propellant HFA.

She said the new inhaler put her in a life-and-death situation.

“I went to use it and nothing came out and I started panicking because I didn't know what to do. I was shaking it and I had to prime the inhaler six times before I could actually use it, which is dangerous for someone with asthma,” Mitchell said.

Mitchell isn’t the only asthma sufferer who has had problems with the new inhalers.

The FDA told Channel 11 it has gotten many similar complaints about the new inhalers.

Dr. David Skoner, an asthma and allergy specialist at Allegheny General Hospital, said he’s also had patients complain about the inhalers.

Skoner said, “These have a tendency to plug up the little holes where the drug comes out. That can cause a life hyphen threatening situation.”

The medication is stickier, so it can clog the hole it comes out of and can reduce the amount of medication delivered.

Many patients don’t realize they must now take the inhaler apart and clean it at least once a week, which they didn’t have to do with the old inhalers.

Mitchell now cleans her inhaler after every use to make sure it will work the next time she needs it.

“If you're having an asthma attack and you use your inhaler and it's clogged, you can't go over to the sink and wash it out,” Mitchell said.

Skoner said the drug manufacturers recommend taking the inhaler mouthpiece apart and running warm water through it for 30 seconds. Then flip it over and run warm water through the other end for another 30 seconds. Then shake it off and let it air dry overnight before putting it back together.

Clogging isn’t the only complaint the FDA is getting.

The old propellant pushed the medication out with a lot of force, but the new propellant sends the medication out in a gentle plume.

Because it feels and tastes different, many of Skoner’s patients don't think it's working.

“The taste and feel are very different. The CFC felt cold in the back of the throat. This one doesn’t. They knew what the old one felt like . When they use the new one, they don’t feel that, so they don’t feel they are getting the drug and may take more puffs of it,” Skoner said.

Skoner and the FDA said tests show the new propellant still delivers the right amount of medication.

Another drawback of the new inhalers is the cost. The new inhalers are two to three times the price of the old generic inhalers.


P.S. prevent asthma attacks by eating Vitamin C and Vitamin D rich foods and fruits.



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Asthma drug developer raises $17 million

Last week asthma drug developer Altair Therapeutics raised $17 million in a Series A funding round that was led by Domain Associates and capped a two-year startup financing period.

Other investors in the round include AgeChem Venture Fund, Thomas McNerney & Partners, Forward Ventures and Isis Pharmaceuticals.

San Diego-based Altair held its first close of $4 million in February, and it then raised the total to $11 million in August, according to Thomson Reuters. Previously, in late 2007, the company raised $6 million from Forward Ventures, Thomas McNerney & Partners, and an undisclosed investor, according to Thomson Reuters. CEO Joel Martin, formerly a partner at Forward Ventures, which helped seed the company, joined the startup in May.

Martin said the company is looking to open another fundraising round next year and added the current round will be used to fund phase II(a) trials for its asthma inhaler product, AIR645. Once it acquires the data from those trials, said Martin, it will go into phase II(b). Altair's goal is to prevent asthma attacks by targeting two different inflammatory pathways in the lungs.

Martin said the experimental data and the need in the market compelled him to join the company. About 16.4 million adults and 7 million children nationwide suffer from asthma, according to the Centers for Disease Control and Prevention.

Products that treat asthma produce about $7 billion annually in sales, Martin said. Most of the sales, or about $4 billion, come from small mid-sized drug companies instead of industry giants, he said.

P.S. prevent asthma attacks by eating Vitamin C and Vitamin D rich foods and fruits.

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Dr. Andy: Used correctly, inhaler effective

The metered dose inhaler, also known as the pump inhaler, has been the main treatment for lung problems such as asthma since it was first sold in the 1950s. For most it is a convenient and cost-effective way to get medications such as Albuterol into the lungs. Earlier this year a major change in these devices occurred, a change which several of my patients are convinced has made their inhalers less effective.

In the past, the propellant in inhalers was a chlorofluorocarbon (CFC) such as freon. However, as freon has disappeared from our air conditioners, so it did from pump inhalers. In fact CFCs have been banned internationally. Today, the inhaler propellant is a hydrofluoroalkanes (HFA).

In the older CFC inhalers, up to 80 percent of the aerosol one breathed in from the inhaler was the propellant. The CFC also caused the cold sensation that many patients associate with their old inhaler medications. The newer HFA inhalers don't have the same cold sensation, and also do not propel the medication at as high a speed. This results in more medicine actually being delivered into the lungs.

Discussions of pump inhalers would also not be complete without mentioning spacers, or holding chambers. These are usually plastic tubes with the inhaler plugged into one end, and the other end in the patient's mouth. Using a spacer dramatically increases the effectiveness of pump inhaler medications.

Using a spacer with a pump inhaler has been shown in repeat studies to help kids with asthma improve faster than when treated with an inhaler without a spacer attached. There is also no need to coordinate the inhalation with the pumping of the inhaler.

The spacer allows more medication to get to the lungs by allowing it to slow down in the chamber, and may reduce some common complications with inhaled steroids, such as oral thrush. For younger children, a mask can even be fitted to the mouth end of the chamber.

Be sure to clean your spacer chamber prior to using it with a mild dishwashing detergent, and repeat that cleaning process occasionally. This will reduce the electrostatic charge that can build up on the plastic, which attracts the medication particles, reducing the amount available for inhaling into the lungs.

In regard to nebulizer machines vs. the pump inhalers with a spacing chamber, numerous repeat studies have shown that a correctly used pump inhaler with a spacing chamber is as effective, if not more effective, than a nebulizer treatment. The significantly lower cost of inhaler medication, ease of portability and lack of reliance upon electrical equipment are just added benefits of inhalers over nebulizer machines.

So if you, or your child, use an inhaled medicine, be sure to talk with your doctor to verify you are using it correctly. Don't be afraid to ask questions, and remember - we work for you.


P.S. prevent asthma attacks by eating Vitamin C and Vitamin D rich foods and fruits.



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