Sunday, February 25, 2007

Levalbuterol (Xopenex) No Better Than Albuterol, Says Public Citizen/

Hah! Guess they've never had to deal with kids on albuterol. (For the uninitiated, you may as well give them a twelve pack of Red Bull and a couple of Hersey bars....)

Levalbuterol Is No More Effective Than Older, Cheaper Asthma Drugs and Should Not Be Used, Public Citizen Advises on
“Worst Pills, Best Pills” Subscribers Receive Life-Saving Warnings About Dangerous Drugs Before They Are Removed From the Market

WASHINGTON, D.C. –Levalbuterol HFA (Xopenex HFA) inhalers are no more effective than older, less expensive drugs used to treat asthma and other diseases and should not be used by consumers, Public Citizen writes in a new February posting on its Web site. The consumer advocacy organization cited information published in the March 2006 issue of Medical Letter on Drugs and Therapeutics.

In 2005, Americans filled more than 2.2 million prescriptions for levalbuterol at a cost of more than $293 million. Marketed by Sepracor Inc., levalbuterol has the same atomic components as the asthma drug albuterol, which has been on the market longer and costs less. The difference is that, while albuterol has both of the two mirror images of the molecule, levalbuterol has only one. Levalbuterol is available in two forms, Xenopex [SIC]HFA, a pocket-sized inhaler approved by the Food and Drug Administration (FDA) in March 2005, and Xenopex, a liquid drug approved in 1999 that is converted to a fine mist when passed through a device called a nebulizer. Levalbuterol is short-acting and is used to relieve symptoms experienced during an asthma attack. In 1999, Public Citizen placed levalbuterol on its “Do Not Use” list of drugs because there was – and still is not – any compelling evidence that levalbuterol is safer or more effective than albuterol.

“Creating a drug that is nearly identical in nature to a drug that is already in existence and then marketing it as a ‘new’ or ‘breakthrough’ drug is a strategy that neither helps consumers nor produces better drugs,” said Dr. Sidney Wolfe, director of Public Citizen’s Health Research Group. “In marketing levalbuterol as such, the manufacturer is manipulating patients into unnecessarily paying hefty prices.”...

Again, I say the value of Xopenex is not the effectiveness of the drug -- we know it's equal to the cheaper, generic albuterol in that way. But the side effects...where albuterol has the kids bouncing off the walls (especially lovely if they're already on oral steroids) levalbuterol yields negligible negative effects.

To be able to give your asthmatic child a neb at 2:00 AM and know that they'll actually be able to sleep after that is worth the higher copay.

Saturday, February 17, 2007

Asthma - Not a disease, a collection of symptoms

Just found this article on NewsTarget, which seems to be an aggregator of highly biased, self-serving news with a decidedly non-medical bent. But this one may have some merit. Here's a pretty comprehensive excerpt:

(NewsTarget) The medical journal The Lancet is appealing to the medical
community to stop using the term "asthma" as it misleads people to believe it is
a disease rather than a group of symptoms with various origins and

Symptoms of asthma include wheezing, coughing and breathing difficulties,
and it is generally accepted that attacks are brought on by inflamed airways,
but the actual spark for the inflammation is not known, nor is the reason why
some people contract asthma while others do not.

"Perhaps asthma as
a symptom is really only the clinical manifestation of several distinct
diseases," said The
article. "Rather than confusing scientists, doctors and patients even
further, is it not time to step out of the straight jacket of a seemingly
unifying name that has outlived its usefulness?"

The article went on to explain that asthma can have a multitude of
triggers, symptoms and treatments, providing more evidence that it is
inappropriate to label it as a single disease.
"The Lancet article raises
some interesting points; asthma is indeed a complex ailment," said Dr. Andrew
Miller, a spokesman for the British Lung Foundation. "But whether this is a good
enough reason to abandon a useful name which encompasses a range of symptoms
treated in a similar way is not yet clear."

...Currently, experts claim that approximately 300 million people have
asthma worldwide -- a number expected to reach 400 million by 2025. One in 250
deaths is caused by it, and children with allergies are more likely to
develop the condition. The Lancet noted that there has been an increase in
childhood allergies across the globe.

"Until the 19th century fever was regarded as a disease and maybe in
20, 30 or 50 years' time we will look back at asthma in the same way," said the

Ig has Croup - allegedly

Saw the peds today -- Ig was up last night coughing so badly, B and I were both freaking out a little. We finally woke him up at around midnight to give him a neb of Xopenex.

This morning I brought him in. It's Saturday, and we were probably among the last patients on what seemed like a very busy day, so she did seem like she was rushing a bit. And I'll confess upfront (and I've said this MANY times before on this blog) while I love my peds, I don't trust them when it comes to determining the clarity of my kids' lungs during the infant/toddler years.

Anyway, she listened to my concerns (low-grade fever, cough, ear pain, etc.), and checked the baby out. She said his ear looked better, so she thought the Omnicef was working -- but based on what I told her, she suspected croup. Now, she didn't hear him cough. And - shocker - she said his chest sounded good.

She wants me to keep up the nebs, and she gave me a box of Pulmicort. I reminded her that he was on Flovent already (fair enough, the pulmo prescribed that), and she said we might want to replace the Flovent with the Pulmicort for now.

Ummm...will one Respule be the same as his regular dose of Flovent 110? She didn't say... I'll cut her some slack. Just this once. I'm a frequent flyer, and she was in a hurry.

She did point out that he'd been in for an ear infection once monthly for the last five months, and that we should follow up with the ENT.

Great. So in the next month, Ig will be visiting the Pediatric Pulmonologist, a Pediatric Cardiologist, and a Pediatric Otolaryngologist. Thank God for health insurance.

Friday, February 16, 2007

No Flu (I don't think) and Iggy's Ear

So, I'm feeling a lot better today, and while I haven't taken my temperature since I woke up, I don't think I have a fever. So...phew.

Ig, on the other hand...not so good. I took him to the peds for his millionth ear infection on Tuesday and we started him on Omnicef. The deal was, if the Omnicef didn't work, we'd have to talk to an ENT about treatment. (read: TUBES)

So we're on the fourth day of treatment, and I've finally brought him back to daycare, and they call me less than two hours after dropoff to tell me that he's running 100.5. Yes, that's a low-grade fever, but four days into an broad-spectrum antibiotic, should there be ANY fever? I think not.

He's also had two rough nights in a row. Wednesday he was up screaming bloody murder every two hours. Last night, he was up at about 1:00 screaming. I gave him some Dimetapp (mostly because he was coughing -- and I couldn't remember when I'd given him Motrin) and a cup of water -- which he sucked back like he hadn't seen fluids in a year.

Both nights were better than Tuesday when he spiked up to 104.9.

Spoke to the peds today, and they said that the antibiotic could take another day or two to kick in (yeah, right...) but that if he had another rough night, they'd see him tomorrow morning.

Ah, nothing like the pediatrician's office on a Saturday!

(Did I mention the hideous cough, by the way? We'll be talking about that with the doc, too. I've been giving him albuterol twice a day.)

Thursday, February 15, 2007

Do I have the flu?

Ugh -- Ig's just getting over his 3 millionth ear infection, Ozzy's coughing his head off in bed, and I think I've got the flu.

I've just got that achey feeling in my back and the chills right now -- along with a goopy throat and slight cough. My temp is a little over 99.

Here's how I know I'm the mother of asthmatic children: I'm relatively unphased by the fact that I'll be sick through the holiday weekend. I'm FAR more concerned that I may have already exposed my three asthmatic kids to the flu.

(Oh, for a plastic bubble!)

I'm a super-affectionate parent, so I've been all over the kids all week, just like always.

Please, please...just let this be a little cold. Or some freaky thing that only grown-ups can get!

Monday, February 12, 2007

Long overdue update - asthma attacks, RSV, cyanosis and more fun!

Wow -- I can't believe how long it's been since my last post! Rather than blather on, I'm going to cut to the chase and just bullet out what's been going on:

  • B - #1 son has been doing great! He's still on Singulair and Flovent 44, but he's had a GREAT winter so far. He had one asthma attack, just last Sunday - stupidly, we let him sleep in his room the night after we'd painted. But honestly, I'd have to check the blog to see when his last flare up was prior to that.
  • Oz - it hasn't been as rosy for this guy. Ozzy developed a nasty case of RSV on 12/15. When I took him to the doctor on 12/18, I asked if he was wheezing, and she said no -- because he couldn't even get a deep enough breath to wheeze. We went for a chest Xray and an RSV test, and we ended up doing nebs every three hours for TEN DAYS. It was rough -- and honestly, he didn't have his color back until about two weeks ago. And now he's coughing again. He's currently on Flovent 110.
  • Ig - Also coughing again. He had mild RSV at the same time Oz had it. At around that time, he started going cyanotic. His lips go blue nearly every morning, and we're not sure why. We're going to the cardiologist next month. He's also on Flovent 110.
  • Me -- Finally taking off the baby weight! Or inches, anyway. Somehow, I've found the time to join Curves (30 minutes x 3 times per week is about all I can manage with a family and full-time job!) I've lost 2 inches off my waist since December -- If I can lose 10 lb. and another 3-5 inches of Iggy weight, I'll be happy!

More soon ... I wont' have this long a lapse again!