A Tragic Misunderstanding
Years ago, a patient told me about the death of her brother from asthma in the 1970s. He had a history of multiple hospital admissions and emergency department visits for his asthma.
One day, his doctor prescribed a new type of inhaler. The patient, who worked overnight alone as a security guard, was found dead one morning with the new inhaler by his side.
From her story, I surmised what had likely happened. This occurred around the time that inhaled corticosteroids (ICSs) first became available in the United States, and probably his new inhaler was an ICS. (Beclomethasone was, in fact, the first ICS available in the United States). He was either not told, or did not understand, the difference between the two types of inhalers (steroid/controller vs bronchodilator/rescue). This saga of the consequences of inadequate patient understanding still haunts me.
Before the advent of combination long-acting bronchodilator/ICS, another drug of its kind was studied. It was a combination inhaler, a short-acting beta agonist (SABA) with an ICS (budesonide) that was compared with budesonide and a SABA separately.[1]
It seemed like a brilliant idea—a way for asthmatics to self-regulate. The more they needed their bronchodilator, the more ICS they also took.
Asthma
COMMENTARY
The Drug Needed for Noncompliant Asthma Patients
Gary J. Stadtmauer, MD
DisclosuresApril 29, 2015
A Tragic Misunderstanding
Years ago, a patient told me about the death of her brother from asthma in the 1970s. He had a history of multiple hospital admissions and emergency department visits for his asthma.
One day, his doctor prescribed a new type of inhaler. The patient, who worked overnight alone as a security guard, was found dead one morning with the new inhaler by his side.
From her story, I surmised what had likely happened. This occurred around the time that inhaled corticosteroids (ICSs) first became available in the United States, and probably his new inhaler was an ICS. (Beclomethasone was, in fact, the first ICS available in the United States). He was either not told, or did not understand, the difference between the two types of inhalers (steroid/controller vs bronchodilator/rescue). This saga of the consequences of inadequate patient understanding still haunts me.
Before the advent of combination long-acting bronchodilator/ICS, another drug of its kind was studied. It was a combination inhaler, a short-acting beta agonist (SABA) with an ICS (budesonide) that was compared with budesonide and a SABA separately.[1]
It seemed like a brilliant idea—a way for asthmatics to self-regulate. The more they needed their bronchodilator, the more ICS they also took.
Medscape Allergy & Immunology © 2015 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Gary J. Stadtmauer. The Drug Needed for Noncompliant Asthma Patients - Medscape - Apr 29, 2015.
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Authors and Disclosures
Authors and Disclosures
Author(s)
Gary J. Stadtmauer, MD
Assistant Professor of Medicine and Clinical Immunology; Staff Physician, Medicine and Clinical Immunology, Mount Sinai School of Medicine, New York, New York
Disclosure: Gary J. Stadtmauer, MD, has disclosed no relevant financial relationships.