Allergy & Asthma Network Mothers of Asthmatics (AANMA)

1. What tips can you offer to get the most from my asthma and allergy medication treatment plan?

  • Contact your physician if you think the treatment plan is not working as expected or if you experience unwanted symptoms or side effects when using a medication.
  • Make sure you understand and follow the specific directions for taking your medication.
  • Read the label on the front of your medication EACH TIME you use it to make certain you are taking the correct medication!
  • Flush or safely dispose of expired medications after the date indicated on the prescription.
  • Plan ahead to have prescriptions refilled BEFORE you run out!
  • If you do not have the money available to purchase needed medications, let your physician know before leaving the office. Temporary but helpful solutions are available for the asking.
  • Be honest about your use of medications. If you haven’t been using medications as prescribed, talk about your reasons rather than hiding them. Your response to treatment dictates the next course of action the physician will take and it should be based on reality.

2. I am a childcare provider and have one family that has asked me to give nebulizer treatments to their child. I don’t have a problem with this, and they have shown me how. However, the child is two years old and there isn’t a mask on the nebulizer. I’m supposed to hold the end of the nebulizer under her nose for her to breathe. How do I know if she is really getting the treatment when I give it this way?

The nebulizer technique you describe is often called “blow by” as the medication is blown in front of the infant or toddler’s face in hopes that some will reach the airways. However, studies show this method is very ineffective. Most of the medication bounces off the face and never reaches the appropriate airways.

You are correct to ask about a face-mask. Young children need a mask to direct nebulized medication mist properly to the mouth. Share this information with the parents and ask them to provide one for you to use while their child is in your care.

3. My mother has asthma and chronic obstructive pulmonary disease (COPD). Recently her physician switched her from inhalers to two nebulized medications: DuoNeb® (ipratropium bromide and albuterol) and Pulmicort Respules® (budesonide). My mother sent her prescription to a mail-order pharmacy and received vials containing a combination of ipratropium, albuterol and budesonide. I called the pharmacy because the names of the medications didn’t match the brand names on her prescription. The pharmacy said the medication she received was a generic version of the ones prescribed, fine to use and would decrease her nebulization time. Should my mother use this medication? It looks just like the ones pictured in your “Fakes and Frauds” article.

DuoNeb and Pulmicort Respules are both brand-name medications approved by the Food and Drug Administration (FDA). Both also have an FDA-approved generic, each dispensed in individual vials. To date, there is no FDA-approved nebulizer medication that mixes those three ingredients, so the medication mixture your mother received has not been approved by the FDA. According to Sarah Sellers, PharmD, MPH, of The Center for Pharmaceutical Safety, “The safety and effectiveness of this medication combination has not been demonstrated and is an unnecessary risk for the patient.” Contact your mother’s physician and/or pharmacist to be sure your mother receives the FDA-approved medications as prescribed. Report the incident to the FDA’s MedWatch at 800.332.1088 or on their Web site.

4. I was ordering my Advair® inhaler through an online pharmacy and noticed the pharmacy offers a liquid form of Advair for use in nebulizers. Their Web site says the nebulized version will provide longer-lasting relief from asthma symptoms than my inhaler. Is this true?

There is no FDA-approved nebulized version of Advair, which means the nebulized medication you saw advertised is not approved by the FDA for safety and effectiveness. Stick with the FDA-approved Advair inhaler.

5. My son’s physician instructed me to break up his Foradil® (formoterol) capsule and add the contents to his Pulmicort Respules nebulizer treatment. I am uncomfortable giving the medication to my son this way. Do you have any advice?

Trust your instincts! Foradil is a dry powder formulation provided in a capsule for use only with the AEROLIZER® inhaler. FDA has not approved Foradil for use as a nebulized medication, and there are no safety or clinical-use studies that demonstrate what happens to the structure or effectiveness of dry powder Foradil when it is used in a nebulizer. The addition of another medication to Pulmicort Respules may also change the effectiveness of the Pulmicort. If your son is not able to coordinate using the Foradil AEROLIZER correctly, discuss other medication options with your son’s physician rather than using the Foradil in his nebulizer.