Expert: Kevin Smith - 8/17/2009

Question
QUESTION: Hi Kevin,

I've been running for about 5 months and finally went to the doctor and was prescribed with EIB.  He gave me a sample of Floradyl, which has been helping.  But I'm on an HSA program (so I pay 100% of my drug costs to the deductible) and a 90 day supply was $375!  I called my doctor to see if there was a cheaper alternative and he is phoning in ProAir... just curious what the differences are.  I looked at both websites, but looking for more lehmans terms.  

Thanks!

ANSWER: Hi there Tani,

Floradyl is a drug I'm not familiar with - I was wondering if, perhaps, you meant Foradil (formoterol fumarate). I was unable to find any but a few vague references to Floradyl in my particular books - do you know it's generic name?

Proair is a HFA inhaler that delivers around 108mcg of albeterol sulfate per puff. That basically means that it's the same-old bronchodilator but the drug is being propelled from the canister by hydrofluoroalkane (HFA instead of the older chlorofluorocarbons (CFCs). In reality, the main reason for this change was 'green' - HFA's are supposedly less damaging to the ozone layer, then the old CFC's.

Albuterol is a bronchodilator that relaxes muscles in the airways and increases air flow to the lungs. Its used to treat or prevent bronchospasm in people with reversible obstructive airway disease. Albuterol is also used to prevent exercise-induced bronchospasm.

Here's a good article basically talking about the differences between CFC's and HFA's :

http://www2.tbo.com/content/2009/jan/08/whats-different-about-the-new-hfa-inhale

Let me know about the Floradyl - always interested to learn about drugs I haven't had experience with :>

---------- FOLLOW-UP ----------

QUESTION: You are correct on the drug, sorry for the spelling error.... I am just wondering if you are familiar with the 2 and the pros and cons of each, used for exercise induced?  The price difference is huge, I'm hoping the effectiveness is not?

Thank you!
Tani

Answer
Hi Tani,

No worries on the spelling - just wanted to make sure we were talking about the same drug.

Proair is a albeterol inhaler - that is, it's usually a fast-relief 'rescue' inhaler. It's a broncodilator, which means it makes the airways - the tubes - in your lungs expand and allows more air to move back and forth within. Albeterol is fast-acting - usually within a minute you are feeling relief if you are suffering from broncho-spasming ( that is, the airways restricting and getting smaller inside ). As a rescue from immediate problems, it's very good - such as exercise-induced attacks. It can also be used to prevent exercise-induced bronchospasm if taken ahead of exercise ( by a drs. orders, of course ). You would have to personally experiment if the HFA-style inhaler ( see above ) is as effective for you as the old CFC's - though, whether you have a choice in them any longer is up for debate depending on your location.

Foradil is a bit different - it's usually used as a long-acting agonist to encourage bronchodilation. It can also inhibit the release of inflammatory 'mediators' ( aka - 'causers' ) in your lungs that would otherwise cause swelling and inflammation. The main idea of Foradil is prevention of the exercise-induced bronchospasms.

For exercise-induced issues - both can be very useful. I am assuming you have been instructed to take the Proair before you start exercising ( that is, to use it as a prevention rather then as a rescue )? If you are feeling unsure about how things are going - talk more to your doctor. I would also be tempted to ask him, if you are worried about it and have experienced it before, about what you do for a 'rescue' inhaler IF you actually have an attack - as that's not really Foradil's area of speciality. It's very possible that taking the Foradil will be enough, however, to control your exercise-induced attacks. Only you can judge how well something is working, so don't be afraid to discuss it further with your dr. however.

In reality, the pros and cons vary between users, but at-a-glance, the Proair is fast-acting, but not long-term whilst the Foradil is long-acting, but not an ideal rescue inhaler. Side-effects vary, but can be similar. The Foradil, as it's long-acting, may cause you experience more long-term side-effects though. Examples of possible side-effects in both would include things like: tremors, headache, nervousness, nausea, hypertension, etc - but they are usually mild if the correct doses are used. If you feel anything that concerns you - talk to the doc though!

Hope this helps a bit - and good luck !