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Pharmacy/nebulizer meds

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Question
do all nebulizer meds work the same? I know the company will tell you yes, but all they want is your money and you can't expect them to say "No my product is not as good as the competition"

Anyway, I have a daughter with asthma. It wasn't bad at all in Maine. She was even hoping she could get off the meds. But we recently moved to Fl where the asthma is getting really bad.

So are all the meds the same? Or will some work better than others?
Right now she uses albuterol.

Answer
Dear Joyce,
Thank you for your question.  This is not so easy to answer without having more insight into your daughter's condition, but I will do my best.  Firstly, it is not unusual to hear that asthmatics fare better in certain parts of the world than they do in others.  In Australia, we have an extremely high rate of asthmatic sufferers, who often experience remission in their symptoms when they travel abroad.  It has been theorized that pollen from certain plants within an area can be especially problematic to some individuals.  How long has your daughter been in Florida for?  Has she been suffering with exacerbated symptoms all the while she's been there?  Has she been there before without these symptoms?  If it's only been a short period, it could be a certain plant or flower local to the area which is pollinating.  There are many other asthma triggers, which you may already be aware of.  Her exacerbation may be due to any number of issues, such as, exercise, stress, recent chest infection, cold weather (although, this is obviously not an issue), other allergens (dust mites, mold etc), smoke, pets, food additives etc.  Sometimes high humidity can exacerbate symptoms, which may be an issue in Florida.  It might be worth considering whether your daughter is being exposed to new triggers in this new area.

Another possibility is that her worsened symptoms are unrelated to her current location. This leads me to medications and disease state management.  How well managed is her asthma usually?  Is she under the care of a physician?  Is her case 'mild', 'moderate', or 'severe'?  If it is severe, does she get reviewed by a specialist respiratory physician?  Have her medical carers devised an 'asthma management plan' for her?  You mention she uses albuterol, which is a 'reliever'.  Relievers work immediately by opening up the airways.  Has a 'preventer' ever been prescribed for her.  Preventers are glucocorticoid steroids which reduce inflammation in the airways, thus 'preventing' or minimizing the occurrence of attacks.   They are ineffective, however, in an acute episode.  Usually, mild sufferers can manage well with a simple reliever such as albuterol usually as an inhaler, but a nebuliser can sometimes be used for worse cases or might be easier to use for children.  How old is your daughter?  Oftentimes, when symptoms worsen, patients need to take the next step up in their asthma management plan.  It is possible that your daughter may need to use a preventer to get on top of her exacerbated condition regardless of the underlying cause or trigger.  This may only be necessary for a sort period of time.  Or if she is already using a preventer, then she may require an increase in the dose or the addition of a 'symptom controller'.  Symptom controllers work similarly to albuterol, but have a longer duration of action.  A general practitioner is the best person to manage this, and it would be a good idea to have her reviewed.  

Now to answer your question.  All three classes of inhalers (relievers, preventers and symptoms controllers) are available as nebulisers.  So, in the broadest of terms, no, not all nebulisers are the same.  But then, they are not designed to be.  Each class has it's own defined role.  Joyce, it all depends on what you are comparing.  If you are comparing albuterol (reliever) to budesonide, for example (preventer), then, no, they are not the same.  However, you may be comparing albuterol from two different companies, which is a fair concern to have.  I am not familiar with the various brands of albuterol in the US, to be honest, but the theory is the same.  During a drug's research and development, a pharmaceutical company will test their product's efficacy and safety. Usually for oral medications, a company wishing to market a competing brand (of the same drug) will test and compare bioavailability studies (ie, the extent and rate at which the drug is absorbed systemically from the gut).  Inhaled drugs will undergo a similar type comparative testing.  If they are deemed bioequivalent, the FDA will endorse them as such, allowing your pharmacist to interchange brands (with your permission).  In practice, these brands should illicit a similar response in patients. Sometimes brands which are not tested for bioequivalence will be prescribed instead.  And although these brands have the same drug and the same strength, slight variations in the way they are manufactured may impact on their characteristics and response rate amongst certain individuals.  The key here is to stick to the same brand, or otherwise ensure that your brand substitute is bioequivalent; your pharmacist should help you with this.  

The last thing I thought I'd mention is that a nebuliser will require maintenance throughout its lifetime.  Is it possible that yours is due for a service.  Once again, your pharmacist should be able to help you here.  Or you can contact the company which makes your nebuliser.

I hope this information helps. Please do not hesitate to send a follow-up question should you require further clarification.  

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Gisella Campanelli

Expertise

I am able to answer questions relating to pharmaceuticals, therapeutic regimes and primary health care. This includes offering advice on drug indications, dosages, and disease state management. I can also identify side effects, drug interactions and contra-indications, and offer recommendations on ways to mitigate these. I can diagnose minor illnesses and suggest appropriate over-the-counter remedies and/or preventive healthcare tips. I can recognize cardinal symptoms which would otherwise require referral to a medical practitioner.

Experience

I am a registered pharmacist in Australia, and I have practiced in a hospital pharmacy for over thirteen years. My clinical specializations lie within the areas of psychiatry and general medicine (including gastroenterology, respiratory, endocrinology, neurology, infectious diseases, gerontology, dermatology). I self-managed the training program for pharmacy interns in preparation for their final registration exams, and I have worked for the Pharmacy Board of Australia as an examiner and exam writer.

Education/Credentials
I hold a Bachelor of Pharmacy from the Victorian College of Pharmacy, Monash University, and I am board-registered to practice within Australia. I also hold a Master's degree in an unrelated field (art conservation).

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