Practical Solutions for Compliance
- Sunday, August 30, 2009, 15:29
- Asthma
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- Rick:
- I know that compliance with taking drugs is a big issue with asthma patients and you mentioned the anti-inflammatories, Dr. Stempel. What does that come down to on a day-to-day basis? What does someone have to do to be where they need to be in terms of the drug dosage to control asthma?
- Dr. Stempel:
- The important thing is to work with your physician in developing a program that you can really stick with. For the most part, we like patients to use their anti-inflammatory drugs twice a day. This allows for the best compliance. Usually breakfast is a pretty decent time to do it. And then we try to pick an evening time. Tie it in with something that you do. Lots of times we’ll tell people to use it in the morning when they brush their teeth and in the evening when they brush their teeth.One of the new therapies in the last several years is a long-acting bronchodilator, the drug called Serevent. And what’s very intriguing about this drug is that it seems to be very effective in controlling the breakthrough symptoms during the day. So the long-acting bronchodilator is one of the new therapies that we’ve had available for the last couple of years which really has improved the quality of life of many of our patients, and is especially helpful in those patients who have nighttime wheezing, whose sleep is disturbed by coughing and wheezing.
- Rick:
- And you say, use the drug twice a day. How difficult is it to use?
- Dr. Stempel:
- The difficulty is to remember to use it when you’re feeling great. If you’re feeling great, it’s real easy to forget. But I think the important thing is to use it, to use it very carefully and really, we’re telling people to use drugs by inhalation. Most people know how to swallow pills. Pills are easy to swallow, but inhalation technique is something that is a bit more complicated, people really have to spend time thinking about how they’re using an inhaler. And a couple of the key points is that the inhaler should be actuated at the same time a breath is started, it should be a slow, deep inhalation that lasts several seconds, and then about 7 to 10 seconds of breath-holding. Most people will use it through spacers and spacers really help for some of the inaccuracies of depressing the canister at the right moment.
- Rick:
- So beginning to end, use the anti-inflammatory drug in the morning, how much time are we talking about?
- Dr. Stempel:
- Oh, probably talking a couple of minutes at most.
- Rick:
- Two minutes.
- Dr. Stempel:
- About that.
- Rick:
- Certainly worth your time, I’d say.
- Dr. Stempel:
- Definitely worth your time. I mean, when you think about the fact that you’re able to run after the bus and be able to sit down on the bus on your way to work and not be coughing, not having everybody on the bus looking at you, you can run after your toddler down the street, be able to catch up to them. I think these are certainly worth a two-minute investment. And if you think about remembering to use it at nighttime, being able to sleep through the night, not waking up, clearly the two minutes there is going to save many minutes on the other side.
- Dr. Redding:
- I think one of the other things that we use as a trick in our practice is to tape together the bronchodilator and the anti-inflammatory. It’s easy to lose one, and you usually lose the one you’re not using very often.
- Rick:
- So physically tape them together?
- Dr. Redding:
- Yes. If you need to use a bronchodilator for relief, then the other medication is right there in front of you, and there’s very little excuse not to use it that way.
- Dr. Stempel:
- We also like to have patients go home with written instructions. For some reason, all of us have the experience when we’re in the doctor’s office of only remembering about 50 percent of what goes on. It’s very important that the instructions for using these medications are written down with the times to take them, and that you and your physician plan what times to take it. Things that are going to work in your family’s environment, that’s going to work for you.
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