Use of Inhaled Cortisteriod With Accolate
- Wednesday, September 16, 2009, 8:53
- Asthma
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- TURNER:
- All right, let’s move on and welcome in Catherine from Auburn. Hi, Catherine.
- CATHERINE:
- Hi.
- TURNER:
- And what’s the issue you’d like to talk about with Dr. Stempel?
- CATHERINE:
- I’d like to know, I started Accolate late December, and I’d like to know how with combining that with Flovent, I want to know how the Accolate worked in the body?
- TURNER:
- And tell us a little bit about your history with asthma, Catherine?
- CATHERINE:
- Well, I had an eosinophilic vaccilitis in ‘88 that pretty well destroyed my lungs and lung function. So I’ve gone through Azmacort and I had to move to Aerobid, the mentholated Aerobid, and now I’ve started on the combination of the Flovent and Accolate which is wonderful, I had forgotten, totally forgotten, what it was like to have seminormal lungs and not to have your conscious mind constantly being drawn to your chest, the heaviness of it and everything that’s going on. So I feel a little bit more like a normal person.
- TURNER:
- So your concern now is what?
- CATHERINE:
- I just would like to know a little bit more about the Accolate, how it works in the body, what the long term effect is, and actually what kind of happened there. Why am I getting such a different response than from moving through the other inhaled steroids?
- TURNER:
- Okay, we got it. Dr. Stempel?
- STEMPEL:
- Let me just ask you one other question. You started the Accolate in December and when did you start the Flovent?
- CATHERINE:
- Um, let’s see, I think a few weeks afterwards.
- STEMPEL:
- Two Accolate?
- CATHERINE:
- Yeah.
- STEMPEL:
- And how much Flovent are you using?
- CATHERINE:
- About four puffs twice a day and I’m on the 220.
- STEMPEL:
- Okay. All right. Well, let’s go through the drugs one at a time and we’ll start with the Flovent because that’s the easiest one to answer because I believe you’re more familiar with the inhaled steroids. Flovent is the newest of the inhaled corticosteroids and it seems to be the most potent and let me describe what I mean by most potent. When you open up your Flovent it’s just 220 mg per spray. When you have your Aerobid, there was about the same number of micrograms about 250 mg. But in the clinical studies it appears that the Flovent is maybe between 2 and 4 times stronger spray for spray than the Aerobid, and about the same comparison with Azmacort. Now the Accolate is a new family of medicines. And what it is called is a leukotriene antagonist. And what that means is that it gets at one of the basic mechanisms of asthma. And you’re asking an important question is what is the synergy between the two products? And the answer is we really don’t know that right at the present time. They work in very different mechanisms so you’re not going to see additive side effects if that’s a concern, you don’t have to worry about that. But their mechanisms are very, very different. This gets at one of the fundamental mechanisms of asthma. It’s important, though, to remember that with what you’re describing as fairly bad problems in the past with breathing, that really if you have asthma, the primary medicine to be on is still the inhaled corticosteroid, plus we have the most confidence that that’s going to do more of what we call lung repair or remodeling that will be of benefit. And that we’ll think of the Accolate more as a supplemental medication in your case.
- CATHERINE:
- It seems to have greatly reduced the inflammatory process.
- STEMPEL:
- Well, I think what you’re noticing is that you’re feeling better. We still don’t have some of the scientific evidence that would be nice to say that it really actually changes the inflammation. We know it blocks some of what we call inflammatory mediators. And what people have done real carefully with inhaled corticosteroids, is they’ve actually taken willing subjects who’ve been bronchoscoped what I mean is that they’ve actually looked down the airway, and been able to show that the inhaled steroids actually reversed some of the changes of inflammation. And as of yet, there isn’t any published information on Accolate doing that. So we know a lot about sort of the basic mechanism of how Accolate works and I would call this one of the new high tech drugs. We don’t know exactly some of the mechanisms that inhaled steroids work, but at least from the science that we know at this time, they seem to still be the most potent anti-inflammatory drugs. So the Accolate is great that it’s making the difference, but I would definitely keep up with your inhaled corticosteroids.
- CATHERINE:
- Oh, right.
- TURNER:
- All right, Catherine?
- CATHERINE:
- Thank you.
- TURNER:
- Thanks for taking part in the program.
- CATHERINE:
- Thank you.
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