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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest effective inhalers for asthma patients

Answered by
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Dr. Kaushal Bhavsar

Pulmonologist

Practicing since :2008

Answered : 14366 Questions

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Posted on Fri, 8 Dec 2017 in Asthma and Allergy
Question: Are there any effective rescue inhalers for asthma patients other than albuterol, but which don't contain steroids or dairy/lactose? (Any physician but Dr. XXXXXXX Rynne please.)
doctor
Answered by Dr. Kaushal Bhavsar 49 minutes later
Brief Answer:
You may take Duolin inhaler.

Detailed Answer:
Thanks for your question on HealthcareMagic.
I can understand your concern.

You should take Duolin inhaler.
Duolin is having Levosalbutamol and Ipratropium bromide.
Both are having a quick onset of action and have a short half-life.
So these are perfect for a rescue inhaler.
It is not having steroid and lactose.
So I'd suggest starting Duolin inhaler instead of albuterol.

Hope I have solved your query.

I will be happy to help you further.

Wish you good health.
Thanks.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Kaushal Bhavsar 31 hours later
Hello again Dr. Bhavsar! You are fielding several of my recent questions and I thank you for such.

Would levosalbutamol cause similar reactions in the body to albuterol? It sounds related. Albuterol makes my heart rate too fast and I would want to avoid such effects if posed in drugs related to albuterol.

So is a Duolin inhaler a combination of a short-acting beta agonist bronchodilator plus an antimuscarinic bronchodilator?

doctor
Answered by Dr. Kaushal Bhavsar 9 minutes later
Brief Answer:
Yes, duolin is combination of SABA and SAMA.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Yes, duolin is combination of levosalbutamol (SABA - short acting beta 2 agonist) and ipratropium bromide (SAMA - short acting Muscarinic antagonist).
Levosalbutamol is similar to albuterol in terms of rapid onset of action.
But it is having less systemic side effects like tachycardia, tremors etc.
So levosalbutamol is better than albuterol.
Please let me know
1. Have you ever tried levosalbutamol?
Please reply me answer of above asked question, so that I can guide you better.
I will be happy to help you further. Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Kaushal Bhavsar 29 hours later
Thank you Dr. Bhavsar.

I have not tried levosalbutamol before.

Are there any contraindications or side effects I should know about with Duolin if I were to have my providers call in such for me to try?

Good health to you as well and regards from XXXXXXX :)
doctor
Answered by Dr. Kaushal Bhavsar 10 minutes later
Brief Answer:
Are you having any cardiac issue?

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Please let me know
1. Do you have hypertension?
2. Do you have any other heart diseases like Coronary artery disease?
Please reply me answers of above asked questions, so that I can guide you whether you should try duolin or not.
I will be happy to help you further. Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Kaushal Bhavsar 2 days later
Hello Dr. Bhavsar. :)

I do not hypertension or coronary heart disease. I do have ANCA-positive vasculitis - specificaly myeloperoxidase and proteinase-3 antibodies. Elevated myeloperoxidase can be indicative of heart damage, though I am not sure if this is in an antibody sense or other MPO sense. I also have heart ectopies - specifically ventricular couplets, PACS, PVCs, sinus arrhythmia, sinus bradycardia, and sinus tachycardia. I am predisposed towards tachycardia from stimulating agents, so if duolin is similar enough to traditional albuterol in this side effect regard I'd want to avoid usage. An additional option might levalbuterol...I think this may be chemically different from albuterol - in XXXXXXX this is called Xopenex.

Looking forward to your reply,

Cory
doctor
Answered by Dr. Kaushal Bhavsar 1 hour later
Brief Answer:
Yes, you can try levoalbuterol.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
See, some degree of tachycardia is always seen with short acting beta 2 agonist (SABA).
But levo isomers (levoalbuterol and levosalbutamol) are less prone for causing tachycardia.
So in my opinion, you should first try levoalbuterol.
If it works then it is good.
If it doesn't work, go for duolin.
Also ask whether you have plain ipratropium bromide without levosalbutamol.
If this is available in your country it would be best.
In XXXXXXX plain ipratropium is not available.
Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Kaushal Bhavsar 22 hours later
Thank you kindly Dr. Bhavsar,

I have my providers calling in levoalbuterol rescue inhalers, as you suggest.

Ipratropium bromide is used in XXXXXXX in ER contexts as a nebulized medication for breathing troubles combined with nebulized albuterol. I believe it may also be available as an inhaler for COPD patients, but for purposes of resolving pulmonary mucus accumulation and not airway opening. Is it your position that ipratropium bromide, if available here as an inhaler, could be used on a PRN basis as a rescue inhaler, whether independently or in concert with SABA rescue inhalers?

My thanks for your words and wishes. I wish you fulfilled life purposes.

doctor
Answered by Dr. Kaushal Bhavsar 29 minutes later
Brief Answer:
Combination will give you better relief.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Ipratropium bromide is short acting Muscarinic antagonist (SAMA).
It can be used alone but unfortunately in XXXXXXX it is not available alone.
It is having bronchodilator, mucolytic and expectorant actions.
It would be more effective if taken in combination with levosalbutamol or levoalbuterol.
I am glad that you will get levoalbuterol.
Hope I have solved your query.
If you are not having further queries, then please close the conversation and rate my answer.
You can ask me directly on bit.ly/askdrkaushalbhavsar. Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Yogesh D
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