Asthma Inhalers

[Haze]

Do any of you have asthma?

(or even if you don't, come in and sit down, I'll put the kettle on!)


What inhaler(s) do you use?

What are the good and bad things about them?

Or what could be better about their form, function, styling, material use.... whatever!


How does the inhaler fit with the rest of the stuff you carry around all the time? Or for a specific activity?

(Phone, wallet, keys, PDA, mp3, diary, etc. - your "personal kit" - the contents of your pockets / handbag)


Looking particularly at the "spray" canister - MDI (metered dose inhaler) ones, ventolin and the like, but just any comments about any inhaler will do.


Go, Discuss!

(You would really be helping me...)


Thank you wonderful people


- Haze

[Peach]

Used to lean on Ventolin. Now I rarely use it. A couple of years ago I switched to a regimen of HEPA airfilter in the bedroom, anti-allergenic mattress cover, cats not allowed in bedroom, Claritin every day, Flonase every day. I also don't go out with the kids to play ultimate frisbee at practice in the summer. The improvement has been steady.

Depends on what sets your asthma off, obviously. In my case dust, cats, & various plant stuff. Oh, yeah, and Christmas trees give me an instant case of bronchitis, my allergist says because of a chemical they're treated with, so I'm switching to artificial this year.

I used to think my asthma was exercise-induced, or worse stress-related (the wheezing made me feel like crying, and crying made me feel like wheezing), but since I went on the new regimen I don't have problems when I fence.

If you carry the inhaler around, rinse it off regularly. Even though you have the cap on the end, dust and fluff have a way of working their way in and there's nothing like inhaling a lungful of dust. I carried one in my fencing bag permanently, and one in my purse.

[MIke Bauer]

Peach speaks wisely.

Asthma is a disease of inflammation (that leads to bronchial spasm, air trapping, shortness of breath and other bad stuff). If the underlying inflammatory process is not under control, you will *always* be behind the 8-ball, and can be missing a chance to stave off irreversible damage that will get you in the end.

Notice that Peach doesn't need the Ventolin since the institution of a proper and comprehensive treatment plan. Get a REALLY Good allergist (or pulmonologist) to help you. This is too serious to goof around with. The most important thing to know, is that the chronic inflammation of today leads to the dysfunctional remodeling of tomorrow's lungs--It can catch up to you in the Worst Way.

FYI-all symptom-treating inhalers contain some sort of "beta-2 agonist" either short- or long-acting. These relax bronchial smooth muscle. Some contain additional medications, such as anti-inflammatory agents. The difference between short-acting b2a medications are not nearly as important as is the differences between proper and improper medication delivery techniques and dosage timing.

[darius]

My asthma was treated with a strong combination of bullheadedness combined with denial. That unwilling, Ventolin is good.

However, the ragweed in mid-August kills me -- enough that my doctor berates me for not going to the emergency room and prescribes a large dosage of prednisone. That, plus my low body weight and high metabolism, worked wonders for my cheery disposition.

As a maintenance drug, I'm really sold on Advair. Nothing else (Singulair, Claritin, etc...) seemed to work, but since I started tracking peak flow, Advar got me through the ugly season with very few issues.

Unfortunately, it's expensive -- after rent, food, and car payment, it's my #4 expense.

darius

[sabrebelle]

In high school I was on a combination of Intal and Ventolin. The former didn't make any noticeable improvement, so I stopped using is for about 6 years. I learned to control my exercise-induced asthma with only an occassional emergency inhaler.

My last year of college, and my fourth year fencing, I finally realized that I had reached a point where my lungs were the only thing holding me back. Now I take Advair daily (when I can afford it), and Albuterol for rescue. Two weeks after starting Advair, I fenced 4 sabre events at Summer Nationals without having an asthma attack. Before, I would only be able to breath into my 2nd DE, if I was lucky. I swear by Advair now, even though it makes my voice kind of scratchy. It's worth it just to know that it's my fault when I lose a bout, and not because I stopped breathing. Oh yeah, and not having to think about breathing in my daily life is good, too.

The only problem I have with Albuterol is that it makes me shake, which can sometimes mess up my blade control.

[Capt. Slo-mo]

Let's not forget, fair fencer folks, that many of the ingredients found in asthma inhalers are banned substances under USFA rules.

If you use them, it's prudent to get a copy of the doctor's prescription and file the appropriate notification paperwork with the USFA each year.

[Peach]

Originally posted by Capt. Slo-mo
Let's not forget, fair fencer folks, that many of the ingredients found in asthma inhalers are banned substances under USFA rules.

If you use them, it's prudent to get a copy of the doctor's prescription and file the appropriate notification paperwork with the USFA each year.

Ventolin (albuterol) inhalers are permitted with the paperwork. The inhaled steroids are not, IIRC.

[Gav]

Yup I am an Asthmatic as well.

Ventolin is a steroid and is considered a controlled substance on the Olympic drugs list. As is my preventor (Ventolin is a reliever) Seretide. There would be no problem competing on them providing that you can prove that you have a history of Asthma (there are official regulations ut basically a note from the doctor will do). To the best of my knowledge there is not a drug that is listed as banned where it is needed for medical reasons.

[John Nguyen]

I have asthmas which acts up when i exercise. But I made a risky and dangerous decision to go off my inhaler 4yrs ago in high school. (I wanted to join the military and get an ROTC Scholarship)...I tell you, after stopping the inhaler use, I had about 2 months of attacks where I would have to just NOT do anything and sit in my room and weeze.

After running and exercising more and more, initially I had more attacks, but then my body adjusted. My lung capacity increased, and it aided where my asthma crippled.

Essentially, I believe I beat the asthma, though I am not as physically fit as I could be without the asthma, i like to think that not having any trouble breathing in a few yrs, was well worth the initial pain. I would not suggest this method to anyone, but just thought i'd share. Of course, I feel it has worked since I definately lead a more active lifestyle (GO ARMY) and i haven't had an attack in years.

Im definately not in the medical profession, but the concept of a steroid seems just seems like its a crutch. And maybe its because my "brand" of Asthma was induced by exercise...but I dont think a steroid is a good idea...it made me dependant for the 4yrs I was on it, and definately put me back at square one EVERY time i missed a dose.

[Peach]

I suspect what happened was that some of your allergies waned, which does happen.

I recommend strongly against "toughing it out" for anyone, because what results is not tougher lungs, but damaged lungs. They don't recover their full function. Inhalers may be a "crutch," but to extend the metaphor, a crutch is what allows your broken bone to heal instead of knitting incorrectly or staying infected.

[John Nguyen]

Indeed, you are correct. Toughing it out is NOT a suggestion. Merely what I did, and has since worked for the past few years. And not all asthmatics have the same triggers. I do feel that many rely, from what i've seen, psychologically on thier inhalers. It is one thing to need it physically, and another to depend on it. A crutch will heal a broken bone. However, it is more like eyeglasses, where you need those for the rest of your life.

Asthma is not an infection or virus, it does not get better, and rarely goes away, its a lifestyle. (and by better, I mean...you are never truly in a state of independence from it...) Some methods work, some don't...but again, i just presented the method which has seemingly worked for me.

[Haze]

Ok, thanks for all your replies, this is all very useful stuff...


Now I need to give it a bit more direction:

I personally have had an inhaler for asthma since the age of 11 (now 21), so I know lots about the condition itself.

I am asking the questions in this case as an Industrial Design student - I am redesigning the MDI-type inhaler for my final year project...

...with particular attention to sustainability issues (use of materials, recycling, etc.) use and interaction (including when not specifically being used, since its something we have to carry all the time), and reducing the stigma that can be associated with the use of inhalers (particularly amongst children and young people but also adults in some cases) by designing and styling.


I had this idea that, with young people, the inhaler could be made to fit more inline with the sort of products they carry around, such as mobile phone, mp3 player, etc. - but I also want the product to be an acceptable (and more pleasing) alternative to current inhalers for the mainstream adult market.


anyone got anymore comments now? or questions for that matter?

Thanks everso,

Haze

[Haze]

and by all means I dont want to stop your conversations about asthma in general, is a topic I would def. read even if it wasnt related to my work.

[npkeith]

Speaking as an ex- emergency room nurse (and current nurse practitioner) the thing I would really like to see is some way to add a spacer to the MDI. For those of you who don't know or haven't used one, an MDI is actually quite hard to use truly effectively. If you don't time things just right (Inhaling as the spray is being delivered) the medication ends up sticking to the membranes of your mouth. It is then swallowed which either does nothing (for instance in the case of ventolin, where the oral dose is much higher than the inhaled dose), or can lead to thrush (candida) of the mouth and throat. even if you do time things right, you tend to take a short sharp breath that only fills the top of your lungs properly.
A much better way is to use a spacer, which is basically a plastic tube that you fire the MDI into, then breath in through. The spacer holds the mist of medication for a few seconds so you don't have to be perfect with the timing. There is also sometimes a whistle thing attached that forces you to take a slower, deeper inhalation ("If you hear the train whistle, slow down your breath") so the medication is delivered all the way to the bottom of your lungs. Much easier for kids or older folks to use.

Could you do something with a bunch of concentric rings of plastic that collapse down for easy carring, but can be extended with just a tug?

[Peach]

It's not a bad design as is, but what would really make a good design is an easy way of personalizing it--I can't tell you how many times I've looked for my inhaler and found one at the club or at a tournament, next to others that look just like it, and I can't tell which one is mine.

[dunastor]

Originally posted by Gav
Ventolin is a steroid.

I don't know where you got that idea. Ventolin, or the generic salbutamol is a selective beta-2 receptor agonist, which works by dilating the bronchioles.

As is my preventor (Ventolin is a reliever) Seretide.

Seretide is a combination of salmeterol and fluticason. Salmeterol is a longer working beta-2 receptor agonist, and fluticason is a inhalation steroid.

The general idea of asthma therapy is to suppress inflammation by using steroids regularly, thus also preventing outbursts of shortness of breath. When that's not enough one can control outbursts with a beta agonist.
On the other hand, when there are rarely problems, or in specific situations, one can get only a beta agonist for those situations.

To the best of my knowledge there is not a drug that is listed as banned where it is needed for medical reasons.

I don't think that's entirely correct.
for example systemic steroids are not permitted, even when prescribed by a doctor. Only intra-articular injections are allowed with a medical notification. So if you're using steroids orally, intravenously or intramuscular, don't go to any tournament.... (btw if you're using iv medication, sporting won't be easy anyway..)

[sabrebelle]

A flatter Ventolin inhaler would be easier to carry around. I always had a hard time stuffing it in my pocket. As for materials use, I love the design of the Advair inhaler, but it really should be refillable...and not purple. There are so many ways that the traditional inhaler could be streamlined and modernized design-wise, but you would have to consider how "cool" you want a drug to look in the hands of a kid.

[Zelda]

The design of the seritide inhaler is good (flat and round) but you cant get it damp (as I found out to my detriment when I was on it for post viral infection from goodness knows what). I personally find the ventolin inhaler akward to carry around in a purse. For me at least when I was taking these types of meds (have stopped as I didnt like the weight gain) I would like something flat, water proof and easy to inhale (a spacer is a great idea).

[Haze]

Sorry this is a bit of an essay, but this is what I have got from what you have all said.

I hate to do more "brain-picking" but does any of this spur any more thoughts or suggestions?

(some great suggestions so far by the way!)


So... :

- flat, waterproof, easy to inhale

- smoother, flatter shape, more easy to pocket

- consideration of level of appeal (+ possible over-appeal) of the device:

This is a very valid point that will be quite challenging to address. I think perhaps a more comfortable shape may be enough to encourage the use and carrying of such a product when this is necessary, without any "loud" or overstated aesthetic colour / style changes.

My friend has some insulin pens from when she was a child that have a body of red, blue and yellow instead of the more subtle cream/beige and green of her newer ones. This is an example of a very basic change designed to suit kids better, but obviously this carries issues of its own. Maybe looking into the pros and cons of this approach could be a starting point though.

Also there are issues of "security" in the sense that kids are often not allowed to keep their inhalers with them at school (I had to walk to the school office 2 buildings away to get mine if I needed it!), presumably due to not wanting other kids to get their hands on the inhaler, and also as the child with asthma may lose it. Again not sure how this one can be addressed.

In terms of adults at least, I have considered ways of making the inhaler fit with the feelings of the user towards it, I.e. the device can be used discreetly, hidden within the hand, etc. but also if the user wants something that looks a bit more trendy (for want of a better word) to carry around or leave on their desk or whatever then it supports this ideal too.


- an easy way of personalising the inhaler (but not too much in light of the "over-appeal" issue above)

- integration of a spacer somehow, look at design of spacer or way of achieving equivalent air flow/space effect which is much more portable:

This is an idea which has quite a lot of "ground" to it, as the use of a spacer seems much more effective than without, and there are suggestions that much less medication is then needed to achieve the same effect. There are MDI-style inhalers that are "breath-actuated" which I need to look into more, one of the major ones was designed by a local consultancy. I have a few admittedly fairly radical concept ideas based on the "spacing" of the medication, related to the fact that air could be contained by a flexible (and thus easily collapsible/portable) material, but like I said this is only a "blue sky" concept.


As an aside, I think there is issue to be taken with the sound that inhalers tend to make when in use, when the medication is being inhaled. The sound often draws attention to the user, in some cases other people in the room may not have been aware that an inhaler was being used until they heard it. This could be an additional benefit of spacer integration.

...And all ensuring that the existing function is not compromised, and hopefully improving on it!

(also the previous more "medical" comments made will provide some direction)

[npkeith]

One comment on the "customizable" thing - in the states, MDI's have known color combinations for different drugs -
brand name ventolin comes in a gray-blue body with a darker blue cap, and combivent comes with a body that is white and clear plastic so that you can see the aerosol container inside it. I used to have a chart on my clipboard that would allow me to identify MDI's (even different strengths of the same meds) just by looking at them. Allowing people to add their own colors might mess that up.

I don't know how things work in europe.

-Keith