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  • After Combivent

    Combivent has been coming with stickers on saying that its to be discontinued in June. What's the recommended replacement?

    TIA

    Jeff

  • #2
    Re: After Combivent

    i read a letter coming at the pharmacy i work at today about discontinuing its use, they listed a replacement and i will let u know tomorrow when i check the replacement name.
    [COLOR=Olive]xxxx They tried to break my back, but i survived. whatever doesn't kill you, will only makes you stronger xxxx
    [/COLOR]

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    • #3
      Re: After Combivent

      It depends. If they are well controlled then just switch to separate salbutamol and ipratropium inhalers. If they are not well controlled then consider using salbutamol and tiotropium.

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      • #4
        Re: After Combivent

        Originally posted by Steve G View Post
        It depends. If they are well controlled then just switch to separate salbutamol and ipratropium inhalers. If they are not well controlled then consider using salbutamol and tiotropium.


        Tiotropium is only licensed for COPD so asthmatic patients currently using combivent SHOULD NOT be given tiotropium
        Kemzo the pharmacist forumly known as kemzero

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        • #5
          Re: After Combivent

          but combivent is only licensed for use in COPD.

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          • #6
            Re: After Combivent

            Originally posted by Steve G View Post
            but combivent is only licensed for use in COPD.

            Indeed it is , but unfortunately pre-New GMS contract days , quite a few practices weren't offering reversibility tests(spirometery) so a number of COPD and asthma patients didn't have conclusive diagnosis.......hence some asthma patients were put on combivent even though its not licensed for it.

            As tiotropium is a fairly recent drug, I'll be surprised if anyone with reversible airways is on it.....
            Last edited by kemzero; 6, June 2008, 04:09 PM.
            Kemzo the pharmacist forumly known as kemzero

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            • #7
              Re: After Combivent

              abviously combivent was a combination of salbutamol and ipratrapium, so the patient should be changed to atrovent inhaler and salbutamol, and have the inconvenience of having to use two inhalers instead of the one. Although like stated tiotropium could be a better alternative if compliance and other therapeutic issues arise,

              and btw i know most people know, but just to restate, doctors can prescribe anything for anything,literally!!!! although most of the time the unlicensed use is from an informed position, however a doctor could one day decide he wants to treat a patient's asthma with paracetamol, now everyone knows paracetmol is not going to help, and in the case that something happens to the patient because of the "untreated" asthma, the doctor would be liable for this, (probs wont be struck off though), people who might be thinking well the pharmacist would surely not dispense in this case, well first pharmacists arent needed to authorise dispensing of all medicne e.g. hospital/ dispensing GP, and also how many times do pharmacist ask the patient what the doctor gave them paracetmol for, lol.

              so many doctors in the case of cases like asthma and COPD base the treatment on theyre experience not on the licensed indication of drugs because not all cases in real life are black or white/asthma or COPD could be a varying mixture of both.

              enough said!!!!!!!
              We are the music makers, We are the dreamers of dreams and God damn we are that good

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              • #8
                Re: After Combivent

                Hi Solomon Q

                .....don't agree with the last part of your statement viz : varying mixture of both
                Your airways are either reversible or not and this is conclusive only by spirometry
                Irreverisble= COPD , physician/prescriber should follow guidelines
                Reversible=Asthma ,physician/prescriber should follow guidleines,
                BTS/SIGN... all out there to improve patient care,IMHO any clinican worth their salt should practice evidence-based medicine , whilst pharmacists should support them ( where appropriate) in doing so
                Last edited by kemzero; 7, June 2008, 08:53 PM. Reason: ed
                Kemzo the pharmacist forumly known as kemzero

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                • #9
                  Re: After Combivent

                  Hey kemzo, I see why you would say that but consider http://www.chestjournal.org/cgi/reprint/112/5/1234.pdf

                  dont expect you to read all but here is the summary:

                  "the inflammatory nature of asthma has been appreciated, the possibility exists that long-term asthma could lead to chronic, irreversible airways obstruction has been
                  acknowledged"

                  "...three types of findings in patients with asthma: (1) those never achieving a normal peak flow, but showing a reversible component; (2) those having a reversible FVC but an irreversible decrease in FEV2 and peak flow; and (3) the "drifter," with irreversible airways obstruction gradually improving over weeks of intensive therapy"

                  "We have described a series of eight patients with long-standing asthma who
                  demonstrate irreversible airways obstruction despite long-term systemic and inhaled corticosteroids. The term "end-stage asthma" or irreversible asthma might be applied to these patients in whom fixed obstruction has occurred in the absence of other pulmonary diseases."

                  just three small but to the point quotes form this journal article, I dont expect you to read it all but its a good one on this type of asthma.

                  We are the music makers, We are the dreamers of dreams and God damn we are that good

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                  • #10
                    Re: After Combivent

                    Originally posted by kemzero View Post
                    Hi Solomon Q

                    .....don't agree with the last part of your statement viz : varying mixture of both
                    Your airways are either reversible or not and this is conclusive only by spirometry
                    Irreverisble= COPD , physician/prescriber should follow guidelines
                    Reversible=Asthma ,physician/prescriber should follow guidleines,
                    BTS/SIGN... all out there to improve patient care,IMHO any clinican worth their salt should practice evidence-based medicine , whilst pharmacists should support them ( where appropriate) in doing so
                    Disagree. COPD and asthma are different conditions with different pathophysiologies. It is possible for them to co-exist. see, for example http://www.npc.co.uk/MeReC_Briefings...fing_no_33.pdf pg 2 col 1.
                    "...asthma should be excluded, although the two conditions commonly co-exist."

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                    • #11
                      Re: After Combivent

                      will catch up o some reading

                      Did read the revised BT/Sign guidelines 2 weeks ago..might av missed something
                      Kemzo the pharmacist forumly known as kemzero

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