Re: Alvesco, HFA, Ethanol and Xolair

[Guest guest]

All the posts re Alvesco and ethanol really prove my point. There is

individual variation in how patients react to different steroids.

That is why physicians who actually treat patients want the ability

to mix and match steroids and Long Acting Bronchodilators (LABs)

rather than being constrained to use flovent or budesonide (advair

and symbicort).

I have been using US Alvesco for a number of months. My voice has

returned, and my adrenal glands have been restored, after years of

advair.

Ethanol I believe is used to dissolve the steroid into a solution,

which is why you do not have to shake the cannister, and it is

important for achieving the small particle size which assures deeper

penetration into the lungs.

But it may not be useful for everyone. The Alvesco labelling does

indicate that people sensitive to any ingredients should not use it.

Thus the FDA should not impose its overly paternalistic rules on

physicians and their patients in this case, and let the patients and

their physicians choose which steroid is right for them.

It is interesting this is coming up in a xolair group. I am on

xolair too, and it has helped me get off of prednisone and modulate

the symptoms, but this discussion shows it is not a cure all for many

if not most people. It seems that asthma is more than an IGE

mediated disease but involves a number of pathways, only one of which

is mediated by IGE. If that is your only pathway causing problems,

xolair may block it all, otherwise, for others, we need a combination

of medicines to regulate our immunie systems.

Good luck to everyone finding the medicine that works for them, and

tell the FDA to emphasize education and warnings, rather than

prohibition.

>

> To keep this post on topic, I would like to mention that Xolair is a

> very good drug. <smile>

>

> Now, with regard to ethanol in Alvesco. Alvesco uses HFA+ethanol as

a

> propellant/solvent. Ethanol seems to be considered by the medical

> community as safe. Although, doing some digging around (Google), it

> appears that with the introduction of HFA based inhalers, ethanol

> appeared on the scene. There are some complaints that people who use

> the new inhalers containing HFA, as the propellant, are having

> difficulty. Difficulty in that the bronchodialator does not work as

> well as the same drug being propelled by CFC. Along this line, I

> could not find an objective comment by a health professional

> suggesting or even saying that the ethanol in HFA's causes no

> problems.

>

> If you do a search on the term " HFA and ethanol " you will see that

> there are articles indicating that the ethanol inhaled through the

> HFA based inhalers does raise blood alcohol levels. It may be short

> lived, but it does happen.

>

> I believe HFA's (with ethanol) are so new that the medical

> establishment has been caught off guard.

>

> A few people have reactions to ethanol. There is a genetic situation

> that causes certain people, mostly asiatic, to have what is called

an

> alcohol flush. There is a flushing of the face, congested nose,

> swollen lips, etc. I believe I have this missing gene and react the

> same way.

>

> Alvesco really piqued my interest in reducing my steroid exposure,

> but I'm going to wait for more of a history of use to be documented

> on it.

>

> I wonder if the insurance companies will put Alvesco on their

> formulaies. It does not contain a LABA, whereas there are inhaled

> steroids that do. This would decrease their cost by eliminating a

> second drug (Rx).

>

> Anyway......we'll see. If anyone has first hand knowledge of

Alvesco,

> it would be interesting to hear from you.

>

> This quote is from Wikipedia with regard to HFA albuterol:

Registered

> complaints run the gamut from " doesn't seem to work as well " all the

> way to serious anaphylaxis in response to using an HFA or

HFA+ethanol

> inhaler.[2]

>

>

> Oh, BTW, Xolair is a good drug.

>

>

>

> Note from moderator: Ok you win LOL!

>

[Guest guest]

Hi all,

I am new to the group and have just been reading the messages.  I am glad to

hear about thie ethanol issue.  I manage a drug/alcohol treatment program in a

prison.  Many of my clients are on asthma meds.  My concern here is the

increased risk of relapse for those in recovery.  Also, anything with alcohol is

an item that may be abused.  Especially in a prison setting.  This type of

propellant may be so new that studies have not been made yet, but have you heard

of this being abused?  Thanks in advance for any input.

Mike

________________________________

From: jffosdick <yaj321@...>

Sent: Tuesday, December 16, 2008 8:57:21 AM

Subject: [ ] Alvesco, HFA, Ethanol and Xolair

To keep this post on topic, I would like to mention that Xolair is a

very good drug. <smile>

Now, with regard to ethanol in Alvesco. Alvesco uses HFA+ethanol as a

propellant/solvent. Ethanol seems to be considered by the medical

community as safe.. Although, doing some digging around (Google), it

appears that with the introduction of HFA based inhalers, ethanol

appeared on the scene. There are some complaints that people who use

the new inhalers containing HFA, as the propellant, are having

difficulty. Difficulty in that the bronchodialator does not work as

well as the same drug being propelled by CFC. Along this line, I

could not find an objective comment by a health professional

suggesting or even saying that the ethanol in HFA's causes no

problems.

If you do a search on the term " HFA and ethanol " you will see that

there are articles indicating that the ethanol inhaled through the

HFA based inhalers does raise blood alcohol levels. It may be short

lived, but it does happen.

I believe HFA's (with ethanol) are so new that the medical

establishment has been caught off guard.

A few people have reactions to ethanol. There is a genetic situation

that causes certain people, mostly asiatic, to have what is called an

alcohol flush. There is a flushing of the face, congested nose,

swollen lips, etc. I believe I have this missing gene and react the

same way.

Alvesco really piqued my interest in reducing my steroid exposure,

but I'm going to wait for more of a history of use to be documented

on it.

I wonder if the insurance companies will put Alvesco on their

formulaies. It does not contain a LABA, whereas there are inhaled

steroids that do. This would decrease their cost by eliminating a

second drug (Rx).

Anyway...... we'll see. If anyone has first hand knowledge of Alvesco,

it would be interesting to hear from you.

This quote is from Wikipedia with regard to HFA albuterol: Registered

complaints run the gamut from " doesn't seem to work as well " all the

way to serious anaphylaxis in response to using an HFA or HFA+ethanol

inhaler.[2]

Oh, BTW, Xolair is a good drug.

Note from moderator: Ok you win LOL!

[Guest guest]

You're right that not all asthma is IgE-mediated, and that many of us

will be stubborn patients who have triggers other than allergies (IgE

mediated). On top of that, most of us have experienced airway

remodeling, which means even if we do experience a lot of improvement

thanks to xolair, we may continue to be at risk of continued asthma

and need some form of anti-inflammatory because our lungs have become

just plain crap.

I switched allergists about 8 years ago, at the age of 32 and nearly

slapped my allergist when he said I had the worst lungs of any of his

patients who wasn't over 65 and a lifelong smoker.

Normally we do not discuss meds other than Xolair here, but since

Avesco is so new and most of us still have to take steroids at least

occasionally (if not daily), the moderators have been letting this

thread continue.

Addy

Group co-owner

> >

> > To keep this post on topic, I would like to mention that Xolair

is a

> > very good drug. <smile>

> >

> > Now, with regard to ethanol in Alvesco. Alvesco uses HFA+ethanol

as

> a

> > propellant/solvent. Ethanol seems to be considered by the medical

> > community as safe. Although, doing some digging around (Google),

it

> > appears that with the introduction of HFA based inhalers, ethanol

> > appeared on the scene. There are some complaints that people who

use

> > the new inhalers containing HFA, as the propellant, are having

> > difficulty. Difficulty in that the bronchodialator does not work

as

> > well as the same drug being propelled by CFC. Along this line, I

> > could not find an objective comment by a health professional

> > suggesting or even saying that the ethanol in HFA's causes no

> > problems.

> >

> > If you do a search on the term " HFA and ethanol " you will see that

> > there are articles indicating that the ethanol inhaled through the

> > HFA based inhalers does raise blood alcohol levels. It may be

short

> > lived, but it does happen.

> >

> > I believe HFA's (with ethanol) are so new that the medical

> > establishment has been caught off guard.

> >

> > A few people have reactions to ethanol. There is a genetic

situation

> > that causes certain people, mostly asiatic, to have what is

called

> an

> > alcohol flush. There is a flushing of the face, congested nose,

> > swollen lips, etc. I believe I have this missing gene and react

the

> > same way.

> >

> > Alvesco really piqued my interest in reducing my steroid exposure,

> > but I'm going to wait for more of a history of use to be

documented

> > on it.

> >

> > I wonder if the insurance companies will put Alvesco on their

> > formulaies. It does not contain a LABA, whereas there are inhaled

> > steroids that do. This would decrease their cost by eliminating a

> > second drug (Rx).

> >

> > Anyway......we'll see. If anyone has first hand knowledge of

> Alvesco,

> > it would be interesting to hear from you.

> >

> > This quote is from Wikipedia with regard to HFA albuterol:

> Registered

> > complaints run the gamut from " doesn't seem to work as well " all

the

> > way to serious anaphylaxis in response to using an HFA or

> HFA+ethanol

> > inhaler.[2]

> >

> >

> > Oh, BTW, Xolair is a good drug.

> >

> >

> >

> > Note from moderator: Ok you win LOL!

> >

>

[Guest guest]

Mike,

Have you tried contacting the pharmaceutical company to see if you

can ask a rep about how the ethanol is used and if they have any info

on its effect on blood levels and whether or not it could be abused

(similar to sniffing inhalents? I guess?)?? Also, if you have a

professional network that has some experts you can contact that might

be helpful.

I would imagine your patients in particular would benefit from an

inhaled steroid that delivers more successfully in lower doses in

order to try to prevent the mood altering side effects, but if the

trade off is triggering an alcohol relapse, that's no solution is it?

Good luck, and thanks for posting. Feel free to come back any time.

Addy

Group co-owner

>

> Hi all,

>

> I am new to the group and have just been reading the messages.  I

am glad to hear about thie ethanol issue.  I manage a drug/alcohol

treatment program in a prison.  Many of my clients are on asthma

meds.  My concern here is the increased risk of relapse for those in

recovery.  Also, anything with alcohol is an item that may be

abused.  Especially in a prison setting.  This type of propellant may

be so new that studies have not been made yet, but have you heard of

this being abused?  Thanks in advance for any input.

>

> Mike

>

>

>

>

> ________________________________

> From: jffosdick <yaj321@...>

>

> Sent: Tuesday, December 16, 2008 8:57:21 AM

> Subject: [ ] Alvesco, HFA, Ethanol and Xolair

>

>

> To keep this post on topic, I would like to mention that Xolair is

a

> very good drug. <smile>

>

> Now, with regard to ethanol in Alvesco. Alvesco uses HFA+ethanol as

a

> propellant/solvent. Ethanol seems to be considered by the medical

> community as safe.. Although, doing some digging around (Google),

it

> appears that with the introduction of HFA based inhalers, ethanol

> appeared on the scene. There are some complaints that people who

use

> the new inhalers containing HFA, as the propellant, are having

> difficulty. Difficulty in that the bronchodialator does not work as

> well as the same drug being propelled by CFC. Along this line, I

> could not find an objective comment by a health professional

> suggesting or even saying that the ethanol in HFA's causes no

> problems.

>

> If you do a search on the term " HFA and ethanol " you will see that

> there are articles indicating that the ethanol inhaled through the

> HFA based inhalers does raise blood alcohol levels. It may be short

> lived, but it does happen.

>

> I believe HFA's (with ethanol) are so new that the medical

> establishment has been caught off guard.

>

> A few people have reactions to ethanol. There is a genetic

situation

> that causes certain people, mostly asiatic, to have what is called

an

> alcohol flush. There is a flushing of the face, congested nose,

> swollen lips, etc. I believe I have this missing gene and react the

> same way.

>

> Alvesco really piqued my interest in reducing my steroid exposure,

> but I'm going to wait for more of a history of use to be documented

> on it.

>

> I wonder if the insurance companies will put Alvesco on their

> formulaies. It does not contain a LABA, whereas there are inhaled

> steroids that do. This would decrease their cost by eliminating a

> second drug (Rx).

>

> Anyway...... we'll see. If anyone has first hand knowledge of

Alvesco,

> it would be interesting to hear from you.

>

> This quote is from Wikipedia with regard to HFA albuterol:

Registered

> complaints run the gamut from " doesn't seem to work as well " all

the

> way to serious anaphylaxis in response to using an HFA or

HFA+ethanol

> inhaler.[2]

>

> Oh, BTW, Xolair is a good drug.

>

> Note from moderator: Ok you win LOL!

>

>

>

>

>

>

[Guest guest]

I appreciate hearing about new meds other asthmatics are taking.  I, too, will

still have to take asthma meds the rest of my life even though xolair has really

helped my breathing and has kept me from developing sinus infections, which in

turn has kept me off of prednisone and antibiotics for three years in January. 

As I've mentioned before, I was on antibiotics and prednisone two, three and

sometimes four times a year before xolair.

 

Adah

From: pyle456 <jamcculloch2@...>

Subject: [ ] Re: Alvesco, HFA, Ethanol and Xolair

Date: Tuesday, December 16, 2008, 3:18 PM

You're right that not all asthma is IgE-mediated, and that many of us

will be stubborn patients who have triggers other than allergies (IgE

mediated). On top of that, most of us have experienced airway

remodeling, which means even if we do experience a lot of improvement

thanks to xolair, we may continue to be at risk of continued asthma

and need some form of anti-inflammatory because our lungs have become

just plain crap.

I switched allergists about 8 years ago, at the age of 32 and nearly

slapped my allergist when he said I had the worst lungs of any of his

patients who wasn't over 65 and a lifelong smoker.

Normally we do not discuss meds other than Xolair here, but since

Avesco is so new and most of us still have to take steroids at least

occasionally (if not daily), the moderators have been letting this

thread continue.

Addy

Group co-owner

> >

> > To keep this post on topic, I would like to mention that Xolair

is a

> > very good drug. <smile>

> >

> > Now, with regard to ethanol in Alvesco. Alvesco uses HFA+ethanol

as

> a

> > propellant/solvent. Ethanol seems to be considered by the medical

> > community as safe. Although, doing some digging around (Google),

it

> > appears that with the introduction of HFA based inhalers, ethanol

> > appeared on the scene. There are some complaints that people who

use

> > the new inhalers containing HFA, as the propellant, are having

> > difficulty. Difficulty in that the bronchodialator does not work

as

> > well as the same drug being propelled by CFC. Along this line, I

> > could not find an objective comment by a health professional

> > suggesting or even saying that the ethanol in HFA's causes no

> > problems.

> >

> > If you do a search on the term " HFA and ethanol " you will see that

> > there are articles indicating that the ethanol inhaled through the

> > HFA based inhalers does raise blood alcohol levels. It may be

short

> > lived, but it does happen.

> >

> > I believe HFA's (with ethanol) are so new that the medical

> > establishment has been caught off guard.

> >

> > A few people have reactions to ethanol. There is a genetic

situation

> > that causes certain people, mostly asiatic, to have what is

called

> an

> > alcohol flush. There is a flushing of the face, congested nose,

> > swollen lips, etc. I believe I have this missing gene and react

the

> > same way.

> >

> > Alvesco really piqued my interest in reducing my steroid exposure,

> > but I'm going to wait for more of a history of use to be

documented

> > on it.

> >

> > I wonder if the insurance companies will put Alvesco on their

> > formulaies. It does not contain a LABA, whereas there are inhaled

> > steroids that do. This would decrease their cost by eliminating a

> > second drug (Rx).

> >

> > Anyway...... we'll see. If anyone has first hand knowledge of

> Alvesco,

> > it would be interesting to hear from you.

> >

> > This quote is from Wikipedia with regard to HFA albuterol:

> Registered

> > complaints run the gamut from " doesn't seem to work as well " all

the

> > way to serious anaphylaxis in response to using an HFA or

> HFA+ethanol

> > inhaler.[2]

> >

> >

> > Oh, BTW, Xolair is a good drug.

> >

> >

> >

> > Note from moderator: Ok you win LOL!

> >

>