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More about treating asthma – focus on Qvar

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Asthma InhalerIn March 2024, we published a blog that covered the wider subjects of breathing difficulties coming from Chronic Obstructive Pulmonary Disease (COPD), Asthma, and ACOS (Asthma-COPD Overlap Syndrome), which dealt mostly with the signs and causes of these conditions, with only brief reference to the treatments. Following its publication, we have received a number of queries from readers for more specific help in identifying the best available treatments for asthma. This blog focuses on just one of the conditions – asthma. We will hone in on QVAR AutoHaler, one of the most widely prescribed medications for treating asthma. 

More about asthma

Asthma is a long-term condition characterized by sudden episodes that make breathing hard due to inflamed and narrowed airways. This experience requires two separate therapy strategies. The first is to quickly and effectively relieve the distress of breathing difficulty. The second is therapeutic, to lessen the frequency and extent of asthma attacks when they do occur. This blog only deals with the latter, looking at the leading therapeutic product, QVAR.

Most asthma cases (around 80%) first develop in childhood. For allergic asthma (with a clear trigger), this usually happens within the first six years of life. For other forms of asthma, the onset is more likely between 12 and 18. Asthma often persists throughout life and is highest among adults. Around 27 million US adults and approximately five million children have asthma. 

The exact cause of asthma remains uncertain, but scientists have highlighted factors like genetics, allergies, and environmental exposures that can play a significant role. This means that individuals with a family history of asthma or allergic conditions are at higher risk. Asthma attacks can be triggered by exposure to substances that can cause sensitivity reactions, ranging from car exhaust or factory emissions to dust mites, mold spores, dead pet skin (dander), tobacco smoke, and chemicals. During an attack, muscles around the airways tighten up, causing inflammation and swelling, while excess mucus blocks airflow, resulting in severe oxygen deprivation.

People can minimize their exposure to allergens, pollutants, fumes, and secondhand smoke and potentially reduce the risk of developing asthma. However, people with a built-in allergy may be limited in the steps that can be taken. For all people with asthma, having a good rescue inhaler like Ventolin on hand is essential. It can reduce congestion quickly and restore normal breathing. A rescue inhaler may only help stop an asthma attack after it has begun – it is not a preventive against further asthma attacks.

More about QVAR 

QVAR is a prophylactic therapy that can help prevent asthma attacks before they even happen. It is not the same as a rescue inhaler, which is needed to provide relief when an asthma attack is already underway. 

QVAR AutoHaler contains a corticosteroid called beclomethasone that acts on many sites to help reverse the pathologic process of bronchial asthma. Beclamethosone works in several ways to help manage asthma. It strengthens the effects of other medications that relax the airway muscles, easing the tightness. It can also reduce inflammation by shrinking the swollen airway lining and constricting blood vessels to limit fluid buildup. It can prevent the release of substances that cause inflammation. 

Beclamethosone reduces mucus production by blocking signals that trigger lung cells to make more mucus. It further controls asthma by reducing the immune system’s overreaction to irritants and preventing inflammation-related damage caused by white blood cells.

Asthmatics may already have inflammation in the linings of the airways, which makes them more susceptible to an asthma attack if even the smallest amount of their trigger is inhaled. Beclomethasone can help to reduce airway inflammation, which can be an aggravator of asthma symptoms and attacks. It also helps reduce the need for a rescue inhaler and helps improve breathing.

Used twice a day, QVAR AutoHaler will help:

  • Reduce airway inflammation (an underlying cause of asthma symptoms and attacks)
  • Reduce the need to use a rescue inhaler
  • Improve breathing 

How does a person living with asthma know that they need more than just a rescue inhaler?

Anyone who relies on a rescue inhaler more than twice a week should consider that their asthma is not under control. This applies not just to handling actual bouts of acute breathing problems but also when symptoms of breathing difficulty occur more than twice a week or sleep is interrupted by breathing problems more than twice per month.

How does the QVAR AutoHaler work?

Inflammation and swelling associated with asthma occur in all areas of the lungs and linings of the bronchial airways.

The small particles of inhaled corticosteroid delivered with each inhalation of QVAR target both the large and small airways to the lungs and air sacs inside the lungs. Medication that targets both areas is vital for achieving asthma control.

The QVAR AutoHaler has a simple design that eliminates the need for synchronizing hand movements and breathing while inhaling a dose, and there is no need for washing or sanitizing the device after use.

The delivery system for a single dose is very simple:

  1. Remove the cover from the mouthpiece
  2. Raise the lever at the top of the device
  3. Breathe out as far as possible
  4. Place the mouthpiece in the mouth and close the lips around it, forming a good seal
  5. Breathe in slowly and deeply through the mouthpiece to release a measured dose of beclomethasone. Continue inhaling as the dose is delivered for as long as comfortable
  6. Remove the inhaler and hold breath for 10 seconds, then breathe out slowly
  7. Lower the lever
  8. Replace the cap.

If the treating healthcare provider has prescribed more than one inhalation per dose, simply repeat steps 2-7 as many times as needed. After taking the prescribed number of inhalations, rinse the mouth with water without swallowing to help reduce the risk of a fungal infection (thrush).

The inhaler doesn’t need priming by being shaken.

What is the difference between QVAR AutoHaler and QVAR RediHaler?

In 2019, the manufacturer of the QVAR inhaler submitted a request to the FDA for switching the approval of QVAR AutoHaler over to QVAR RediHaler, which is a new form of the inhaler that delivers exactly the same dose of beclomethasone, with a simpler delivery mechanism. The regulation of approved drugs is controlled by the Drug Price Competition and Patent Term Restoration Act of 1984, which required the withdrawal of QVAR AutoHaler before QVAR RediHaler could be registered. However, outside the US, QVAR AutoHaler is still being marketed in many countries, including Israel, Canada, the UK, and the EU.

It’s important to remember that QVAR AutoHaler and QVAR RediHaler are therapeutically identical, delivering exactly the same quantity of the active ingredient (beclomethasone) with each dose. The only difference is that with QVAR RediHaler, there is no need to flip a lever to open the airway before taking a dose and then to close the lever. It’s a slightly simpler operation. The therapeutic equivalence is supported by the FDA’s determination under the act that “the QVAR 40 and QVAR 80 (beclomethasone) inhalation aerosol were not withdrawn for reasons of safety or effectiveness.” The manufacturer of QVAR made a business decision to discontinue marketing QVAR AutoHaler in the US, but it was not withdrawn from sale in other markets.

Who can use QVAR AutoHaler?

QVAR AutoHaler can be used as a prophylactic treatment for the prevention and control of asthma in people four years of age and older. QVAR RediHaler doesn’t substitute for a rescue inhaler and does not relieve sudden breathing problems.

How effective is QVAR

In a randomized, double-blind, placebo-controlled clinical study of patients 12 years of age and older with symptomatic asthma, the subjects receiving either 80 mcg or 160 mcg per day of QVAR achieved significantly greater improvement in Forced Expiratory Volume in 1 Second (FEV1), which is the standard way of measuring lung function.

Why buy QVAR AutoHaler from IsraelPharm?

Remembering that the differences between QVAR RediHaler and QVAR AutoHaler are very small and do not interfere in any way with the effectiveness of the medicine, it makes great sense to stock up on QVAR from IsraelPharm.

Product
QVAR RediHaler 80 mcg US retail price – $340
QVAR AutoHaler 100 mcg IsraelPharm price – $63

 

Questions people ask

How does asthma affect a child’s growth?

Some studies have suggested that asthma may negatively impact children’s growth. However, different studies suggest that this is largely a transient effect due only to the delayed onset of puberty.

What are the side effects of QVAR steroid inhaler?

Like all medications, QVAR can produce some unwanted side effects. These include hoarseness, difficulty in swallowing, swollen glands, earache and sore throat, mouth sores (less likely to occur if the mouth is washed after every use), changes in taste, nausea, tremors, blurred vision, or dizziness. These should clear up, but if they persist or worsen, ask a doctor or pharmacist for medical advice.

If a sudden allergic reaction such as swelling of the face, tongue, or throat makes it difficult to breathe or swallow, wheezing, hives, rash, and severe sloughing of the skin, see a doctor immediately or call 911 and go to an emergency room.

Is QVAR a preventer or reliever?

QVAR AutoHaler is a prophylactic that can reduce the frequency and extent of asthma attacks. It does not relieve breathing once an asthmatic attack has set in. For this, a rescue inhaler such as Ventolin is necessary.

Does QVAR relieve inflammation?

Yes. One of the main effects of inhaled corticosteroids like beclomethasone is to reduce inflammation in the linings of the airways. This can reduce the narrowing of the airways that occurs when an asthma attack is triggered.

How long does it take QVAR to work?

QVAR AutoHaler delivers a long-acting corticosteroid medication that works to lower inflammation. It can take two to three months before the full benefits are felt, although there can be some improvement almost immediately.

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