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Month: August 2018

Bronchodilators evolve better and safer

Bronchodilators evolve better and safer

Dear Dr. K:  I recently heard that the “black-box” warnings on LABAs (long-lasting bronchodilators) has been removed.  Is that true, and are LABAs safe?

These are two great questions.  The answer to both is “yes”.  It’s best, however, that we explain a few things.  The two most common of these bronchodilators are Formoterol and Salmeterol.  They are basically long-acting forms of Albuterol.  When they first became available about 20 years ago they could be used as a single agent to treat asthma.  It soon became apparent this was not a good idea in moderate-to-severe asthmatics because they don’t treat the underlying inflammation that causes the asthma in the first place.

Until this was understood there were some asthmatics who were hospitalized or even died because of severe exacerbation of their asthma.  This led the FDA to do two things:  No. 1. To require the black-box labeling, and No. 2. To issue specific guidelines never to use LABAs by themselves, but only in combination with an inhaled steroid.

Once these guidelines were instituted, a number of academic studies have shown that these medications not only help control moderate and severe asthma, but also reduce hospitalizations and mortality.

It is for this reason that the FDA decided to do what is rarely done, and that is to remove the black-box warning.  Their rationale for doing so is to eliminate patients’ fear of taking a medicine that could truly help (and not harm) them.

An allergy shot for Alzheimer’s? In the pipeline. . .

An allergy shot for Alzheimer’s? In the pipeline. . .

By:  Sasha Klemawesch, RN, MD

Well…sort of.  Alzheimer’s has been and continues to be one of the most frustrating diseases for researchers, patients, and caregivers alike.  But there may be hope on the horizon.

A new immune therapy called Aducanumab – an antibody against B-Amyloid – is undergoing human testing right now.  B-Amyloid leads to plaque creation and deposition in the brain, and those plaques, along with neurofibrillary tangles  caused by the Tau protein, are the two key pathologic findings in the neuro-degeneration seen in Alzheimer’s.

The early data is promising; the drug has shown to significantly decrease plaque burden in the recipients’ brains, and many of those same patients showed delay in cognitive decline based on a simple mental status test.  However, they did not have similar clinical improvements in cognition scores on more complex/comprehensive testing.  It is also not known whether this drug may be able  to prevent high-risk populations from developing the disease in the first place.

Obviously, more testing needs to be done, but this drug has been hailed by many Alzheimer’s researchers as “very exciting”  and overall, the best news we’ve had in 25 years of Alzheimer’s clinical research.

In the meantime, there are a few basic things you can do that have already been proven to help decrease your risk for dementia:

Exercise: Staying active helps in several ways; angiogenesis neurogenesis, and synaptogenesis.  In lay terms, exercise improves blood flow (and therefore oxygen) to and in the brain, helps prevent brain cell loss and improves the connection between brain cells.

Sleep:  The B-Amyloid we just talked about?  The body normally clears it out while you sleep, and studies have shown that even one night of sleep deprivation can lead to an increase in that protein.

Wear a helmet:  sustaining certain types of traumatic brain injuries may increase the risk for developing Alzheimer’s and other forms of dementia.

Eat right:  heart healthy diets like the DASH or Mediterranean diets are good, not only for your heart, but evidence has shown they can protect the brain as well.

Don’t worry, be happy:  multiple studies have shown that older adults who are depressed are more than 50% more likely to develop dementia.

Eczema med Dupixent may also offer major benefits to asthmatics

Eczema med Dupixent may also offer major benefits to asthmatics

In a previous newsletter we discussed the new biologic drug Dupixent (Dupilumab) as a true “Godsend” for severe eczema.  By way of reminder, it is a monoclonal antibody that blocks the interleukin-4 receptor, and thereby prevents the inflammation that causes eczema.  This medicine has proven to be both safe and effective, and the injections can be done at home.

Because interleukin-4 also plays a big role in asthmatic inflammation, researchers at Washington University have studied its benefits in severe steroid-dependent asthmatics.  Their study showed it to be both safe and effective for this disease also.

Dupixent use saw a 70% decrease in need for systemic steroids, and 59% fewer asthmatic attacks.

If other scientists confirm these finding it might allow the FDA to approve Dupixent for asthma therapy.  At present the monoclonal antibodies for severe asthma (Xolair, Fasenra, Cinqair and Nucala) work very well, but must be administered in a doctor’s office.  Dupixent may offer an at-home alternative.

Summer means lots of swimming fun, but remember to stay alert and aware

Summer means lots of swimming fun, but remember to stay alert and aware

Bathing in warm sulfur spring water has been touted for its potential health benefits, but some susceptible individuals – especially allergic people who may tend to have dry skin or eczema – may turn up with a severe skin rash from exposure to this water.

Typically, the rash appears suddenly about 24 hours after the water exposure.  The rash is red with a look of “punched out” ulcers and pits.  It is caused by the acidic nature of the hydrogen sulfide, sulfate and sulfur that are in the water.

Many of the aquifers here in Florida are rich in these natural sulfur compounds.

Care also needs to be taken if area health authorities post warnings of bacteria risks if warm, shallow lake water gets inhaled.

Just be cautious and enjoy those summer splashes!

Q – Tips : Summer is here

Q – Tips : Summer is here

Summer is grass pollen season in Florida and throughout the United States.  This summer’s weather pattern has led to higher than usual pollen levels.  One simple measure to reduce grass pollen is to mow the lawn more frequently.  The pollen comes from tall “overgrown” grass stalks that contain the flowering plant heads.


Q Tips: NAC

Q Tips: NAC

If you’re looking for help with breaking up thick mucus in the sinuses or lungs, try N-Acetyl-Cysteine (NAC).  NAC is a stable form of the amino acid L-cysteine and has a wonderful benefit of loosening and lessening thick mucus.  Because it is basically an amino acid (a building block for proteins), it is considered a food supplement and is safe to use.