acuity mutual insurance

FP Revolution Dawn of a New Age of Health Information
published by

Colin P Kopes-Kerr, MD
Santa Rosa Family Medicine Residency Program Santa Rosa CA 95404

END-OF-THE YEAR ROUND-UP 2008 THE NEW WORLD OF ASTHMA INHALERS:(1) We are coming to the end of the period characterized by an unpredictable mix of CFC and HFA inhalers, each with a different set of instructions. Since so much of effective asthma care depends on the proper use of inhalers, all physicians need to refamiliarize themselves with the basic instructions for the new inhalers. The old CFC inhalers will no longer be available after December 31st, 2008. The policy behind this relies on cost-analyses: It is projected to cost about $118 million over the period from 2009-2017 with the switch to the new, more expensive inhalers. This will, however, avoid further depletion of the ozone layer over the period of 1990-2165; continued depletion would have resulted in an estimated public health expense of $4.3 trillion and 6.3 million American lives. So it is kind of a no-brainer. In January 2009 there will be 4 different Albuterol HFA inhalers and each will have a dose counter to inform the patient how much medication remains after each use:

ProAir HFA: Requires priming 3 times upon opening and after 2 weeks of disuse.

Proventil HFA: Requires priming 4 times on opening and 2 times after 4 days of disuses.

Ventolin HFA: Requires priming 4 times on opening and 4 times after 2 weeks. Discard 2 months after removing from pouch.

Xopenex HFA: Requires priming 4 times on opening and after 3 days of disuse.

All MDIs need to be primed again if dropped.

For patients using HFA inhalers they have a different feel. The spray is described as softer since the actuator supplies less force; this results in a smaller plume. To use it the HFA inhaler should be placed in the mouth between the teeth to make up for the lesser force of the spray. Placing the inhaler in front of an open mouth is not effective for this type of inhaler. There is no difference in the procedure for washing the spacer/valved holding chamber. Clogging of HFA albuterol actuators has been reported. The medication canister should be removed weekly and flushed under running warm water for 30 seconds, shaken to remove excess water, then allowed to dry overnight. The actuator should not be dried with a towel, to avoid clogging the nozzle with fibers from the towel. [Thanks to CHW, Pat Christiansen, for bring this article to my attention.] DOES SCREENING COLONOSCOPY PREVENT COLON CANCER? Not as far as we know. There are no randomized trials supporting the benefit of colonoscopy alone for the prevention of colon cancer; the limited evidence suggesting benefit is indirect.(2) In this report of a population-based analysis of colonoscopy and colon