Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG INTERACTIONS: Monoamine oxidase inhibitors (for example,
tranylcypromine) and tricyclic
antidepressants (for
example, amitriptyline (Endep)] may
increase the effect of salmeterol on the heart and blood pressure. Since Advair
Diskus contains salmeterol, it should not be used with or within two weeks of
discontinuing monoamine oxidase inhibitors or tricyclic antidepressants.
PREGNANCY: Adequate studies
of fluticasone or inhaled salmeterol
during pregnancy have not been done. Fluticasone use during pregnancy should be
avoided unless the potential benefit justifies the potential but unknown risk to
the fetus. In some, but not all, pregnant animal models exposure to very high
doses of oral salmeterol has led to offspring with birth defects. The
concentrations of salmeterol in the blood after these very high doses, however,
were much higher than the concentrations observed after inhalation. Salmeterol
inhalation should be used during pregnancy only if the potential benefit
justifies the potential risk to the fetus.
NURSING MOTHERS: It is not known if fluticasone propionate is secreted
in breast milk. Other medications in the same class as fluticasone propionate
are secreted into breast milk, but it is not known whether the small amounts
that may appear in the milk have effects on nursing infants. In rats, salmeterol
is excreted in milk. Therefore, caution should be exercised when salmeterol is
administered to nursing women.
SIDE EFFECTS: Upper respiratory tract infections occur in 20%-25% of
patients using Advair Diskus. Headaches occur in about 1 in 8 patients who use
it. Other potential adverse events include nausea, vomiting, diarrhea, mouth or
throat candidiasis, and musculoskeletal pain. Use of long acting agents like
salmeterol, an active ingredient in Advair Diskus, may increase the risk of
asthma-related death. Therefore, Advair Diskus should only be used in patients
who's asthma is uncontrolled by other agents, and who are using long-term asthma-controlling medications such as an inhaled corticosteroid.
Bronchitis is a disease of the respiratory system in which the bronchial passages become inflamed. There are two types of bronchitis, acute and chronic. Symptoms of acute bronchitis include frequent cough with mucus, lack of energy, wheezing, and possible fever. Treatment may require medication such as bronchial inhalers and predinsone. Supportive treatment is focused on relieving the symptoms with fever reducers, cough suppressants, and rest. Treatment may be more aggressive in patients with pre-existing conditions such as empyema, COPD, or cigarette smoking.
Chronic cough is a cough that does not go away and is generally a symptom of another disorder such as asthma, allergic rhinitis, sinus infection, cigarette smoking, GERD, postnasal drip, bronchitis, pneumonia, medications, and less frequently tumors or other lung disease. Treatment of chronic cough is dependant upon the cause.
COPD (chronic obstructive pulmonary disease) is a disorder that persistently obstructs bronchial airflow. COPD mainly involves three related conditions, chronic bronchitis, chronic asthma, and emphysema. Symptoms of COPD include chronic cough, shortness of breath, frequent respiratory infections, wheezing, morning headaches, and pulmonary hypertension. Treatment of COPD is focused on the related condition(s).
Emphysema is a progressive disease of the lungs. The primary cause of emphysema is smoking. Alpha 1-antitrypsin deficiency is a rare disorder that has a genetic predisposition to emphysema. Aging, IV drug use, immune deficiencies, and connect tissue illnesses are also risk factors for emphysema. Emphysema is a subtype of COPD (chronic obstructive pulmonary disease, COLD). Symptoms include shortness of breath and wheezing. Management of symptoms may be achieved with medications, quitting smoking, pulmonary rehabilitation, or surgery.
Asthma is a common disorder in which
chronic inflammation of the bronchial tubes (bronchi) makes them swell, narrowing the airways. Signs and symptoms include shortness of breath, chest tightness,
cough and wheezing.
Asthma, the main cause of chronic illness in children, has signs and symptoms in children that include frequent coughing spells, low energy while playing, complaints of chest "hurting," wheezing while breathing, shortness of breath, and feelings of tiredness. Treatment will involve a doctor creating an asthma action plan which will describe the use of asthma medications and when to seek emergency care for the child.
Bronchiectasis is a condition in which the bronchial tubes of the lung become damaged. Inflammation from infection or other causes destroys the smooth muscles of the bronchial tubes. Bronchiectasis is a form of COPD (which includes emphysema and chronic bronchitis). There are three primary types of bronchiectasis: 1) cylindrical bronchiectasis; 2) saccular bronchiectasis; and 3) cystic bronchiectasis. Bronchiectasis may also be acquired or congenital. The most common symptoms of bronchiectasis are recurrent cough and sputum production. There is no cure for bronchiectasis. Treatment is often geared toward controlling the symptoms of bronchiectasis.
Patients who have infrequent, mild bouts of asthma attacks may use over-the-counter (OTC) medications to treat their asthma symptoms. OTC asthma medicines are limited to epinephrine and ephedrine. These OTC drugs are best used with the guidance of a physician, as there may be side effects and the drugs may not be very effective.
There are two types of asthma medications: long-term control with anti-inflammatory drugs and quick relief from bronchodilators. Asthma medicines may be inhaled using a metered dose inhaler or nebulizer or they may be taken orally. People with high blood pressure, diabetes, thyroid disease, or heart disease shouldn't take OTC drugs like Primatene Mist and Bronkaid.
There are many unusual symptoms of asthma, including sighing, difficulty sleeping, anxiety, chronic cough, recurrent walking pneumonia, and rapid breathing. These symptoms may vary from individual to individual. These asthma complexities make it difficult to accurately diagnose and treat asthma.
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