Michael Marcus MD Ped Pulmonary DrMDK
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Male: Today we use a lot of nebulization in different medicines to use. I know you like to use Xopenex because of some reasons. What is the reason why you use Xopenex on a kid who is wheezing? Is there any advantage over using the old Albuterols? Dr. Marcus: Children who have asthma get repeated episodes of wheezing. There are two types of medications that we use to treat asthma. Medications to prevent the wheezing and medications to treat the wheezing once it occurs. There are two common medications that we use at this point for treating the active wheezing. One of those medications is Albuterol which is their route for more than 20 years now. The other medication is more new and it is called Xopenex. This comes in both nebulizer form as well in a metered dose inhaler, a pump. The advantage of Xopenex is that it is the single isomer so called the more purified form of the Albuterol molecule. Being the single isomer, it has all the advantages of relieving the wheezing very rapidly having a relatively long duration of action while minimizing the risk of a number of common side effects in patients who would previously be getting these problems when being given Albuterol. Male: Some of the common side effects we hear about is sometimes kids, they have shaking of the hands? Dr. Marcus: Some of the common side effects from Albuterol included tremors, shaking of the hands, hyperactivity, difficulty to sleep, a racing heart rate, and nervousness. These side effects certainly could make taking the medication properly difficult and therefore some patients don’t take the medicine in the proper fashion and others merely suffer to the side effects. Xopenex in its present form can alleviate some if not many of these side effects depending on the dose and the frequency of dosing. Also since the medication Xopenex lasts longer, we actually need to give less doses of the medication thereby sparing the need for the child to take repeated doses as frequently as he previously have been given the Albuterol. Male: I mean Xopenex is expensive but effective but keeping a kid out of a hospital and an emergency room, which is very, very expensive so it is a rejustification for the extra cost. Dr. Marcus: Xopenex is a bit more expensive than the Albuterol but when you factor in the number of doses that you are giving and the fact that you are saving the child from that emergency visit and even from a hospitalization, the cost can certainly balance out. Male: The Albuterols, you have to give it four times a day which means you probably have to give it in school and the school nurse gets involved in a standard treatment where as Xopenex you give it before school, coming home from school and at bedtime makes life a little bit easier for us, the patient, and the school nurse having an extra burning session. Dr. Marcus: Absolutely and in fact when you really look at the data, Albuterols work most effectively, really should be given roughly every three to four hours. Beyond that it starts to lose some of its effectiveness. Whereas the effectiveness of Xopenex does last a good eight hours and helps the children get to that school day more effectively.

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