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  1. A quick survey about COPD patients and devices There is no one-size-fits-all treatment for chronic obstructive pulmonary disease (COPD). To help healthcare providers consider each patient’s individual needs when formulating their treatment regimen, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends continual evaluation and management of therapy based on assessment of device technique, reviews of the patient’s symptoms and exacerbations, and any adjustments necessary to meet other outstanding patient needs.1 Matching the right device to the right patient can help adherence to a treatment plan.2 Take this quick survey to see how your peers assess a patient’s satisfaction and ability to use their devices. Matching the right device to the right patient could make all the difference in managing their COPD symptoms.1,2 Managing COPD requires consistent revaluation and reassessment of patient ability and preference.1 For patients who may need another option, consider twice-daily LONHALA® MAGNAIR® (glycopyrrolate). LONHALA MAGNAIR is an anticholinergic indicated for the long-term maintenance treatment of airflow obstruction in patients with COPD, including chronic bronchitis and/or emphysema. LONHALA MAGNAIR is not a rescue medication. References: 1. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2020:1-125. 2. Amin AN, Ganapathy V, Roughley A, Small M. Confidence in correct inhaler technique and its association with treatment adherence and health status among US patients with chronic obstructive pulmonary disease. Patient Prefer Adherence. 2017;11:1205-1212. To learn more about LONHALA MAGNAIR, visit www.sunovionprofile.com/lonhala-magnair. This survey is sponsored by Sunovion Pharmaceuticals. IMPORTANT SAFETY INFORMATION AND INDICATION IMPORTANT SAFETY INFORMATION LONHALA MAGNAIR is contraindicated in patients with a hypersensitivity to glycopyrrolate or to any of the ingredients. LONHALA MAGNAIR should not be initiated in patients with acutely deteriorating or potentially life-threatening episodes of COPD or used as rescue therapy for acute episodes of bronchospasm. Acute symptoms should be treated with an inhaled short-acting beta2-agonist. As with other inhaled medicines, LONHALA MAGNAIR can produce paradoxical bronchospasm that may be life-threatening. If paradoxical bronchospasm occurs following dosing with LONHALA MAGNAIR, it should be treated immediately with an inhaled, short-acting bronchodilator; LONHALA MAGNAIR should be discontinued immediately and alternative therapy instituted. Immediate hypersensitivity reactions have been reported with LONHALA MAGNAIR. If signs occur, discontinue LONHALA MAGNAIR immediately and institute alternative therapy. LONHALA MAGNAIR should be used with caution in patients with narrow-angle glaucoma and in patients with urinary retention. Prescribers and patients should be alert for signs and symptoms of acute narrow-angle glaucoma (e.g., eye pain or discomfort, blurred vision, visual halos or colored images in association with red eyes from conjunctival congestion and corneal edema) and of urinary retention (e.g., difficulty passing urine, painful urination), especially in patients with prostatic hyperplasia or bladder-neck obstruction. Patients should be instructed to consult a physician immediately should any of these signs or symptoms develop. The most common adverse events reported in ≥2% of patients taking LONHALA MAGNAIR, and occurring more frequently than in patients taking placebo, were dyspnea (4.9% vs 3.0%) and urinary tract infection (2.1% vs 1.4%). LONHALA solution is for oral inhalation only and should not be injected or swallowed. LONHALA vials should only be administered with MAGNAIR. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088. For additional information, please see full Prescribing Information and Patient Information for LONHALA MAGNAIR at www.sunovionprofile.com/lonhala-magnair. INDICATION LONHALA® MAGNAIR® (glycopyrrolate) is an anticholinergic indicated for the long-term maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema. LONHALA and are registered trademarks of Sunovion Pharmaceuticals Inc. MAGNAIR is a registered trademark of PARI Pharma GmbH, used under license. SUNOVION and are registered trademarks of Sumitomo Dainippon Pharma Co., Ltd. Sunovion Pharmaceuticals Inc. is a U.S. subsidiary of Sumitomo Dainippon Pharma Co., Ltd. ©2020 Sunovion Pharmaceuticals Inc. All rights reserved. Sunovion Pharmaceuticals Inc., 84 Waterford Drive, Marlborough, MA 01752. 5/20 LON-US-00043-20
  2. In this third video, I cover respiratory medications for allergies, cough, asthma, and anaphylactic shock. Antihistamines We'll start with two antihistamine generations, 1st and 2nd. First generation causes drowsiness and is shorter acting, while second generation is non-sedating and longer acting. Recall we already learned a different set of antihistamines in the first video, the H2 receptor blockers for acid reflux. Stems are sometimes similar, -atadine vs. -tidine, so be careful. Decongestants Pseudoephedrine is only available behind the pharmacy counter (BTC) and often paired with a 2nd generation antihistamine as the "hyphen 'D'," on the end of a drug name. Phenylephrine is often marked as "P.E." and is available over the counter (OTC). Finally, oxymetazoline, brand Afrin is only meant for a few days of use to avoid rebound congestion. Allergic rhinitis Anti-inflammatories like triamcinolone produce fewer side effects with a nasal spray formulation. Full effects may take a few weeks, but steroid nasal sprays are hands down the best prophylaxis for seasonal allergies. Expectorants / antitussives / oral steroids Expectorants like guaifenesin help remove mucus and antitussives suppress the urge to cough. The choice of antitussive often depends on cough severity. Oral steroids like prednisone and methylprednisolone reduce severe inflammation sometimes from this cough. Asthma Asthma is straightforward, an inflammatory condition paired with bronchoconstriction. Our drugs then work as anti-inflammatories and bronchodilators. An inhaled steroid with long-acting beta-2 agonist is a common combination. While patients can safely use an inhaled steroid like fluticasone alone, in certain conditions beta-2 agonists like salmeterol must be paired with an inhaled steroid for safety. Anticholinergics Also relax bronchial smooth muscle for asthma and COPD and include short-acting ipratropium and long-acting tiotropium inhaled forms.There is also non-inhaler asthma therapy. Leukotriene inhibitors such as montelukast and the biologic omalizumab have their place in respiratory therapy. Anaphylaxis Epinephrine is part of the LEAN acronym, lidocaine, epinephrine, atropine, and naloxone for critical emergency medicines. It's sometimes easier to see the divisions in outline rather than paragraph form of the major classes. Antihistamines 1st Generation Diphenhydramine 2nd Generation Cetirizine Loratadine Loratadine-D Decongestants Pseudoephedrine- BTC Phenylephrine - OTC Oxymetazoline - nasal spray, rebound congestion, 3 days max Allergic rhinitis Triamcinolone - no proper stem Cough Guaifenesin / dextromethorphan (DM) Guaifenesin / codeine (AC) Oral Steroids Methylprednisolone Prednisone Both use "pred" as prefix or infix Asthma Steroid and long acting beta-2 agonist Budesonide / formoterol (Symbicort) Fluticasone / salmeterol (Advair) Nasal / oral steroid Fluticasone comes as both nasal (Flonase) and oral (Flovent) form Short acting rescue inhaler Albuterol Anticholinergic / beta-2 agonist Ipratropium/ albuterol (Duoneb) Anticholinergic alone Tiotropium - long acting Leukotriene inhibitor Montelukast Anti- IgE antibody Omalizumab - monoclonal antibody Anaphylaxis Epinephrine also known as adrenaline

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