No. This blog is not about any miracle drug or vaccine against SARS Co-V2 virus responsible for the current deadly pandemic of COVID19. This is regarding the class of medications already invented & used by millions of people across the globe daily - by force or by choice. They are inhaler medications or as commonly called "Pump".
Well, the general perception of inhaler medications is “not much” positive irrespective of the socioeconomic strata one belongs to. Usually people try to avoid being on inhaler & prefer oral medications as far as possible. The same has been symbolized in the Bollywood cinema, where taking inhaler medication is the symbol of vulnerability of the character. The examples are many but to illustrate, in the climax of famous movie Dabangg (2010), the fate of the villain was influenced by the inability to take inhaler medicine (referred as 'Fus-Fus') by the mother of the lead character "Chulbul Pandey".
While there are obvious advantages of inhaler medications over oral route (described later), being regularly adhered to the inhalers as advised remains a challenge. There are many reasons rooted in the psyche of people resulting in the behavior of poor adherence. To highlight few: there is fear of being "addicted" to the inhaler, feeling oneself as "abnormal" or "vulnerable", perceived threat that inhalers are taken by the persons whose disease is uncontrolled or in "last stage" & so on. Most of them are shear myth which are usually busted time to time.
Adherence to inhaler medication is a common topic of debate and discussion in Pulmonology CMEs, seminars & conferences. The international body, GINA (Global Initiative for Asthma), a resource of literature on Asthma, enlists, 'poor adherence' to inhaler medications, as a risk factor for frequent flare-ups (exacerbations) even with few symptoms.
Talking about the other end, a Pulmonologist's view : "Not to" prescribe inhaler medication is too easy as choosing the right molecule in the right formulation to the right patient to bring the desired outcome involves lot of thinking (described later), which can become cumbersome in busy OPDs. However, it becomes routine & quite skillfully executed by many, once thinking process is clear for the ultimate benefit of the patient & for the symptom control.
An important piece of information can be gathered from the chemists or medical representatives, as they know the prescription habit & "comfort zone" of a particular physician. Some even take advantage & market some molecule according to the routine practice as well as degree of a practitioner. It highlights the preferences of the doctors as well as the patients which differs significantly according to geography.
To be continued......
Symbolism : A Pulmonologist passes through lot of thought processes to choose an inhaler just like Hanumanji’s struggle to fetch the herb. An optimized inhaler therapy reduces the symptom (particularly of breathlessness) & risk of the disease - just as sanjivani cured army to conquer the evil.
Sanjivani : a miracle herb described in the ancient scripture of "Ramayana", was obtained by Hanumanji after unprecedented struggle. Very few people know that the herb was actually "inhaled" leading to restoration of the army lead by Lord Shri Ram to conquer the evil.
The Part-1 of this blog series provides insights on the general perception of the inhaler medications among specific groups.
- Dr. Jaykumar Mehta
MBBS (Gold Medalist)
MD, DNB, MNAMS, PD Fellow (Pulmonology)
Consultant Interventional Pulmonologist (Zydus Hospital, Ahmedabad)