Action, not Advocacy, to Prevent Negative Health Outcomes

While we recognize that climate change increases air pollution and other exposures that can lead to negative health outcomes, advocacy to support policy and regulatory action is a long-term strategy. Advocacy alone does nothing for the vulnerable populations threatened by environmental triggers today.  There are individuals experiencing the consequences of potentially severe health outcomes and preventable symptoms due to air pollution. 

In our changing climate, the threat to individual health from environmental exposure is increasing daily. This fact, compounded by the aftermath of more frequent extreme weather events, is resulting in very real health implications for growing segments of the population.  Now is the time for the medical community to recognize this threat.  It is time practitioners focus on preventative health and wellness strategies that can empower an individual to respond to this ever-changing environment. Medicine needs to include a person-centric approach to health and symptom awareness that can support a personalized response to environmental exposures that can cause everything from annoying allergic symptoms to a severe respiratory distress – and in some cases - death. 

Right now, vulnerable populations like children, the elderly, and people with chronic respiratory conditions are the most impacted by pollution; however, research indicates that these conditions are impacting the broader population each year.  As the climate changes, more and more people are becoming sensitive to pollutants.  Based on recent reports, it’s likely that the current risk scales do not sufficiently measure the actual threat of pollutant levels to human health and long-term wellness.  The reality is that as the climate changes the environments in which we live, individuals are becoming significantly more sensitive to health impact at much lower thresholds of pollution.  

The threat of a changing climate on the land is indisputable. The threat of a changing climate to humans is equally so. Now is the time to act.  Now is the time for the health care community to support a person-centered approach to environmental factors.  Now is the time for individuals to be empowered to understand the when, where, and what of the triggers that impact their health.  Now is the time to empower people to be environmentally informed, location aware, and health prepared.

Ask the Experts - A Question from a DailyBreath Community Member

Why was the ProAir® HFA inhaler discontinued? I use this inhaler, what should I do now? ~ Lea, DailyBreath Community member

Author: Lorene Alba, AE-C, Certified Asthma Educator, Content Manager, DailyBreath, LLC

On October 1, 2022, Teva, the manufacturer of the ProAir® HFA inhaler announced they have discontinued making this inhaler. ProAir® HFA is a metered dose inhaler (aerosol) that includes albuterol sulfate and propellant. If you currently use this inhaler, do not panic. It is now being offered in different inhalers.

Teva is still making ProAir®, but as dry-powder inhalers (non-aerosol). This means there is no propellant in the inhaler, so the medicine does not spray out on its own. Instead, the user takes a deep, fast, hard, breath in to pull the medicine out of the inhaler and into the lungs.

Why is the HFA Inhaler discontinued?

DailyBreath has not been able to find an official statement from Teva as to why this inhaler is no longer being manufactured. However, Teva is the first pharmaceutical company to develop a family of dry-powder, smart inhalers, called Digihaler®. The Digihaler® is a smart inhaler that has a built-in sensor to help you better understand how you use your inhaler. The sensor works with an app on your smartphone to record how often you use your inhaler and provides feedback on how well you inhale the medicine. You can share this information with your doctor. Together, you can create a personalized treatment plan that’s best for you. The Digihaler® family includes:

·        ProAir® Digihaler® (albuterol sulfate), a rescue inhaler

·        ArmonAir® Digihaler® (fluticasone propionate), a long-acting controller medicine

·        AirDuo® Digihaler® (fluticasone propionate and salmeterol), a long-acting combination controller medicine.

Inhalers are also known as delivery devices. Some inhalers are long (like the Digihaler®) while others are flat (like the Diskus). Each delivery device requires different priming, holding, and inhalation techniques. By offering three types of medicine in the same delivery device, Teva is hoping users will easily remember the steps to using the Digihaler® and avoid mistakes.

Is the Digihaler right for you? Things to consider when using a dry-powder inhaler.

There are benefits to using a dry-powder inhaler (DPI). DPIs do not need priming or shaking before use. You do not use a spacer or valved-holding chamber with a DPI. There is no button to press, so no need to coordinate pressing the inhaler at the same time you inhale. Since there is no propellant, users do not need to worry about reactions to the propellant, or the propellant impacting air quality when sprayed in the air.

DPIs may be harder to use than metered-dose inhalers for some. You must be able to take a hard, deep, and fast breath in to get all the medicine out of the inhaler. Sometimes you can’t taste the dry powder so you are not sure if the full (or any) dose of the medicine was received. The ProAir® DPIs are larger than the metered-dose inhaler version and they may be harder to hold.

What should I do now that the inhaler is no longer available?

Users have four options:

Option 1:  ProAir® RespiClick® is an inhalation powder for people four years and older.

Option 2:  ProAir® Digihaler® is a digital, breath-actuated, DPI rescue inhaler for people four years and older. Do not use ProAir® Digihaler® if you are allergic to lactose or milk proteins.

Option 3:  Generic albuterol sulfate is available as a metered dose inhaler.

Option 4:  Switch to a different name brand of albuterol sulfate (Proventil, Ventolin) or to levalbuterol (Xopenex).

Talk with your doctor and insurance company.

Ask your insurance company which asthma medicines are available on their formulary. Work with your doctor to find the best medicine and delivery device for you to use.

Answering the Question: What's YOUR symptoms experience outdoors?

There has been a proliferation of air quality apps including pollen over the last few years, some based on data from measurement devices, others based on satellite data.  However, all of these track each exposure; allergen, irritants (pollution), and/or weather, in isolation. 

And, tracking each of these in isolation only pushes you a data point that is a level assessment that isn’t associated with any evidence of health correlation.  The Air Quality Index was actually created in a regulatory context as a means to incent towards achieving reductions in air pollution, not necessarily a thorough understanding of health impacts broadly, and certainly not personal impacts.

But each individual who ventures outdoors experiences an environment in which a confluence of allergens and irritants converge with weather conditions at a particular time and place.  It is the confluence of all these variables that may impact your health based on your individual sensitivity.  

So, DailyBreath collects all this data, but it develops a personalized risk index based on the symptoms recorded in the app that mark this impactful convergence of exposures that you experienced at the time.  This is using real world evidence, your symptoms experience as it relates to exposure variables, to drive your real understanding of the conditions that are problematic for your health.

Once empowered to understand your personal risk, you can take proactive steps to reduce or avoid triggers that often lead to respiratory difficulty.  Join a revolution in symptom tracking that correlates to weather and environmental conditions and does so, so that you can determine your individual sensitivity and take appropriate action based on YOUR risk of experiencing symptoms. Download DailyBreath today and register to build your personalized exposure risk profile by tracking symptoms and pinpointing triggers..

September Asthma Peak, a Perfect Storm of Triggers.

Twenty-five percent (25%) of all children’s asthma hospitalizations occur in September. Now commonly known as the September Asthma Peak, this time between early-mid September and mid-October, is a perfect storm of triggers and a return to school impacts.

With a hot summer and warm fall, ragweed plants will not stop dispersing pollen until the first frost in mid-November. Each ragweed plant disperses over 1 billion pollen grains and ragweed pollen grains are very small and easily inhalable, even into one’s lower airways.

Ragweed pollen is prevalent because ragweed grows easily in various types of soil. It grows often in areas where soils have been disturbed, and particularly along the margins near developed areas. Other habitats include weedy meadows, cropland, abandoned fields, vacant lots, fence rows, roadsides, gravelly areas along railroads, gardens and lawns, construction sites, and waste areas.

Because of the volume of pollen grains and that they are small and easily inhalable, even modest winds have a big impact on how ragweed pollen travels. Even a modest 5 mph winds may disturb ragweed pollen sufficiently to increase your risk outside. And, thunderstorms disturb ragweed pollen grains sufficiently to create the thunderstorm asthma phenomena sometimes experienced. Thunderstorms disperse pollen grains, but it also breaks pollen grains down into even smaller grains.

Ragweed allergies are prevalent among children and, unfortunately, disturbed areas are often found around schools, or at school bus stops along the roadside. Students with asthma are often being exposed to problematic allergens, some exposed to school bus exhaust, and then confront a classroom with poor indoor quality or perhaps an irritant present in the classroom. 

 These are among the exposures that a student with asthma experiences potentially reaching a symptom threshold that risks an asthma attack. This is the environment that a child with asthma faces as they return to school this and every year.  Download DailyBreath today to take action against your environmental triggers!